Order
No. 127n dated 02/25/2016

!!! Lost force in accordance with order No. 1043n dated December 22, 2017!!!

In accordance with part 1.1 of Article 100 of the Federal Law of November 21, 2011 N 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation” (Collected Legislation of the Russian Federation, 2011, N 48, Art. 6724; 2013, N 27, Art. 3477; Art. 6165; Art. 6951; Art. 2016, Art. 9)

1. Approve the attached terms and stages of accreditation of specialists, as well as categories of persons with medical, pharmaceutical or other education and specialists subject to accreditation.

2. The Department of Medical Education and Personnel Policy in Healthcare of the Ministry of Health of the Russian Federation shall organize the accreditation of specialists, taking into account the stages of transition.

3. Entrust control over the implementation of this order to the First Deputy Minister of Health of the Russian Federation I.N. Kagramanyan.

Minister
V.I.Skvortsova

Approved
by order of the Ministry of Health
Russian Federation
dated February 25, 2016 N 127n

Deadlines and stages
accreditation of specialists, as well as categories of persons with medical, pharmaceutical or other education and specialists subject to accreditation

In accordance with Part 1.1 of Article 100 of the Federal Law of November 21, 2011 N 323-FZ “On the fundamentals of protecting the health of citizens in the Russian Federation”.

Judicial practice and legislation
Order of the Ministry of Health of Russia dated February 25, 2016 N 127n
“On approval of the terms and stages of accreditation of specialists, as well as categories of persons with medical, pharmaceutical or other education and specialists subject to accreditation”

<Письмо>Ministry of Health of Russia dated 08/05/2016 N 16-5/10/2-4838<Об осуществлении медицинской деятельности специалистами, прошедшими аккредитацию по специальностям "Стоматология" или "Фармация">

order dated 02/25/2016 N 127n “On approval of the terms and stages of accreditation of specialists, as well as categories of persons with medical, pharmaceutical or other education and specialists subject to accreditation” (registered with the Ministry of Justice of Russia on 03/14/2016, N 41401) (hereinafter referred to as order N 127n);

<Письмо>Ministry of Health of Russia dated July 7, 2016 N 16-5/10/2-4126<Об аккредитации специалистов>

In accordance with the provisions of Order N 127n, persons who have received higher education in basic educational programs after January 1, 2016 in accordance with federal state educational standards in the specialties “Dentistry” and “Pharmacy” undergo the specialist accreditation procedure.

On this page you can download for free current version regulatory legal act on labor protection: rules on labor protection when performing painting work.

Additional information about the document:

• Approved by order of the Ministry of Labor of Russia dated March 7, 2018 No. 127n (Order 127n)
• Order 127n was registered with the Ministry of Justice of the Russian Federation on 06/07/2018 under number 51323
• Valid from 09.09.2018

Scope of application:

Rules for labor protection when performing painting work establish state regulatory requirements for labor protection when organizing and carrying out basic production processes and performing work on preparing painting materials and surfaces for painting, applying paints and powder polymer paints, drying and treating surfaces of paint and varnish coatings (hereinafter - painting work).

The requirements of labor protection rules when performing painting work are mandatory for compliance by employers - legal entities, regardless of their organizational and legal forms, and by individuals (with the exception of employers - individuals who are not individual entrepreneurs), when organizing and carrying out painting work.

MINISTRY OF LABOR AND SOCIAL PROTECTION OF THE RUSSIAN FEDERATION

ORDER
dated March 7, 2018 No. 127n

ABOUT APPROVAL OF THE RULES
OCCUPATIONAL SAFETY WHEN PERFORMING PAINTING WORKS

Below you can leave your comments (questions) regarding the application of this document in practice.

In accordance with paragraph 6 of Article 144 of the Code of the Republic of Kazakhstan dated September 18, 2009 “On the health of the people and the healthcare system,” the attached Sanitary Rules “Sanitary and epidemiological requirements for healthcare facilities” were approved.

In particular, the Sanitary Rules contain sanitary and epidemiological requirements for:

1) selection of land for construction, design and placement of healthcare facilities;

6) collection, neutralization, storage of medical waste at healthcare facilities;

The choice of land plot for construction, design of healthcare facilities is determined by the design assignment in accordance with the requirements of state standards in the field of architecture, urban planning and construction, in accordance with subparagraph 23-16) of Article 20 of the Law of the Republic of Kazakhstan dated July 16, 2001 “On architectural, urban planning and construction activities in the Republic of Kazakhstan" (hereinafter referred to as state standards in the field of architecture, urban planning and construction).

When designing infectious diseases hospitals and departments, the following are provided:

2) isolated departments for hospitalization of patients with airborne, intestinal, viral infections, especially dangerous and quarantine infections;

When designing the examination box of an infectious diseases hospital, a separate isolated external entrance is provided.

When designing perinatal centers and maternity hospitals, it is necessary to provide postpartum wards with a capacity of no more than two maternal beds. The perinatal center has departments for resuscitation and intensive care for newborns.

The composition and area of ​​in vitro fertilization departments is determined by the technological process and capacity of the institution.

When operating rooms are located on top of each other, septic operating rooms are placed above aseptic ones.

Operating units (departments) are designed as non-passable. Entrance for medical personnel is provided through sanitary checkpoints, for patients through locks.

Aseptic departments (blocks) include: rooms with a toilet, bath or shower, a treatment room, a doctor’s office, storage rooms for sterile material and other rooms depending on the profile of the department.

Sanitary passages for personnel are designed as part of three adjacent rooms. The first room is equipped with a shower and sanitary unit. The second room is used for putting on clean surgical suits, shoes, and shoe covers. The third room is intended for changing and collecting used linen.

In outpatient, plastic and aesthetic surgery centers, dermato-cosmetology facilities, outpatient clinics, small operating rooms with a minimum set of premises are provided - an operating room, a pre-operative room, a sanitary passage, a gateway at the entrance to the operating room for patients and a post-operative ward. The sanitary passage is designed as part of one room, which is equipped with a shower and provides conditions for storing clean linen and collecting dirty linen for personnel.

The patient enters the small operating rooms through an airlock, and the staff enters through the preoperative room.

The design of magnetic resonance imaging, radiation diagnostics and therapy rooms, as well as hygienic standards for the permissible effective dose rate, are carried out in accordance with the requirements of sanitary rules, hygienic standards, approved by the state body in the field of sanitary and epidemiological welfare of the population in accordance with paragraph 6 of Article 144 and Article 145 Code of the Republic of Kazakhstan dated September 18, 2009 “On the health of the people and the healthcare system” (hereinafter referred to as standardization documents) and state standards in the field of architecture, urban planning and construction.

Psychiatric and tuberculosis drug treatment facilities are located in suburban areas or outlying areas, if possible in green areas, maintaining distances from residential areas.

In residential buildings, it is allowed to locate healthcare facilities that provide outpatient care with a capacity of no more than 100 visits per shift, including day hospitals, ambulatory surgery centers (patient stays no more than 5 days), if there is a separate entrance.

It is not allowed to place hospitals with 24-hour stay of patients in a residential building, except for the cases provided for in paragraph 15 of the Sanitary Rules.

Reception and ward departments for patients, operating rooms, dressing rooms, treatment rooms, manipulation rooms, maternity rooms, dental offices, central sterilization departments, electro-phototherapy rooms, workshops, warehouses for toxic, potent, flammable and combustible liquids are not located in the ground and basement floors of buildings.

The order comes into force twenty-one calendar days after the day of its first official publication.

Legislation

Acting order Minister of National Economy of the Republic of Kazakhstan No. 127 dated February 24, 2015

Order Acting Minister of National Economy of the Republic of Kazakhstan No. 127 dated February 24, 2015
Registered with the Ministry of Justice of the Republic of Kazakhstan on April 14, 2015 No. 10713

I ORDER:

1. Approve the attached Sanitary Rules “Sanitary and Epidemiological Requirements for Healthcare Facilities”.

2. The Committee for the Protection of Consumer Rights of the Ministry of National Economy of the Republic of Kazakhstan shall ensure, in the manner prescribed by law:
2) within ten calendar days after the state registration of this order, its submission for official publication in periodicals and in the information and legal system “Adilet”;
3) placement of this order on the official Internet resource of the Ministry of National Economy of the Republic of Kazakhstan.

3. Control over the implementation of this order shall be assigned to the supervising Vice-Minister of National Economy of the Republic of Kazakhstan.

4. This order comes into effect upon the expiration of ten calendar days from the date of its first official publication.

Acting Minister
national economy
Republic of Kazakhstan M. Kusainov

Order 127 of the Ministry of Health of the Republic of Kazakhstan 2018

On approval of the Rules for organizing and conducting the procurement of medicines, preventive (immunobiological, diagnostic, disinfectant) drugs, medical products and medical equipment, pharmaceutical services to provide a guaranteed volume of free medical care

On approval of the Sanitary Rules “Sanitary and epidemiological requirements for healthcare facilities”

Order Acting Minister of National Economy of the Republic of Kazakhstan dated February 24, 2015 No. 127

On approval of the Rules for conducting compulsory medical examinations

Acting order Minister of National Economy of the Republic of Kazakhstan dated February 24, 2015 No. 128

On approval of the List of harmful production factors, professions in which mandatory medical examinations are carried out

On approval of the Sanitary Rules “Sanitary and epidemiological requirements for the organization and implementation of sanitary and anti-epidemic (preventive) measures to prevent infectious diseases”

On approval of the Sanitary Rules “Sanitary and epidemiological requirements for laboratories using potentially hazardous chemical and biological substances”

Acting order Minister of National Economy of the Republic of Kazakhstan dated April 15, 2015 No. 338.

On approval of the Regulations on the activities of organizations and (or) structural divisions of healthcare organizations performing pathological diagnostics, and the Rules for conducting a pathological autopsy

Order of the Minister of Health and Social Development of the Republic of Kazakhstan dated February 25, 2015 No. 97.

acting order Minister of Health
Republic of Kazakhstan
dated November 23, 2010 No. 907

www.almaty-pab.kz

On approval of the Sanitary Rules “Sanitary and epidemiological requirements for healthcare facilities”

Order of the Minister of Health of the Republic of Kazakhstan dated May 31, 2017 No. 357. Registered with the Ministry of Justice of the Republic of Kazakhstan on September 27, 2017 No. 15760.

In accordance with paragraph 6 of Article 144 of the Code of the Republic of Kazakhstan dated September 18, 2009 “On the health of the people and the healthcare system”, I ORDER:

1. Approve the attached Sanitary Rules “Sanitary and Epidemiological Requirements for Healthcare Facilities.”

2. Recognize as invalid the order of the Acting Minister of National Economy of the Republic of Kazakhstan dated February 24, 2015 No. 127 “On approval of the Sanitary Rules “Sanitary and Epidemiological Requirements for Healthcare Facilities” (registered in the Register of State Registration of Normative Legal Acts No. 10713, published in the Information -legal system “Adilet” dated August 5, 2015).

3. The Committee for Public Health Protection of the Ministry of Health of the Republic of Kazakhstan, in the manner established by law, shall ensure:

1) state registration of this order with the Ministry of Justice of the Republic of Kazakhstan;

2) within ten calendar days from the date of state registration of this order, sending its copy in paper and electronic form to the Republican State Enterprise with the right of economic management “Republican Center for Legal Information” for official publication and inclusion in the Reference Control Bank of Regulatory Legal Acts of the Republic of Kazakhstan;

3) placement of this order on the Internet resource of the Ministry of Health of the Republic of Kazakhstan.

4. Control over the implementation of this order is assigned to the supervising Vice Minister of Health of the Republic of Kazakhstan.

5. This order comes into force twenty-one calendar days after the day of its first official publication.

"AGREED"
Minister of Investment and Development
Republic of Kazakhstan
____________ J. Kasymbek
September 8, 2017

"AGREED"
Minister of National Economy
Republic of Kazakhstan
____________ T. Suleimenov
September 20, 2017

"AGREED"
Minister of Energy
Republic of Kazakhstan
____________ K. Bozumbayev
August 22, 2017

Sanitary rules

“Sanitary and epidemiological requirements for healthcare facilities”

Chapter 1. General provisions

1. These Sanitary Rules “Sanitary and Epidemiological Requirements for Healthcare Facilities” (hereinafter referred to as the Sanitary Rules) establish sanitary and epidemiological requirements for healthcare facilities.

2. Sanitary rules contain sanitary and epidemiological requirements for:

2) water supply and sanitation of healthcare facilities;

3) lighting, ventilation and air conditioning and heat supply, premises of healthcare facilities;

4) repair and maintenance of premises of healthcare facilities;

5) organization and implementation of sanitary, anti-epidemic and sanitary and preventive measures at healthcare facilities;

7) food conditions at healthcare facilities;

8) working conditions and personal services for personnel.

3. These Sanitary Rules use the following concepts:

1) medical waste of class “A” – no different in composition from municipal waste and not having hazardous properties;

2) antiseptic - a chemical antimicrobial agent intended for use on skin or fabric to destroy microbes;

3) aseptic department - premises for providing medical care in the absence of a purulent infection in the patient;

4) aseptic regime - a set of sanitary-technical and sanitary-hygienic measures that prevent microbes from entering the wound;

5) medical waste of class “B” - epidemiologically hazardous medical waste (infected and potentially infected waste. Materials and instruments, objects contaminated with blood and other biological fluids. Pathological waste, organic surgical waste (organs, tissues). Food waste from infectious diseases departments . Waste from microbiological, clinical diagnostic laboratories, pharmaceutical, immunobiological production, working with microorganisms of III-IV pathogenicity groups. Biological waste of vivariums. Live vaccines, unsuitable for use;

6) box – a room with a separate entrance for admission of a patient from outside. It consists of: a ward, a sanitary unit, a bath and an airlock;

7) medical waste of class “B” - extremely epidemiologically hazardous medical waste (materials that have been in contact with patients with especially dangerous and quarantine infectious diseases, which can lead to emergency situations in the field of sanitary and epidemiological well-being of the population and require measures for sanitary protection of the territory. Waste from laboratories, pharmaceutical and immunobiological industries working with microorganisms of pathogenicity groups I-II. Waste from patients with anaerobic infection and from patients with tuberculosis. Waste from microbiological laboratories working with pathogens of tuberculosis);

8) medical waste of class “G” - toxicologically hazardous medical waste (medicinal, including cytostatics, diagnostic, disinfectants that cannot be used. Mercury-containing items, devices and equipment. Waste of raw materials and products of pharmaceutical production. Waste from the operation of equipment, transport , lighting systems);

9) medical waste of class “D” – radioactive medical waste (containing radioactive substances in quantities and concentrations that exceed the regulated values ​​for radioactive substances established by the legislation of the Republic of Kazakhstan in the field of atomic energy use);

10) healthcare facilities – facilities where healthcare organizations and individuals engaged in medical practice in the field of healthcare operate;

11) healthcare organization – a legal entity operating in the field of healthcare;

12) an individual maternity ward or a shared ward - an equipped room with a bathroom for childbirth for one woman in labor, in which the mother and the newborn stay until discharge from the hospital;

14) mobile medical facility - a mobile consultative and diagnostic facility located on the basis of vehicles (road, rail, sea, river, aviation) with equipment and places for medical personnel;

15) medical waste – waste generated in the process of providing medical services and performing medical procedures;

16) neutralization of medical waste - reduction or elimination of hazardous properties of waste by mechanical, physical-chemical or biological treatment;

17) special installation for the neutralization of medical waste - specialized technological equipment designed for the neutralization of medical waste, using incineration, autoclaving, microwave processing, plasma treatment and other methods of neutralization;

18) container for the safe collection and disposal of medical waste (hereinafter referred to as KBSU) - waterproof and puncture-resistant disposable containers for the collection and safe disposal of sharp and piercing medical waste;

19) sanitary clothing - industrial clothing to protect objects of labor from workers and workers from general industrial pollution;

21) residential territory - part of the territory of a settlement intended for the placement of residential, public (public and business) and recreational zones, as well as individual parts of engineering and transport infrastructure, other objects, the placement and activity of which does not have an impact requiring special sanitary protection zones;

22) airlock - a part of the room between the ward, department and the common corridor, eliminating the possibility of air penetrating from one room to another through the ventilation system and located between rooms with different levels of air pollution.

Chapter 2. Sanitary and epidemiological requirements for the selection of land for construction, design and placement of healthcare facilities

4. The selection of a land plot for construction, design of healthcare facilities is determined by the design assignment in accordance with the requirements of state standards in the field of architecture, urban planning and construction, in accordance with subparagraph 23-16) of Article 20 of the Law of the Republic of Kazakhstan dated July 16, 2001 “On architectural, urban planning and construction activities in the Republic of Kazakhstan" (hereinafter referred to as state standards in the field of architecture, urban planning and construction).

5. When designing infectious diseases hospitals and departments, the following are provided:

1) admission department, where it is necessary to have at least two examination rooms or boxes;

3) diagnostic department (diagnostic wards);

6. When designing the examination box of an infectious diseases hospital, a separate isolated external entrance is provided.

7. When designing perinatal centers and maternity hospitals, it is necessary to provide postpartum wards with a capacity of no more than two maternal beds. The perinatal center has departments for resuscitation and intensive care for newborns.

8. The composition and area of ​​in vitro fertilization departments is determined by the technological process and capacity of the institution.

9. When operating rooms are located on top of each other, septic operating rooms are placed above aseptic ones.

10. Aseptic departments (blocks) include: wards with a toilet, bath or shower, treatment room, doctor’s office, storage rooms for sterile material and other rooms depending on the profile of the department.

11. Sanitary passages for personnel are designed as part of three adjacent rooms. The first room is equipped with a shower and sanitary unit. The second room is used for putting on clean surgical suits, shoes, and shoe covers. The third room is intended for changing and collecting used linen.

12. In outpatient, plastic and aesthetic surgery centers, dermato-cosmetology facilities, outpatient clinics, small operating rooms with a minimum set of premises are provided - an operating room, a pre-operative room, a sanitary passage, a gateway at the entrance to the operating room for patients and a post-operative ward. The sanitary passage is designed as part of one room, which is equipped with a shower and provides conditions for storing clean linen and collecting dirty linen for personnel.

The patient enters the small operating rooms through an airlock, and the staff through the preoperative room.

13. The design of magnetic resonance imaging, radiation diagnostics and therapy rooms, as well as hygienic standards for the value of the permissible effective dose rate are carried out in accordance with the requirements of sanitary rules, hygienic standards, approved by the state body in the field of sanitary and epidemiological welfare of the population in accordance with paragraph 6 of Article 144 and Article 145 of the Code of the Republic of Kazakhstan dated September 18, 2009 “On the health of the people and the healthcare system” (hereinafter referred to as standardization documents) and state standards in the field of architecture, urban planning and construction.

14. Psychiatric and tuberculosis drug treatment facilities are located in suburban areas or outlying areas, if possible in green areas, maintaining distances from residential areas.

15. In residential buildings, it is allowed to locate healthcare facilities that provide outpatient care with a capacity of no more than 100 visits per shift, including day hospitals, ambulatory surgery centers (patient stays no more than 5 days), if there is a separate entrance.

16. It is not allowed to place hospitals with 24-hour stay of patients in a residential building, except for the cases provided for in paragraph 15 of these Sanitary Rules.

17. Reception and ward departments for patients, operating rooms, dressing rooms, treatment rooms, manipulation rooms, birth rooms, dental offices, central sterilization departments, electro-phototherapy rooms, workshops, warehouses for toxic, potent, flammable and combustible materials are not located in the ground and basement floors of buildings. liquids.

Chapter 3. Sanitary and epidemiological requirements for water supply and sanitation of healthcare facilities

18. Healthcare facilities are provided with centralized drinking and hot water supply and sanitation.

19. In the absence of a centralized water supply system, the healthcare facility uses water from non-centralized water supply sources (wells) or imported water that complies with standardization documents. Water is delivered by a special vehicle. Water is stored in special marked containers.

20. In all doctors’ offices, wards, auxiliary rooms (staff room, nurse-housekeeper, collection of dirty linen, sanitary rooms, sanitary facilities) the installation of sinks with cold and hot water supply is provided.

Preoperative, dressing, procedure, manipulation, vaccination rooms, resuscitation rooms and wards, delivery rooms, airlocks of boxes, half-boxes, nursing stations in newborn wards, requiring special treatment, should be equipped with sinks with cold and hot water supply with the installation of elbow and contactless taps with mixers.

21. In the absence of a centralized hot water supply in preoperative and delivery rooms, treatment rooms, dressing rooms, vaccination rooms, sterilization, intensive care and departments of newborns and children under one year of age, reception departments, sanitary rooms, washing rooms, buffets, dispensing rooms, catering units, laundries, continuous water heaters.

22. When locating a facility in settlements that do not have or have a partially centralized sewerage network, the installation of a local sewerage system is provided. Wastewater is received into an underground waterproof container. The container for receiving wastewater is equipped with a lid, placed in the utility area and cleaned as it is filled.

Chapter 4. Sanitary and epidemiological requirements for lighting, ventilation and air conditioning and heat supply, premises of healthcare facilities

23. Natural and artificial lighting is provided in the premises of healthcare facilities.

Windows oriented towards the southern horizon are equipped with sun protection devices.

Lighting with “second light” or only artificial lighting is allowed in rooms where operating rules do not require natural lighting.

24. Natural and artificial illumination of the premises of healthcare facilities is determined by parameters in accordance with Appendix 1 to these Sanitary Rules.

25. Optimal microclimate and air conditions in the premises of healthcare facilities are provided by ventilation, air conditioning and heating systems. Supply and exhaust ventilation systems serve groups of rooms in accordance with the cleanliness class.

26. Buildings of healthcare facilities that provide inpatient and outpatient care for 150 or more visits per shift should be equipped with mechanically driven supply and exhaust ventilation systems.

For healthcare facilities with less than 150 visits per shift, it is planned to install air conditioning devices with bactericidal filters in aseptic rooms.

In infectious diseases hospitals (departments), including anti-tuberculosis ones, a separate exhaust ventilation system with gravity assist is installed in each box and half-box in the ward section. In the absence of mechanically driven supply and exhaust ventilation in infectious diseases departments, natural ventilation is installed with each box and half-box equipped with shielded bactericidal irradiators, allowing use in the presence of people.

In all rooms, except operating rooms, in addition to mechanically driven supply and exhaust ventilation, natural ventilation is provided.

27. The air supplied to operating rooms, anesthesia rooms, maternity rooms, resuscitation rooms, postoperative wards, intensive care wards, wards for patients with skin burns and oncohematological patients with immunodeficiency is disinfected using bactericidal air filters with a high degree of purification (at least 95%) . In operating rooms, intensive care wards, resuscitation rooms, maternity wards, treatment rooms, laboratories, rooms in which the operation of medical equipment is accompanied by the release of harmful substances into the air, local suction units or fume hoods are installed.

28. The frequency of air exchange is selected based on calculations to ensure a given purity and maintain the gas composition of the air. Relative air humidity no more than 60%, air movement speed no more than 0.15 meters per second.

29. Air ducts, grilles, ventilation chambers are kept clean, without mechanical damage, signs of corrosion, or leaks. The internal surface of the supply and exhaust ventilation (air conditioning) air ducts prevents the removal of particles of the air duct material and protective coating into the premises and is made of materials that do not have sorbing properties.

30. Ventilation system equipment is located in special rooms, separate for supply and exhaust systems, not adjacent vertically and horizontally to doctors’ offices, operating rooms, wards, and premises for permanent residence of people.

31. Exhaust ventilation with a single air exchange and supply ventilation with a double air exchange are installed in the premises.

32. In aseptic rooms, hidden installation of air ducts, pipelines, and fittings is carried out.

33. At healthcare facilities providing inpatient care and outpatient care with a capacity of 150 or more visits per shift, mechanically driven exhaust ventilation without an organized inflow device is equipped in showers, toilets, sanitary rooms, rooms for dirty linen, temporary waste storage and storage rooms for disinfectants.

34. In anti-tuberculosis organizations (departments):

1) the ventilation system must provide at least six air exchanges per hour in wards and twelve times in rooms for performing aerosol-generating procedures (sputum collection room, bronchoscopy), with a balanced supply, preventing the occurrence of stagnant zones;

2) rotary or plate type recuperators are not used;

3) exhaust units serving high-risk areas and biological safety cabinets of class 1-2 are equipped with devices for air disinfection using HEPA filters or bactericidal ultraviolet irradiation of sufficient intensity;

4) it is not allowed to combine floor networks with one vertical collector;

5) equipment for supplying and removing air is located on opposite walls;

6) all doors of rooms and airlocks are equipped with devices for automatic closing, doors of chambers and boxes (in the lower part of the door) with ventilation grilles for air flow;

7) exhaust ventilation from departments for patients with multidrug-resistant mycobacteria is arranged separately from each room with mechanical stimulation and additionally with gravitational stimulation with the installation of a deflector. Supply ventilation in these departments is provided with mechanical stimulation and air supply into the corridor;

8) staircases, elevator shafts, elevator shafts are equipped with autonomous supply and exhaust ventilation with a predominance of exhaust.

9) the supply and exhaust ventilation system must be operated around the clock.

35. Preventive inspection, repair of ventilation and air conditioning systems, cleaning and disinfection are carried out according to the approved schedule of the institution.

36. At healthcare facilities, by order of the manager, a person is appointed responsible for the operation of ventilation and air conditioning systems and the implementation of the schedule for planned preventative repairs of ventilation systems.

37. Independent supply and exhaust ventilation systems with heating and air conditioning are provided for the following premises: operating units, resuscitation rooms and intensive care wards (separately for septic and aseptic departments), delivery rooms (delivery wards), neonatal wards, oncohematological, dialysis, burn rooms dressing departments, separate ward sections, sputum collection, bacteriological laboratory, endoscopy, X-ray rooms, except for dental clinics (offices) with dental devices and pantomographs working with a highly sensitive image receiver (without a darkroom), and dental devices with digital image processing, workload , not exceeding 40 (mA*min)/week.

38. Air conditioning is allowed in operating rooms, anesthesia, delivery, postoperative wards, intensive care wards, oncohematological patients, patients with acquired immunodeficiency syndrome, with skin burns, intensive care units, in wards for newborns, infants, premature, injured children. Air conditioning is not provided in wards fully equipped with incubators.

39. Health care facility buildings are equipped with central heating systems. In the absence of a centralized source of heat supply, an autonomous boiler house is provided, running on liquid, solid and gaseous fuel.

40. In rural settlements, stove heating is allowed in one-story buildings. The combustion is carried out in an isolated room with a separate entrance.

41. In the maternity ward, the air temperature is ensured at least +25 0 C. In case of premature birth, the air temperature in the delivery room is provided at least + 28 0 C.

42. In the ward for premature babies, the air temperature is provided at +25 0 C – + 28 0 C.

43. Temperature, air exchange rate, category of cleanliness in premises, including day hospitals of healthcare facilities, are determined by the parameters established in Appendix 2 to these Sanitary Rules.

Chapter 5. Sanitary and epidemiological requirements for the repair and maintenance of premises of healthcare facilities

44. During the period of major repairs, the functioning of the premises of healthcare facilities ceases.

45. It is allowed to carry out routine repairs provided that reliable isolation of functioning premises from those being repaired is ensured.

46. ​​Current defects are eliminated immediately.

47. In the premises of healthcare facilities with a wet operating regime, subject to wet current disinfection (operating rooms, dressing rooms, labor and delivery, pre-operative, anesthesia, procedural, manipulation, vaccination rooms, hospital premises for patients with tuberculosis with multidrug-resistant mycobacteria, sputum collection rooms, as well as bathrooms, showers, sanitary facilities, enema rooms, rooms for storing and dismantling dirty linen, surgical rooms) moisture-resistant material is used for interior decoration.

48. Suspended ceilings are not used in infectious diseases and anti-tuberculosis departments.

49. In maternal and child health organizations, surgical and infectious diseases hospitals, elbow dispensers with antiseptic for hand treatment are installed at the entrance to each department.

50. Furniture, equipment, small-scale mechanization and cleaning equipment for healthcare facilities are used from materials that are resistant to detergents and disinfectants.

51. At healthcare facilities it is not allowed:

1) use of faulty small-scale mechanization equipment, equipment, devices;

2) the use of anesthesia and breathing apparatus with broken sealing of the gas supply system.

52. Wet cleaning (floors, furniture, equipment, window sills, doors) is carried out at least twice a day, in operating rooms between operations, using detergents and disinfectants approved for use in the Republic of Kazakhstan.

53. Cleaning equipment (buckets, basins, rags, mops) is marked indicating the premises and types of cleaning work, is used strictly for its intended purpose and is disinfected after use.

Sanitary rooms are equipped with structures for drying cleaning equipment. At healthcare facilities that provide outpatient care with a capacity of no more than 25 visits per shift, it is allowed to store cleaning equipment in sanitary facilities and utility rooms if there are storage shelves.

It is allowed to use new technologies when cleaning premises in compliance with epidemiological and disinfection regimes.

54. General cleaning of healthcare facilities is carried out:

1) in the premises of the operating unit, small operating rooms, central treatment centers, sterilization rooms, in the delivery room, maternity wards, dressing rooms, manipulation rooms, examination rooms, vaccination rooms, treatment rooms, surgical dental offices, in the dairy room at least once every seven calendar days;

2) in wards for patients with burns, in wards for patients with infectious diseases, purulent-septic infections, tuberculosis, in aseptic wards after the immediate discharge of patients, as well as upon the death of a patient;

3) in other premises of healthcare facilities is carried out at least once a month.

55. When carrying out general cleaning of healthcare facilities, the following requirements must be observed:

1) workers use specially designated sanitary clothing and personal protective equipment (hereinafter referred to as PPE);

2) cleaning is carried out using disposable napkins or reusable disinfected rags;

3) wet cleaning of surfaces is carried out with detergent solutions in the following sequence: ceiling, windows and sills, walls and doors - from top to bottom, equipment, floor - from the far wall to the exit, the toilet is cleaned last;

4) rinsing off the applied detergents is carried out with water, using disposable napkins or reusable rags;

5) disinfection of walls, window sills, floors, equipment, furniture is carried out with chemical disinfectants in accordance with the instructions for their use;

6) changing sanitary clothing and protective gloves to clean ones is carried out by workers before the stage of washing off the applied chemical disinfectants;

7) chemical disinfectants are washed off with water using a rag. Rinsing may not be necessary if disinfection is carried out using chemical disinfectants that do not require a rinsing procedure after use;

8) after general cleaning of the premises, disinfection, cleaning and drying of cleaning equipment is carried out;

9) after finishing cleaning, turn on the bactericidal irradiators for the estimated time in accordance with the instructions.

Advertisement . The estimated quartzing time is determined in accordance with the equipment operating instructions.

57. Unshielded mobile bactericidal irradiators are installed at a power rate of 2.0-2.5 watts per cubic meter of room.

58. In anti-tuberculosis hospitals and primary health care network organizations, shielded bactericidal irradiators are used and are continuously used in the presence of people in places with insufficient ventilation, where sources of airborne infections are concentrated (corridors; rooms for procedures accompanied by increased aerosol release, sectional halls of pathomorphological laboratories, operating rooms for surgical operations and similar premises).

Shielded bactericidal irradiators are installed at the rate of one 30-watt lamp per 20 sq. m along the floor and at a height of at least 2.20 m from the floor, provided that the radiation is not directed towards people in the room. In this case, the level of ultraviolet radiation in the upper part of the room at a distance of 1 m from the lamp should be in the range of 100-300 microWatt/sq. cm and no more than 0.2 microwatt/sq. cm in the area where people predominate.

59. When using other installations for air disinfection, the calculation is carried out in accordance with the operating instructions.

The operation of an open bactericidal irradiator is accompanied by a sign “Do not enter, the bactericidal irradiator is on!” in Kazakh and Russian languages.

60. The following requirements apply to the linen regime at healthcare facilities:

1) facilities are provided with bed linen, diapers, towels;

2) in operating rooms, maternity rooms, and rooms with aseptic conditions, sterile or disposable linen is used;

3) patients’ linen is changed once every seven calendar days and when soiled;

4) bed linen is changed for postpartum women every three calendar days and when soiled;

5) in the emergency departments of hospitals, a room is allocated for temporary storage of patients’ outer clothing.

61. Collection of used linen is carried out in dense special containers (oilcloth, plastic bags, equipped linen trolleys). Disassembly of dirty linen in departments is not permitted.

Temporary storage (no more than twelve hours) of dirty linen in departments is carried out in sanitary rooms, specially designated rooms for this purpose in closed containers (metal, plastic tanks), which are easily washed and disinfected. To work with dirty linen, personnel are provided with a change of sanitary clothing.

62. Linen of infectious diseases, purulent-surgical and pathological departments is subject to disinfection before washing.

63. Washing of linen is carried out in laundries, regardless of the form of ownership, subject to the allocation of special technological lines that exclude the possibility of contact of linen with non-hospital linen.

Independent laundries are required in maternity hospitals, children's hospitals, infectious diseases and specialized hospitals.

64. At healthcare facilities providing outpatient care with a capacity of no more than 100 visits per shift, a mini-laundry consisting of at least two adjacent rooms (one for collection and washing, the other for drying and ironing) with an automatic washing machine is allowed .

At healthcare facilities providing outpatient care with a capacity of less than 25 visits per shift, it is allowed to combine collection, washing, drying and ironing in utility rooms.

65. In hospitals, a disinfection department is provided (the composition and area are determined by the capacity of the hospital). If there is no own disinfection department, disinfection of bedding is carried out in organizations that have disinfection chambers.

66. Bedding (mattresses, pillows, blankets) at healthcare facilities are subject to disinfection using the chamber disinfection method in the following cases:

1) after discharge or transfer of a patient from surgical, traumatological, oncological, hematological, burn departments, departments for pregnant women and women in labor, departments for children, infectious diseases, anti-tuberculosis, dermatovenerological departments;

2) according to epidemic indications;

3) when bedding is contaminated with biomaterial;

4) after the death of the patient.

Mattresses and pillows in tightly sewn hygienic covers are disinfected by wiping or sprinkling the covers with chemical disinfectants.

67. Transportation of clean and dirty linen is carried out packaged in closed, marked containers (“clean”, “dirty” linen).

Clean linen is stored in specially designated rooms on racks and in cabinets on shelves.

Paragraph 1. Sanitary and epidemiological requirements for the maintenance of surgical departments

68. The following areas are provided in the operating block (department):

1) “sterile” (operating and assisting surgeons, operating room nurse),

2) “clean” (anesthesiologists, junior and technical staff, patient delivery, clean linen, medications),

3) “dirty” (disposal of medical waste, used linen, dressings).

The following areas are provided for small operating rooms:

1) “sterile” through the sanitary inspection room (operating and assisting surgeons, anesthesiologists, operating room nurse, clean sterile linen),

2) “clean” (junior and technical personnel, patient delivery, medications).

After the operation is completed, the removal of medical waste and used linen is allowed through the airlock.

69. Surgical departments are provided with at least 2 dressing rooms. Dressings with purulent discharge are carried out in a septic dressing room, if there is none, in an aseptic dressing room after dressings of patients who do not have purulent discharge.

Paragraph 2. Sanitary and epidemiological requirements for the maintenance of dermato-cosmetology, plastic and aesthetic surgery facilities

70. At dermato-cosmetology facilities that use local anesthesia, as well as manipulations to correct functional wrinkles, local hyperhidrosis, using drugs based on botulinum toxin, are carried out in treatment or manipulation rooms.

71. At plastic aesthetic surgery facilities, surgical procedures using drugs based on botulinum toxin are carried out in operating rooms or small operating rooms, with the exception of the correction of functional wrinkles and local hyperhidrosis.

72. The interior decoration, engineering support and equipment of procedural and manipulation rooms used to provide medical services in dermato-cosmetology, operating rooms and small operating rooms used to provide plastic and aesthetic surgery services must comply with the requirements established by these Sanitary Rules.

73. Treatment and manipulation rooms used for the correction of functional wrinkles, local hyperhidrosis, using drugs based on botulinum toxin are additionally provided with refrigeration equipment for storing the drugs used.

74. Storage of drugs based on botulinum toxin is carried out in conditions that exclude access by unauthorized persons, on a separate shelf of the refrigerator, in a separate labeled container (original packaging), taking into account temperature conditions and other restrictions established by their manufacturer.

Paragraph 3. Sanitary and epidemiological requirements for the maintenance of perinatal centers and obstetric hospitals

75. In the reception areas of the gynecological, maternity departments and the reception department of the children's hospital, sanitary passages for staff with a dressing room and showers are equipped.

76. The wards of the postpartum department are filled cyclically, no more than three calendar days of stay.

77. In the ward where mothers and children are staying together, individual cots and a changing table for newborns are installed.

78. Newborn pathology and nursing departments are provided only as part of perinatal centers and children's hospitals, with appropriate planning isolation.

79. An individual maternity ward is provided with liquid soap, an antiseptic, a disposable towel, a visual wall-mounted manual on hand washing techniques, a mat, a ball, and a wall bars. A free interior in the wards is allowed, subject to the use of items subject to wet processing, and the use of personal clean clothing for mother and child.

80. The provision of medical care to newborns, infants and young children with infectious pathologies is carried out in departments for children in specially designated, separate boxed rooms.

81. Boxed rooms are filled taking into account the cyclicity, age of the child and his pathology.

82. In the departments of the second stage of nursing and departments for children under 3 years of age, wards are provided for the mothers to stay together around the clock, a filter for their preventive examination and changing clothes.

83. The children's department includes at least 2 rooms for preparing and dispensing infant formula and a room for processing dishes. After opening the package, dry milk formulas are marked with the date and time of opening.

84. In children's departments there is a canteen for children over three years of age.

85. In children's departments, toys are used that are made from materials that allow disinfection by physical or chemical means. To disinfect toys, specially designated and marked containers are used.

86. Cleaning and disinfection of incubators and incubators for children are carried out by a medical worker, taking into account the recommendations of the manufacturer, in a specially designated room.

Paragraph 4. Sanitary and epidemiological requirements for the maintenance of blood service facilities

87. At blood service facilities, the premises comply with the following requirements:

1) work areas should not be walk-through;

2) authorized access is ensured in production premises for the preparation and storage of blood products and in laboratory premises.

88. In premises, wet cleaning (floors, furniture, equipment, window sills, doors) is carried out at least twice per shift, before starting work using detergents, after finishing work using detergents and disinfectants approved for use in the territory of the Republic of Kazakhstan .

89. Work areas are provided with sinks for hand washing, dispensers with liquid soap and antiseptic solution, disposable towels or electric towels.

90. Separate storage of various categories of blood products and materials is ensured:

1) collected whole blood and its components;

2) intermediate blood products;

3) blood products in temporary quarantine (until quality test results are received);

4) finished blood products intended for medical use;

5) blood products not subject to issue for medical use.

In the absence of separate storage conditions, specially marked areas of the premises, racks, refrigerators, and containers are allocated.

91. At all stages of production, storage and transportation of blood products, “cold chain” conditions are ensured:

1) refrigeration equipment, thermal containers and/or refrigerated trucks that maintain the established temperature conditions for storage and transportation, as well as constant monitoring of compliance with the temperature conditions at all stages;

2) packaging that prevents physical damage and minimizes the risk of microbiological contamination of blood products;

3) constant monitoring of compliance with the temperature regime at all stages.

92. Refrigeration equipment equipped with locks or access restriction devices is used to store blood products.

93. In the premises used for on-site donor sessions, the flow of work procedures, sufficient ventilation, electrical equipment, lighting, and authorized storage of blood products are ensured. The suitability of the proposed external premises is determined before the start of the donor session.

Paragraph 5. Sanitary and epidemiological requirements for the maintenance of infectious diseases hospitals and departments

94. The admission department of infectious diseases hospitals is provided with:

1) a supply of clean bags (made of thick fabric) for putting clothes and linen of patients in them and for storing them until they are sent to the disinfection chamber;

2) containers for collecting vomit and feces;

3) separate cleaning equipment for cleaning premises and sanitary facilities;

4) detergents, disinfectants and disinfestants;

5) sterile laboratory glassware for collecting material for research;

6) shielded bactericidal ultraviolet irradiators, allowing disinfection in the presence of people;

7) gowns, scarves, respirators for working medical personnel;

8) anti-pediculosis styling;

9) sets of protective suits of the first type.

95. Sanitary treatment of the patient is carried out in the emergency department. If a patient is admitted to a box or half-box, sanitary treatment is carried out directly in these rooms.

96. Departments for hospitalization of patients with airborne, especially dangerous and quarantine infections and the diagnostic department (diagnostic wards) must be completely boxed. In other departments, boxes and half-boxes must make up at least 30% of the total number of wards.

97. The work of the departments is organized according to the principle of providing medical care and serving patients in the ward.

98. Personnel entry into the boxes is provided from a non-infectious “conditionally clean” corridor through locks, in which sanitary clothing is changed, hands are washed and disinfected.

99. In the boxes of infectious disease departments, glazed openings are provided from the airlocks to the wards, transfer cabinets for the delivery of food, medicines and linen from the airlock to the ward. In boxed wards, transfer cabinets are provided from the corridor to the ward. Patients eat food in the ward.

100. The filling of boxes is carried out taking into account the cyclicity, nosological forms and characteristics of the clinical course of individual forms of infectious diseases.

101. Patients with intestinal infections are provided with individual labeled pots, the marking of which must correspond to the patient’s bed number. The patient's secretions are disinfected.

Paragraph 6. Sanitary and epidemiological requirements for the maintenance of anti-tuberculosis organizations

102. On the territory of anti-tuberculosis organizations, separate walking areas are provided for patients in accordance with the epidemiological status.

103. Anti-tuberculosis organizations provide an emergency department with at least two examination rooms or boxes.

In anti-tuberculosis organizations, separate hospitalization of patients is provided in accordance with the results of microscopy of sputum smears, drug sensitivity tests and the prescribed treatment regimen (hereinafter referred to as epidemiological status) in the following specialized departments:

1) department for sick bacteria excretors with preserved sensitivity to rifampicin;

2) a department for patients without bacterial excretion with preserved sensitivity to rifampicin;

3) department for patients with multidrug resistance;

4) department for patients with extensive drug resistance;

5) a department for patients with chronic tuberculosis with bacterial excretion who do not receive specific treatment;

6) department for compulsory treatment.

104. Each department for the treatment of patients with bacterial excretion is zoned in accordance with the epidemiological status. Patients with bacterial excretion and unknown drug susceptibility status are kept in single rooms with a private toilet and shower until the results of the drug susceptibility test are obtained.

105. In the compulsory treatment department, separate hospitalization of tuberculosis patients is provided depending on drug sensitivity.

106. Patients with chronic forms of tuberculosis with constant bacilli excretion, who require symptomatic treatment, are subject to isolation in specialized organizations or departments at anti-tuberculosis organizations until the period of abacillation.

107. In anti-tuberculosis organizations, separate rooms are allocated for outpatient treatment of patients who isolate multi- (poly-) resistant strains.

108. In anti-tuberculosis organizations, a cycle of filling wards within fourteen calendar days is observed.

109. The buildings of anti-tuberculosis hospitals are divided into “clean” and “dirty” zones, with a gateway installed between them, equipped with a mechanical ventilation system, air disinfection devices, and a sink for washing hands.

Patient rooms and treatment rooms are not located in the “clean” zone.

110. In each department, in primary health care organizations, facilities providing outpatient and inpatient care, a room is allocated for sputum collection.

The sputum collection room is equipped with a bactericidal irradiator, a sink for washing hands with a dispenser with antiseptic soap and antiseptic solution, containers with a disinfectant solution, containers for clean containers and containers with sputum (bins, metal boxes with handles made of galvanized or stainless steel), equipped with a local system ventilation with a room air exchange rate of at least twelve air changes per hour.

111. Patients with cough, with the release of mycobacteria and patients with the release of drug-resistant forms of mycobacteria use surgical masks:

1) when communicating with medical workers and visitors;

2) when moving through the territory of other departments and administrative buildings.

112. Used patient care products, linen, bedding, furniture, equipment are subject to mandatory disinfection before removal from the department of anti-tuberculosis organizations (for use in other departments, write-off, disposal).

113. In tuberculosis hospitals, visiting patients in wards, unauthorized movement of patients from ward to ward, and unauthorized movement of patients outside the departments is prohibited.

114. Patients with the release of Mycobacterium tuberculosis eat food in the wards.

115. In the bacteriological laboratory of anti-tuberculosis organizations (departments), three separate sections are provided for performing bacterioscopic studies:

1) for preparing and staining smears;

2) for bacterioscopy;

3) for registration and storage of drugs.

Paragraph 7. Sanitary and epidemiological requirements for the maintenance of physiotherapy rooms

116. Isolated cabins are not provided in children's departments (offices); all procedures are carried out in the presence of a nurse.

117. Remote-controlled devices and devices with a power above 50 watts are placed in isolated rooms or booths, shielded with metallized fabric (with microwire).

118. Physiotherapeutic equipment is installed in isolated cabins, free from grounding (insulation from walls and floors).

119. Devices for UHF and microwave therapy with remote and universal arrangement of capacitor plates of emitters require the organization of specially designated rooms or booths, shielded with fabric with a microwire.

120. Laser installations of hazard classes 3 and 4 are located in separate rooms. The walls are made of fireproof materials with a matte surface. The doors of the rooms are closed with internal locks with blocking devices that prevent access to the room while the lasers are operating. A laser danger sign is placed on the door and a light sign that automatically turns on “Danger, the laser is working!” in the state and Russian languages.

121. Laser installations of hazard classes 1 and 2 are permitted to be placed in common areas.

122. The electrical sleep room is located in a non-passable area, taking into account the orientation of the windows into a quiet area, under soundproof conditions. The office has a walk-through equipment room with an observation window for observation.

123. The group inhalation room is isolated from other rooms.

The compressor for individual inhalation devices is placed with them or in an adjacent room. Compressors for inhalation units for several treatment places can be placed in the basement or semi-basement floor.

124. The inhalation facility provides for independent supply and exhaust ventilation. In an individual inhalation room, it is necessary to provide four air changes per hour, in a group inhalation room, ten times air changes per hour.

125. Physiotherapy departments are divided into a “dry” zone (electrical, light, heat therapy rooms) and a “wet” zone (hydrotherapy, mud therapy). Separate rooms are equipped for carrying out procedures for each type of treatment. It is allowed to place equipment for electrotherapy and light therapy in the same room.

126. Individual, reusable or disposable underwear is used for each patient. During procedures, medical personnel use disposable gloves.

Paragraph 8. Sanitary and epidemiological requirements for the maintenance of centralized sterilization departments

127. The premises of centralized sterilization departments are divided into three zones:

1) “dirty” (reception of dirty material, sorting, putting into a disinfection and washing machine);

2) “clean” (unloading cleaned, disinfected and dried material from the disinfection-washing machine, packaging, placing it in the sterilizer). A separate room is provided for packaging medical linen;

3) “sterile” (receipt of sterile material from sterilizers and its storage).

Entrance to the “clean” and “sterile” areas is through a sanitary entrance.

128. When using reusable medical instruments in work, a washing and sterilization department is provided.

Sterilizing equipment is installed in accordance with its operating instructions.

129. The organization and conduct of disinfection, pre-sterilization cleaning, sterilization and storage of medical products is carried out in accordance with standardization documents.

Paragraph 9. Sanitary and epidemiological requirements for the maintenance of dental clinics (offices)

130. In dental facilities with a capacity of more than 50 visits per shift, children are received in separate rooms.

In dental facilities with a capacity of 50 or fewer visits per shift, it is allowed to conduct therapeutic and orthopedic appointments in one office, crossing the flow of adults and children in therapeutic, orthopedic, orthodontic and separately in surgical profiles, subject to disinfection and sterilization regimes.

131. In rural settlements, it is allowed to have separate rooms for combined reception of adults and children for surgical and therapeutic purposes, in compliance with isolation and disinfection and sterilization regimes.

132. In the premises of a dental clinic located in a residential and public building, it is allowed to place dental devices and pantomographs operating with a highly sensitive image receiver (without a darkroom), and dental devices with digital image processing, a workload not exceeding 40 (mA*min)/ week.

133. The work of the surgical dentistry office is organized taking into account the separation of the flows of “clean” and “purulent” interventions.

134. Each dental office is equipped with a table for sterile materials and instruments or a bactericidal chamber for storing instruments.

135. All dental offices are provided with medical equipment and medical supplies in quantities sufficient for uninterrupted operation, taking into account the time required for their processing between manipulations.

An individual dental examination kit is provided for each visit.

136. Prostheses and templates with wax rollers must be disinfected before fitting. Impression trays are disinfected and sterilized.

The burr tips are subject to disinfection, pre-sterilization cleaning and sterilization after each use in accordance with the manufacturer's recommendations.

137. Offices are equipped with bactericidal irradiators or other air disinfection devices.

Paragraph 10. Sanitary and epidemiological requirements for the maintenance of healthcare facilities for palliative care and nursing care

138. Palliative care and nursing care departments are provided as part of a multidisciplinary or specialized healthcare facility, or function as an independent facility.

139. In hospices and palliative care departments (hereinafter referred to as hospices), it is necessary to provide additional rooms for sleeping and eating for persons caring for patients (relatives, volunteers and other persons who are not employees of the healthcare facility).

140. The construction of wards for hospice patients is provided with a capacity of up to four beds.

141. The hospice department provides a separate ward with one or two beds for patients with purulent-septic and infectious diseases.

142. In hospices, a separate room is provided for visiting patients and organizing the reception of deliveries to patients.

Paragraph 11. Sanitary and epidemiological requirements for the maintenance of hemodialysis departments

143. Premises for outpatients in the chronic hemodialysis department are allocated in a separate area.

144. Rooms for resting, changing clothes and storing personal belongings are provided for outpatients.

145. Premises for hemodialysis in infectious diseases hospitals should be located adjacent to the boxes for patients.

146. For program hemodialysis patients who are carriers or patients with chronic forms of an infectious disease, as well as for persons with positive test results for markers of parenteral viral hepatitis, a separate area or a separate room and equipment is provided.

147. The premises for water treatment, preparation and storage of dialysis concentrates, storage of ingredients for the preparation of dialysis concentrates are located isolated from each other. All rooms are equipped with supply and exhaust ventilation.

148. An uninterrupted supply of purified water is provided in dialysis rooms.

149. Before dialysis, the expiration date of single-use products (dialyzer, column, blood container, lines) is checked, and the integrity of the consumer packaging is also ensured. Single-use products with damaged consumer packaging that violates their sterility are not used.

150. During the procedure, equipment, devices and devices that have not been disinfected and sterilized are not used.

151. The connection of the patient’s vessels to the lines of the device is carried out under aseptic conditions. During each dialysis procedure, sterile oilcloths and diapers must be used to prevent contamination of the puncture area. The puncture site is covered with a sterile dry gauze swab for the entire period of the procedure.

152. The mattress on the bed in the dialysis room must be protected from the ingress of blood and other biological fluids with oilcloth or other waterproof covering. After each dialysis procedure on a bed (chair-bed), bed linen must be changed. The use of the patient's individual underwear is allowed, but it must be ensured that the individual underwear is not contaminated with blood stains or other secretions.

Paragraph 12. Sanitary and epidemiological requirements for the maintenance of pathological organizations

153. The room for storing corpses is equipped with refrigeration units providing a temperature of +2 0 C - +4 0 C, mechanization means for transporting corpses, racks, shelves or special safes. Corpses are not stored on the floor.

154. Cold and hot water is supplied to the sectional tables. The sectional table is equipped with a container for collecting and disinfecting wastewater before draining it into the drainage system. The work place at the sectional table is equipped with a wooden grid.

155. Section tables, gurneys, stretchers and other devices for transporting corpses are covered with waterproof material that is resistant to detergents and disinfectants.

156. The floor is washed daily with hot water and detergents. Wall panels and doors are washed when dirty, but at least once a week.

157. At least once a month and after autopsy of corpses who died from infectious diseases, the premises are thoroughly cleaned using detergents and disinfectants.

158. Work with sectional material is carried out using PPE (robe, gloves, aprons, goggles). In cases that do not exclude tuberculosis, high-protection masks and respirators are used.

Chapter 6. Sanitary and epidemiological requirements for the organization and implementation of sanitary, anti-epidemic and sanitary and preventive measures at healthcare facilities

159. To effectively organize and carry out measures to prevent nosocomial infectious diseases (hereinafter referred to as nosocomial infectious diseases), an infection control program is being developed at a healthcare facility, which provides for:

1) accounting and registration of nosocomial infections;

2) analysis of morbidity, identification of risk factors, investigation of outbreaks of nosocomial infections and taking measures to eliminate them;

3) organization and implementation of microbiological monitoring;

4) development of tactics of antibiotic prophylaxis and antibiotic therapy;

5) organization of measures to prevent occupational diseases;

6) training of personnel on infection control issues;

7) organization and control of the sanitary and anti-epidemic regime;

8) organization of collection, neutralization, storage and transportation of medical waste.

160. At non-infectious health care facilities, if a patient is diagnosed with an infectious disease that poses an epidemiological danger to others, he is transferred to an isolation ward. In the absence of an isolation ward, patients with infectious diseases must be transferred to the appropriate infectious diseases hospitals.

161. The flow of patients admitted for inpatient treatment is provided on a planned and emergency basis from the admission department to the department according to the profile of hospitalization. It is allowed on an emergency basis (according to clinical indications) for patients to move to the operating room, anesthesiology and intensive care unit, or maternity ward, bypassing the emergency department.

To prevent the intersection of “dirty” and “clean” flows, transportation of patients, visitors, and delivery of food to patients, elevators should be designated as “conditionally dirty” and “conditionally clean.”

162. In the emergency department, the pharynx is examined, temperature is measured, and incoming patients are examined for lice, scabies, and dermatomycosis, with a note in the medical history. Biological material is selected according to epidemiological indications for laboratory research.

163. If an infectious disease is suspected, the patient is isolated in the diagnostic ward at the emergency department (box) until transferred to the infectious disease department (hospital).

164. Patients with purulent-septic infectious diseases are isolated in the purulent surgery department, and in its absence, in a separate ward.

165. Patients are sanitized upon admission to the hospital and given a set of clean underwear, pajamas, and slippers. It is allowed for patients in the hospital to wear home clothes, with the exception of patients undergoing treatment in anti-tuberculosis organizations.

166. In wards, beds are installed in strict accordance with the area established in accordance with current state regulations in the field of architecture, urban planning and construction.

167. The cyclical filling of wards during hospitalization of patients is ensured (within three calendar days).

168. The repurposing of beds in healthcare facilities for epidemiological reasons is coordinated with the territorial division of the state body in the field of sanitary and epidemiological welfare of the population.

169. In hirudotherapy rooms, leeches are used once, reuse is not allowed. After use, leeches are disposed of in accordance with the accepted scheme for handling medical waste of class “B”.

170. All medical procedures associated with violating the integrity of the skin and mucous membranes are carried out using disposable gloves.

171. Medical personnel clean their hands before and after each medical procedure in compliance with all stages of hand treatment.

172. Permissible levels of bacterial contamination of the air environment of premises, depending on their functional purpose and the cleanliness class of healthcare facilities, are determined by the parameters established in Appendix 3 to these Sanitary Rules.

173. Laboratory and instrumental studies carried out during inspections according to a special procedure at healthcare facilities are carried out in accordance with Appendix 4 to these Sanitary Rules.

174. The organization of activities to implement production control is carried out in accordance with standardization documents.

175. Disinfection, disinfestation and deratization measures at healthcare facilities are organized and carried out on a systematic basis in accordance with standardization documents.

Chapter 7. Sanitary and epidemiological requirements for the collection, disposal, and storage of waste at healthcare facilities

176. Collection, neutralization, storage and removal of medical waste from healthcare facilities is carried out in accordance with the Waste Management Program approved by the head of the healthcare facility, which provides for:

1) composition of generated waste by class;

2) the procedure for collecting medical waste;

3) applied methods of disinfection (neutralization) and waste disposal;

4) waste management scheme;

5) hygienic training of personnel in the rules of epidemic safety when handling waste.

In order to organize a medical waste management system, by order of the head of a healthcare facility, a responsible person is appointed to monitor compliance with the requirements of these Sanitary Rules.

177. To collect waste, disposable, waterproof bags, packages, metal and plastic containers, containers for collection and safe disposal are used. Metal and plastic containers, containers for collecting hazardous waste are tightly closed.

178. The classification of medical waste is determined in accordance with the Basel Convention on the Control of Transboundary Movements of Hazardous Wastes and Their Disposal. To collect each class of waste, colored bags and containers are used:

1) waste class “A” – black;

2) class “B” waste – yellow;

3) waste class “B” – red;

4) waste class “G” – white.

179. The following requirements apply to the collection of medical waste of class “A”:

1) collection is carried out in reusable containers and disposable bags;

2) disposable bags are located on special carts or inside reusable containers. Waste collection containers and carts are marked with the appropriate inscriptions “Medical waste. Class "A".

180. The following requirements apply to the collection of medical waste of classes “B” and “C”:

1) are collected in disposable soft (bags) or hard, puncture-resistant (containers) packaging that is yellow or has yellow markings. The choice of packaging depends on the morphological composition of the waste;

2) piercing and sharp objects are collected in puncture-proof and waterproof KBSU without prior disassembly and disinfection;

3) in the presence of special devices for separating needles (needle pullers, needle destructors, needle cutters), used syringes without needles are collected in disposable soft (bags) with other medical waste of class “B”, which are subjected to disinfection in special installations;

4) to collect organic, liquid medical waste of class “B”, moisture-resistant containers with a lid that ensures their sealing are used;

5) KBSU are filled to no more than three-quarters of the volume. Once filled, the KBSU is tightly closed with a lid and sent to the medical waste storage room, where it is stored for no more than three days;

6) during the final packaging of medical waste of classes “B” and “C” for their removal from the unit, disposable containers (bags, KBSU) are marked with the appropriate inscriptions “Medical waste. Class “B” or “C”, indicating the name of the unit, date, surname, first name and patronymic (if any) (hereinafter referred to as full name) of the person responsible for waste collection.

181. Medical waste of class “G” is collected in containers marked with the appropriate inscriptions “Medical waste. Class “G”, indicating the name of the department, date, full name of the person responsible for waste collection.

182. When organizing waste neutralization using special installations, the collection and storage of medical waste of class “B” is carried out without prior neutralization at the places of generation, subject to ensuring epidemiological safety.

183. Pathological and organic operational medical waste of class “B” (organs, tissues, etc.) are subject to cremation (burning) or burial in cemeteries in a specially designated area. Preliminary disposal of this medical waste is not required, with the exception of waste from infectious patients.

184. Medical waste of class “B” is subject to mandatory neutralization by physical or chemical methods at a healthcare facility. Removal of non-neutralized medical waste of class “B” outside the territory of the organization is not allowed.

185. Liquid biological medical waste after neutralization by chemical methods (disinfection) is discharged into the drainage system.

186. The burning of medical waste of classes “B” and “C” on the territories of healthcare organizations outside specialized installations is prohibited.

187. For the storage of medical waste of classes “B”, “C”, “D” at healthcare facilities providing inpatient care and outpatient care with a capacity of more than 50 visits per shift, a separate room is allocated, equipped with mechanical exhaust ventilation and refrigeration equipment for storing biological waste (if any), shelving, scales, containers for collecting bags of medical waste, a sink with hot and cold water supply, air disinfection units, hand sanitizer.

188. At healthcare facilities providing outpatient care with a capacity of 50 or fewer visits per shift, it is allowed to store medical waste in utility rooms equipped with refrigeration equipment for storing biological waste (if any) and hand sanitizer.

189. Storage of more than twenty-four hours of food waste, non-neutralized medical waste of class “B” is carried out in refrigerators and freezers, but not more than three days.

190 Biological medical waste of class “B” is stored at a temperature not exceeding +5 0 C.

191. Collected medical waste is hermetically packed into bags without damaging the integrity using a tie to the opening of the bag. As they accumulate, they are removed and disposed of by specialized organizations.

192. Transportation, neutralization and disposal of hazardous medical waste of classes “B” and “C” are carried out in accordance with standardization documents.

193. After removal of medical waste, the storage room for medical waste, used equipment and supplies are disinfected.

194. Class “D” radioactive medical waste is handled in accordance with standardization documents.

195. The responsible person of the medical organization keeps daily records of generated medical waste in a journal in the form according to Appendix 5 to these Sanitary Rules.

196. Personnel are provided with sets of sanitary clothing and personal protective equipment (gowns, overalls, gloves, masks, respirators, special shoes, aprons, oversleeves).

Chapter 8. Sanitary and epidemiological requirements for food conditions at healthcare facilities

197. The catering unit of healthcare facilities is located in a separate building or in a separate block of premises connected to the main building and other buildings, convenient ground and underground passages, with the exception of infectious diseases departments.

198. The design, maintenance of the catering unit and equipment, requirements for raw materials and finished products are provided in accordance with standardization documents.

199. A daily sample of prepared dishes is left at the catering unit every day.

For a daily sample, half portions of first courses are left, portioned second courses are selected entirely in quantities of at least 100 grams (hereinafter referred to as grams), third courses are selected in quantities of at least 200 grams.

Daily samples are stored in labeled (1, 2, 3 dishes) jars with lids at a temperature of +2 0 C - +6 0 C in a specially designated place in the refrigerator for storing prepared food. After 24 hours, the daily sample is discarded as food waste. The containers for storing the daily sample (containers, lids) are treated by boiling for five minutes.

200. To deliver prepared food to hospital pantries, labeled (for food) thermoses or dishes with lockable lids are used. Transportation is carried out using special trolleys.

201. Distribution of ready-made food is carried out by barmaids and nurses on duty in the department wearing gowns marked “for food distribution”.

Technical personnel involved in cleaning wards and other department premises are not allowed to distribute food.

202. The head nurse monitors the distribution of food in accordance with the prescribed diets.

203. During distribution, first courses and hot drinks have a temperature of not lower than + 75 0 C, second courses – not lower than +65 0 C, cold dishes and drinks – from +7 0 C to +14 0 C. Until the moment of distribution, first and second courses are on a hot stove for up to two hours from the moment of preparation.

204. The buffet departments provide:

1) two rooms - for serving food and washing dishes;

2) backup water heaters with water supply to washing baths.

205. The processing of dishes is carried out in the following sequence: mechanical removal of food and washing in the first sink with degreasers, rinsing with hot water in the second sink and drying the dishes on special shelves and racks.

206. In the pantry of infectious diseases, skin and venereal diseases, anti-tuberculosis organizations (departments), for epidemiological indications in departments of other profiles:

1) after eating, the dishes are collected in the pantry on a separate table, freed from food residues, disinfected, washed and dried. Disinfection is carried out chemically (solutions of disinfectants, including in a washing machine) or thermally (boiling, treatment in an air sterilizer);

2) food remains are dumped into a special marked tank with a lid and disinfected according to the regimes for the corresponding infections by adding a dry disinfectant in a ratio of one to five (one hour exposure). The table for used dishes, brushes, and ruffers are disinfected after each use. Cloths for tables and washing dishes are disinfected by immersing in a disinfectant solution, rinsing and drying.

207. Transfers for patients are sent in plastic bags indicating the patient’s name and surname, date and time of transfer. Lists of permitted dishes (indicating their quantity) and ready-to-eat food products are posted at delivery reception areas and departments.

208. After opening the package, powdered infant formula is marked with the date and time of opening and is stored under the conditions and terms indicated on the package “storage after opening the package.” Dilution of mixtures is carried out using sterile containers. Ready-made milk formulas are transported, used, stored and distributed in accordance with the manufacturer's documents.

209. In hospitals with a capacity of up to 50 beds, ambulatory surgery centers, and organizations providing hospital-replacement care, it is allowed to provide hot meals to patients on a contractual basis with the relevant organizations, subject to compliance with established norms and rules.

Chapter 9. Sanitary and epidemiological requirements for working conditions and consumer services for personnel of healthcare facilities

210. At healthcare facilities, if there are no canteens for staff, a room is allocated equipped with a refrigerator, devices for heating water and food, and sinks for washing hands.

211. It is not allowed to eat or smoke in toilet rooms, directly in functional rooms, and in rooms not designated for these purposes.

212. At healthcare facilities that provide inpatient care, household premises for staff are equipped as a sanitary checkpoint and include dressing rooms, washrooms, a toilet, a room for storing sanitary clothing and personal protective equipment. Dressing rooms are equipped with separate cabinets for storing special and personal clothing.

At healthcare facilities that provide outpatient care with a capacity of no more than 25 visits per shift, it is allowed to have separate closets for storing sanitary clothing and personal clothing in the household premises.

213. Sanitary facilities are equipped with sinks for washing hands with a supply of hot and cold water, equipped with washing supplies, disposable towels or electric towels.

214. Medical personnel are provided with sets of replacement work clothes (robes, caps (scarves), replacement shoes, PPE).

215. Medical personnel of anti-tuberculosis organizations, when working in the presence of coughing patients with the release of mycobacteria, patients with the release of drug-resistant forms of mycobacteria, when working with infected material, use surgical masks, protective gloves, and sanitary clothing.

216. Medical personnel of anti-tuberculosis organizations use respirators with a filtration efficiency of at least 94% of particles up to 0.3-0.4 microns in size, and corresponding in size and configuration to the medical worker, ensuring a tight fit to the face.

217. The change of sanitary clothing for medical personnel performing invasive diagnostic and therapeutic procedures, as well as having contact with biological material, is carried out daily and/or when soiled.

Change of sanitary clothing for medical personnel whose work does not involve invasive procedures is carried out at least twice a week and/or when soiled.

218. Washing of sanitary clothing is carried out centrally, separately from the linen of patients.

219. Medical personnel providing advisory assistance, technical and administrative personnel performing temporary work in hospital departments are provided with a change of clothes and shoes.

220. Medical personnel in sanitary clothing are not allowed outside the healthcare facility.

221. When entering work and subsequently, medical personnel undergo mandatory medical and periodic examinations, in accordance with standardization documents.

Personal medical records with permission to work are kept at workplaces.