Rules On Hygiene And Pretepidēmisk In Essential Medical Institution

Original Language Title: Noteikumi par higiēniskā un pretepidēmiskā režīma pamatprasībām ārstniecības iestādē

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Cabinet of Ministers Regulations No. 574 Riga, July 11, 2006 (pr. No 37 22. §) rules on hygiene and pretepidēmisk in the treatment of essential requirements Issued under the law of 23 epidemiological safety. the first paragraph of article i. General questions 1. Rules provide a hygienic and against the epidemic mode requirements (hereinafter requirements) medical institution and its departments (hereinafter referred to as the authority) to prevent the spread of infectious diseases, which is related to the patient's health care (hereinafter referred to as the nozokomiāl infection).
2. the essential requirements shall be determined in accordance with the precautionary principle. The precautionary principle is based on the assumption that any patient can be carriers of communicable disease agents and its organs, tissues, biological fluids and separation directly or indirectly disseminate live infectious pathogenic agents authority, which may have been contaminated.
3. On the origin of infectious diseases and the control authority is responsible authorities. Authorities: 3.1 ensure authorities and pretepidēmisk mode of hygiene plan (hereinafter plan authority) according to these rules the following basic requirements and particular circumstances. Authorities plan shall contain at least the following sections: 3.1.1. space-separated zones of purity and cleaning;
3.1.2. hand processing methodologies;
3.1.3. the use of personal protection equipment in accordance with a procedure (of high inflation to me);
3.1.4. disinfection and sterilization. This includes equipment and medical devices by risk of contamination;
3.1.5. laundry sorting laundry change frequency and branding;
3.1.6. waste management;
3.1.7. nozokomiāl registration of establishment of infection, indicating information necessary for epidemiological analysis;
3.1.8. actions and information scheme authority, if the patient is found to be nozokomiāl infection or there is a reasonable suspicion of infection with nozokomiāl infections;
3.1.9. the internal control;
3.2. organizes the work of body to ensure the implementation of the plan, the authority, or designate a responsible person for authorities and implementation of the plan, internal controls (treatment) (hereinafter referred to as the person responsible for the Authority's plan), or create a nozokomiāl infection control Council or group;
3.3. position descriptions include the obligation to comply with the Authority's plan;
3.4. appoint responsible employees who organized the sterilization process of medical devices and their storage, as well as the sterile medical devices the term of validity of a points method in accordance with the provisions of the annex (hereinafter referred to as the responsible person for the disinfection and sterilization).
4. person responsible for the Authority's plan: 4.1. assess and determine the space Division in the following areas of purity: 4.1.1. increased clean area (including an operation room, intensive care, diagnostic and invasive medical procedure, patients with immune deficiency, burns the House of a patient, the Court House and care for newborn);
4.1.2. the usual purity area (including the patient waiting room, room or place of registration, patient recruitment, space (wardrobe, lounge), hallway, Court, rehabilitation of patients in the study, blood zobārs of the vanity Cabinet, Cabinet, Division of medical investigation, patient reception, clean dry warehouse and administration space);
4.1.3. the potentially contaminated area (including infectious patient wards, patient or employee shower room, toilet room accessories, cleaning, septic, Operations Division microbiological laboratory work space in the laundry room, waste collection room, laundry, autopsy room and the room of the dead human body for storage);
4.2. the manager shall inform the institutions, organise and coordinate the epidemiological investigation measures, if pretepidēmij found nozokomiāl infectious disease block (two cases) and in other emergency situations;
4.3. arrange stacked cases (two cases) and at least the following particularly dangerous bacteria who induced infectious nozokomiāl registration authority: 4.3.1. resistant Methicillin Staphylococcus aureus (MRSA);
4.3.2. against vancomycin resistant Staphylococcus aureus (BRING);
4.3.3. with reduced susceptibility to penicillin of Streptococcus pneumoniae;
4.3.4. against Vancomycin Enterococcus resistant (VRE);
4.3.5. Clostridium difficile induced infectious diseases;
4.3.6. karbapenēm of Actinobacteri are resistant against Bauman;
4.3.7. amikacīn resistant to Pseudomonas aeruginosa;
4.4. analyse the causes of infectious nozokomiāl and risk factors, as well as develop proposals nozokomiāl the infection risk factor prevention or provide proposals to the authorities the Authority's head of development of the plan;
4.5. before new health care services or medical equipment purchasing specification development look with the authorities, if necessary, make proposals for amendments to the plan of the authority, as well as proposals for the authorities to managers for selection of medical equipment and modernisation;
4.6 organise staff in the education of the nozokomiāl infection prevention (employee training, entering, and at least every three years, in accordance with the authorities of training the driver approved training plan).
5. the staff of the institution is responsible for the personal care and institutions plan requirements.
II. the area of the premises and territory of the authority and 6 rooms, including holding and treatment area, plan, deploy, and maintain equipment, provide an efficient areas and room cleaning horse, as well as space, equipment and medical devices to limit pollution.
7. clean rooms in accordance with the Authority's plan. Authorities plan in accordance with the provisions referred to in paragraph 4.1 of the purity of the zones is determined the frequency of cleaning, washing and disinfection measures, as well as the work of the artist.
8. for each purity is only intended for zone cleaning accessories. It is marked to show the use of the premises (rooms) or in the corresponding area of purity.
9. If the Authority (except for specialized infectious disease authority) infectious patients isolated in a separate room (except in the case of strict isolation mode), this room clean with appropriate marked only the space provided for cleaning accessories. Cleaning supplies should be kept separate.
10. washing, cleaning and disinfection products used in accordance with the manufacturer's instructions for use provided.
III. Requirements for the processing of employee hand 11. Hand cleanliness, hand washing provide or disinfection of the hands or performing surgical disinfection, according to the manipulation (procedure) and in accordance with the Authority's plan includes hand processing of the relevant methodology. Hand processing methodology is available to each employee.
12. Hand wash: 12.1. starting and ending labor day;
12.2. If hands are visibly dirty;
12.3. the physiological needs;
12.4. before distribution of food and eating;
12.5. before distribution of the medicinal product;
12.6. If the specific situation of doubt about the purity of arms.
13. Hand disinfection: 13.1. by direct contact with the patient;
13.2. If is possible the transmission of the infectious agent patient one part of the body to another;
13.3. before an invasive surgical procedures;
8.3. by contact with biological fluids, separation and possible jam contaminated medical devices and equipment;
13.5. before and after the use of gloves;
13.6. before and after non-sterile procedures (manipulation) (including dressing change);
8.5. before patient care.
14. Hand surgical disinfection carried out before surgical procedures (manipulation).
IV. Requirements for use of gloves is not a clean sterile 15. use gloves once used when: 15.1. staff shall hand in contact with the patient's mucous membranes: 15.1.1., damaged skin, blood and biological fluids, as well as potentially infectious patient isolation (including saliva, pus, sputum, faeces and skin damage su sed in the EC);
15.1.2. with the equipment and medical devices that are contaminated or potentially contaminated with blood, biological fluids and separation;
15.2. the employee has skin lesions on the hands;
15.3. the employee must take blood (including blood sample).
16. Once you use sterile gloves used by making a fist of surgical proc (manipulation) and working with sterile equipment and medical devices.
17. Gloves change: 17.1. after each patient's care (if required, multiple times on the same patient care);
17.2. If the glove is corrupted;
17.3. before touching clean surfaces, where it is suspected that the gloves are contaminated.
18. Between sturdy neoprene rubber and butyl gloves you use many times used: 18.1. cleaning the room;
18.2. washing equipment and medical devices, instruments, and patient care items;
18.3. collecting and transport (transport) waste and dirty laundry.
V. equipment requirements and medical equipment for cleaning, disinfecting and sterilizing 19. Equipment and medical device with a low risk of contamination, which may come into contact with intact skin (intact), clean (wash) and, if necessary, disinfected.

20. Equipment and medical device, with an average risk of contamination or of equipment and medical devices which come into contact with the mucous membranes or broken skin (e.g., inhaler, nasal and the flexible mirrors an endoscope), disinfected manually or using automatic washing – dez. infection
21. Equipment and medical device with a high risk of contamination, the use of which comes into contact with the internal (for IE sterile) body tissues, organs and cavities, as well as blood and injection solutions (such as cardiovascular and bladder catheter, biopsy instruments, acupuncture and neurological test needles), sterilized.
22. Medical devices are used in accordance with the manufacturer's instructions for use provided.
23. employees, performing sterilization, ensure to avoid the sterile and sterile object of contact (one direction principle "no way back"). The sterilization process is separated from the cleaning process or space.
24. Sterilizing packaged medical devices are designed for a single procedure. Medical devices packaged so that after sterilization it can freely remove from sterilizers.
25. The person in charge of disinfection and sterilization of sterilized packed before the sterilization of medical devices the labelling shall provide information on: 25.1. the contents of the package, if the package is transparent;
25.2. the ability to track the process of sterilization quality in schools after the medic sterile devices use: 25.2.1. sterilization in place, if the medical device is sent to another institution;
25.2.2. sterilization facility number;
25.2.3. sterilization cycle, if the institution uses multiple methods of sterilization;
25.2.4. cycle number (if multiple cycles);
25.2.5. date of sterilization;
25.2.6. sterile medical device expiration date determined in accordance with the provisions of this annex;
25.3. indicator, which shows that the package has been sterilized.
26. the person responsible for the disinfection and sterilization provides sterile sation process equipment and sterilization and sterilization cycle validation in physical size: 26.1. after sterilization equipment installation;
26.2. at least once a year;
26.3. after repair or maintenance of the equipment associated with the equipment change parameters that affect the sterilization process and quality.
27. the effectiveness of Sterilizers routinely (daily) by means of physical, chemical, physical and biological methods, applying appropriate indicators or autonomous class cycle parameter controls.
28. Sterilization facility that does not have automatic sterilization cycle notation, the sterilization process and control document indicating sterilisation of equipment, number of the sterilization cycle the way the cycle number (if multiple cycles), physical parameters at the beginning and end of sterilization, sterilization and the total duration of the cycle time.
29. Sterile medical device stores to ensure sterility until use of start. When you open the packaging, the storage time expires. If the packaging is damaged, damp or it falls to the floor, the medical device is considered not sterile.
30. Sterile medical device storage space (closet or rack) is lockable and is located close to the place of use. Sterile medical device storage in direct sunlight or in close proximity to avoid is prohibited.
Vi. Claim of laundry and bed accessories 31. Institution used easily washable and durable in use, avoid the use of laundry that needs dry chemical or other special cleaning. Prevents dry, keeping pollution and transport, as well as dirty laundry, additional contamination during washing and disinfection.
32. Medical couches are pulled with waterproof and bējoš adsor material. This material is easily washable and resistant to washing and disinfecting of means of exposure. Medical couches disinfected after each of their contamination with biological materials and the care of each patient. The medical couch, you can set the disposable drapes and can change after each patient's care.
33. The Authority used the bed mattresses and cushions that are passed with a waterproof material covers and washed, sanitized and dry.
34. after each patient's discharge or transfer mattresses and cushions that are not passed to the quilt with waterproof material, as well as blankets disinfected dez infection in the camera or in disinfected and washed laundry, using technology that provides disinfection.
35. the laundry washed at the laundromat or outside authorities. Wash your laundry is: 21.8. barrier type, or two or flow type tunnel washing machines, which are washing and disinfecting the required parameters and the technology that supports automatic disinfection (temperature, detergent-disinfectant dosing and exposure). The laundry is separate dirty and clean linen;
35.2. documentary proof that at least once a year check washing and disinfecting washing machine required parameters.
36. If the institution laundry service is provided in another legal person, the authority shall be responsible for the washing in compliance with this provision in paragraph 35.
VII. Claim of waste operations 37. Waste collected, sorted, moved (transported), stored, as well as processed and processed in accordance with the laws and regulations in the field of waste management.
38. Garbage collecting (graded) of adequate size and properly highlighted waste collection once used for bags or tanks. Sharp objects German dūrienizturīgo containers.
VIII. Infectious patient admissions, placement and care of Infectious patients, 39. If it is possible for another patient or staff infection with infectious diseases and environmental pollution, after taking an institution inserts (insulated) single Chamber and his care and treatment organised in such a way as to prevent environmental pollution, as well as other patients and staff infection.
40. If infectious patients is not possible to insert a (isolate) a single Chamber, the treating physician in consultation with the responsible person for the premises of the Authority's plan for the adaptation of the isolation of infectious patients, evaluating deployment option, part of the Court to hand washbasin. The patient, who is infected with the aerogēn way the distributable infectious disease must be isolated in a separate room or, if this is not possible, transferred to a specialised institution of infectious diseases.
41. If the patient is infectious in the same ward with other patients, the treating physician informed patients, employees and visitors to the blind pretepidēmij in general the measures the spread of infectious diseases.
42. Infekciozo patient, infected with the same infectious disease agent, placed in one room, if not this communicable disease causes repeated infections and if any of the patients are not infected with other contagious (contagious) diseases. If there is a case for the block (two cases), infekciozo patients compulsorily placed in a separate room.
43. If infectious patients need to move (to transport), infectious patient and staff provide with appropriate personal protective equipment, as well as with the disinfectant solution for hand and potentially contaminated surface treatment.
IX. Isolation mode 44. Isolation mode aerogēn way the distributable infectious disease ever mo is as follows: 44.1. infectious patient inserts a single chamber where the air pressure is lower than in the other rooms, and air exchange at least 6-12 times per hour. The air output of the Court outside the premises of the authority through the type of suction ventilation. If the patient is isolated bacteria, who is draining the ventilation system in case of a high degree of purification filters;
44.2. restrict TRANS portēšan infectious patient and movements, (except medical and epidemiological indications in the case) to ensure appropriate precautions;
44.3. when entering the room to the infectious patients, staff and visitors to use the appropriate respirator.
45. the isolation mode drop distributable in the form of cases of communicable diseases is as follows: 45.1. infectious patient inserts a single Chamber. If it is not possible to provide a separate Chamber, the infectious patient bed placed at least two feet away from another patient beds and separated with a screen;
45.2. If there is a risk of contamination, the employee uses a face mask;
45.3. restrict TRANS portēšan infectious patient and movement (except for medical or epidemiological indications), with adequate precautions.
46. the isolation mode contact distributable infectious disease cases is as follows: 46.1. infectious patient inserts a single Chamber, providing it with a dressing room. If it is not possible to provide a separate Ward, assess the ability of the other Chamber isolation;
46.2. the infectious patient in the Ward staff disinfect their hands and put on gloves. Before exiting the House employee takes off the gloves and discarded medical waste tank. Hands disinfected;
46.3. If, the infectious patient tending, an employee has been in contact with infected separation (including feces, wound separation), change of gloves;

46.4. restrict TRANS portēšan infectious patient and movement (except medical and epidemiological indications in the case) to ensure appropriate precautions to be taken in the presence of the person for treatment;
46.5. the infectious patient medical devices (including stethoscope, tonometr) used only in a particular patient care and keep the patient on the ward;
46.6. If it is possible to direct the employee's clothing contact with infectious patients, or contaminated objects, employee pulled coveralls (apron). Before exiting the Court's employee vest (apron) takes off and discarded medical waste tank. Hands washed and disinfected;
29.0 in court. the equipment, medical devices and patient personal things that cannot be disinfected, discarded medical waste tank.
X. closing issues These provisions, 3.1.8., 4.3, 4.4 and 4.6 above and referred to in chapters VIII and IX requirements apply to specialized hospitals and centers.
48. This rule 3.1., 3.2., 3.3., 4.4 and 4.5., 5., 7., and 40, paragraph requirements for institutions plan and responsible parties for the Authority's plan to enter into force by 1 July 2007.
49. That rule 26 requirements referred to in paragraph shall enter into force on July 1, 2008.
50. This rule 44.1. the requirements referred to in subparagraph concerning the Court's pressure and exchange of air, ventilation and ventilation system refers to specialized hospitals and centers, with patients with tuberculosis who are health care, and shall enter into force on July 1, 2008.
Prime Minister a. Halloween Health Minister g. Smith Editorial Note: rules shall enter into force on July 15, 2006.
Annex to the Cabinet of Ministers of 11 July 2006, the Regulation No 574 Sterile medical devices for the determination of the term of validity at the point of Packaging methods i. outer layer material (points) 1.
Tissue paper (one sheet) 20 2.
Tripling of non-woven material (one sheet) 40 3.
Medical paper bag 40 4.
Paper-plastic bag 80 5.
Tyvek packaging 100 6.
Container (with the filter, without the double cover, with the inner packaging) 160 7.
Container (with the filter lid or cover with double valve system with inner packaging) 400 II. Packaging materials internal sequence (points) 1.
Fabric 20 2.
Tissue paper (one sheet) 60 3.
Tripling of non-woven material (one sheet) 80 4.
Medical paper bag 80 5.
Paper-plastic bag 100 6.
Tyvek packaging 120 III. Additional packaging into sterile barrier protection (points) 1.
3 anti-dust Pack 400 2.
Closed container (non-sterile) 250 3.
Boxes for transport to a hospital in the territory 250 4.
Container for transportation outside the hospital area 750 IV. Storage method (points) 1.
Table dressings in 0 Chapter 2.
Transport cart 0 3.
The open shelf or table 0 4.
Closet, drawer, shelf 100 v. closed storage sites (points) 1.
Court 0 2.
The procedure room 50 3.
Medical supply warehouse in chapter 75 4.
Sterile material inventory (ventilation system through which air is not bactericidal filter) 100 5.
Sterile material inventory (ventilation system through which air is bactericidal filters) 300 VI. Number of points and the corresponding expiration date 1.
1-25 24 hours 2.
26-50 7 nights 3.
51-100 1 month 4.
101-200 2 months 5.
201-300 3 months 6.
301-400 6 months 7.
401-600 1 year 8.
601-750 2 years 9.
> 750 5 years VII. Calculation example no PO box

Points expiration date 1.
2 x in the crepe paper packaging in a closet in the room procedure 1.1.
tissue paper packaging (outer layer) 20 1.2.
tissue paper packaging (inner layer) 60 1.3.
closet 100 1.4.
the procedure room 50 total 230 3 months 2.
Tissue paper (internal), non-woven material (outer layer) of the operation sterile packaging material warehouse shelf 2.1.
tissue paper packaging (outer layer) 20 2.2.
tripling of non-woven material (inner layer) 80 2.3.
the open shelf 0 2.4.
surgical operation of sterile materials block warehouse 100 total 200 2 months 3.
In summary the paper-plastic packaging procedure room on table 3.1 dressings.
paper-plastic bag 80 3.2.
table dressings in 0 Chapter 3.3.
the procedure room 50 total 130 2 months Health Minister g. Smith