Cabinet of Ministers Regulations No. 104 in 2016 (16 February. 8. § 21) 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. determines the hygienic and pretepidēmisk in the treatment of essential requirements in order to prevent the spread of infectious diseases. 2. the essential requirements shall be determined in accordance with the precautionary principle that any patient can be the agent of the carrier of infectious diseases and its organs, tissues, biological fluids and separation directly or indirectly disseminate live infectious disease pathogens in the environment, which may have been contaminated. 3. This provision 4.2, 4.7, 4.8, 6.8, 6.9, 7.4, 7.5, 7.6, and in chapter VI the requirements apply only to the fixed medical institutions. 4. On the origin of infectious diseases, and curbing the spread of medical institution is responsible for the hospital's Manager. Treatment Services Manager: 4.1 supports the hospital's hygiene and pretepidēmisk treatment plan (hereinafter referred to as the hospital's plan) the development and implementation of compliance with these rules, having regard to the hospital's operations and services; 4.2. multi purpose hospital or University Hospital creates an infectious disease control team (hereinafter referred to as the control command), which is responsible for the implementation of the plan of treatment institutions and internal control and which is made up of one doctor for every 500 beds and one nurse for every 250 beds, but not less than one doctor and one nurse of the medical institution; 4.3. other medical institutions designated for the implementation of the plan of treatment institutions and internal control of a responsible person (hereinafter person responsible); 4.4. provides administrative support and cooperation between the control command or the person in charge, the hospital's management and departments; 4.5. designate the person responsible for the processing of medical devices, according to the hospital's plan to organise the processing of medical devices (including the fixed processing of medical devices control parameters, tests or indicators in accordance with new science-based recommendations, as well as sterile medical devices the term of validity in accordance with the provisions of annex 1) and, if necessary, arrange the storage of medical equipment; 4.6. ensure that developed and, if necessary, updated in invasive procedures and medical devices description of postrelease treatment methods, as well as ensure their availability for work; 4.7. provide means of monitoring, antimicrobials to promote the rational use of antimicrobials; 4.8. the procedure for screening examination for the count who host identification; 4.9. the contract of employment, job description or treatment services manager determines the order of the employee's obligation to comply with treatment plans; 4.10. provides treatment services a territory and space planning, installation and maintenance so as to effectively manage patient flow, restricted areas, space, equipment and medical equipment contamination and facilitate cleaning. 5. Patient health care medical institution organized in such a way as to timely identify patients with infectious diseases features distinguish infekciozo patients from non-infectious ones, prevent patients, employees and visitors to the contamination, as well as the pollution of the environment. 6. Treatment Plan include the following: 6.1. space-separated zones of purity, cleaning frequency and sequence, and disinfecting used features, cleaning supplies, storage and labelling of washing; 6.2. employee and visitor hand treatment (a description of the method); 6.3. requirements for employees (including clothing, arms, jewellery use, etc.), taking into account the duty. 6.4. use appropriate personal protection equipment for the hospital's head of fixed procedure or pretepidēmij you want to measure; 6.5. hospital's processing of medical devices according to their rank at the possible risk of contamination and the processing stages in accordance with the provisions of annex 2, as well as documentation of the treatment process and medical devices (including sterile); 6.6. dry grading, marking and dry; 6.7. the waste management; 6.8. the patient's healthcare associated infection epidemiological surveillance procedures physicians ' Office, including the necessary epidemiological data collection and analysis; 4.3. actions and information flow (schema) medical institution, if a patient is diagnosed with health care associated infections disease or there is reasonable suspicion of professional infected with infectious diseases related to health care, including an infectious disease agent who wear; 6.10. the risk of contamination with vakcīnregulējam and communicable diseases, risk assessment and specific prevention measures; 6.11. action in cases where the hospital's employee found the infectious disease, which leads to the risk of infection and patient; 6.12. the hospital's plan for implementing internal control assurance. 7. control team or responsible person: 7.1 determine the space Division in the following areas of purity: increased purity 7.1.1 zone (including the operations room, the intensive care ward, invasive diagnostic and therapeutic procedures, the Court in patients with immune deficiency, burn patients, the Court House and care for newborn room, medical device Assembly and packaging area, a sterile medical device storage space); 7.1.2. 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, the study of blood, dental office, a branch of the medical investigation, patient reception, clean dry warehouse and administration space); 7.1.3. the potentially contaminated area (including infectious patient wards, operation room, septic patient or employee shower room, toilet room accessories, cleaning, microbiological laboratory space, work space, laundry room, waste collection room, necropsy room and the dead man's body in a storage room, used for processing medical devices); 7.2. the arrangements in the hygienic and pretepidēmisk mode in the sensitive area of the purity of the premises; 7.3. If found with health care-related infectious disease outbreak (at least two epidemiologically linked cases): 7.3.1. inform the hospital's Manager; 7.3.2. organise the epidemiological inquiry; 7.3.3. coordinate pretepidēmij activities; 7.4. at least the following epidemiological significance of bacterial detection of cases of medical institution and on a quarterly basis (until the next quarter the first 15th date of the month) provide a Centre for disease prevention and control report on these bacteria records in accordance with the provisions of annex 3:7.4.1. Methicillin resistant Staphylococcus aureus (MRSA); 7.4.2. against vancomycin resistant Staphylococcus aureus (BRING); 7.4.3. against vancomycin resistant Enterococcus (VRE); 7.4.4. Clostridium difficile;

7.4.5. against Acinetobacter spp. resistant to karbapenēm/Acinetobacter baumanni; 7.4.6. a broad spectrum beta-laktamāz (Extended spectrum beta-Lactamase (ESBL)), including the karbapenemāz, the gramnegatīv produced rods; 7.5. identifies and analyzes health-related infectious disease risk factors, as well as develop proposals on what to do; 7.6. If, when taking a patient to the medical institution, there is a reasonable suspicion of professional patient infected with the bacterial epidemiological significance for infectious diseases or previous medical institution or social care institution, shall notify the appropriate hospital or social care institution; 7.7. before new health care services or medical equipment acquisition, which assesses the health and pretepidēmij measures required to take the medical institution, and provide information to treatment services manager; 7.8. organized employee education about treatment plan requirements and pretepidēmij measures, as well as a new infectious disease epidemiological significance of spreading pathogens and risk factors of other current events by health care-related infectious disease prevention and control and on changes in external and internal regulations; 7.9. inform employees if happened with health care related infectious disease outbreaks, as well as the prevalence of risk factors, the necessary pretepidēmij measures and epidemiological surveillance. 8. Cleaning and disinfecting use tools and cleaning supplies prepared and used according to the manufacturer's instructions for use or the prescribed methods. 9. the Centre for disease prevention and control in collaboration with the health authorities in the development of medical inspections in hygienic and pretepidēmisk mode of landing. Landing is available on the Centre for disease prevention and control and health inspection tīmekļvietn. Landing is updated according to the latest scientific insights and examples of good practice.
II. requirements for the processing of employee hand Hands 10 uses the following methods: 10.1. hand washing with SOAP and water; 10.2. hand disinfection with alcohol-free resort; 10.3. surgical disinfection of the hands. 11. Hand processing provides the following cases: 11.1. before and after direct contact with the patient; 11.2. before clean, invasive or surgical procedures regardless of the use of gloves; 11.3. before cleaning and disinfecting medical device Assembly, packing or use; 11.4. before food distribution; 11.5. before distribution of the medicinal product; 11.6. after contact with a patient's biological fluids, separation and contaminated medical devices; 7.3. after use of gloves; 7.3. after contact with a patient's environment (equipment and personal things); 7.4. If hands are visibly dirty; 11.10. in cases where the patient was treated, move from contaminated body parts to clean the body part. 12. Hand disinfection with alcohol-optional feature provides the procedures to be conducted before the aseptic (including wound pārsiešan, catheter care) regardless of glove use. 13. surgical disinfection hands necessarily ensure before surgical procedures. 14. At hand washbasin is liquid soap and disposable paper towels. Normal and potentially contaminated area of purity levels of electric hand dryer.
III. 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, gastrointestinal contents, sputum and exudation of skin damage); 15.1.2. with 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 performs the sampling of blood manipulation. 16. many times the most Hardy or non-sterile gloves to use gloves once used: 16.1. washing and cleaning and medical device surfaces (such as floors, walls, furniture); 16.2. collecting and transport (transport) waste and dirty laundry. 17. Once you use of Sterile gloves used in performing the procedure, during which the need to comply with the sterility, or by the actions of sterile medical devices. 18. Gloves change: 18.1. after each patient's care (if required, multiple times on the same patient care); 18.2. If glove is corrupted; 18.3. before touching clean or sterile surfaces if gloves are contaminated or suspected of it.
IV. Requirements for medical device sterilization, storage and processing of 19. Medical devices are carried out in accordance with the manufacturer's requirements for medical devices to the instructions for use and the rules referred to in annex 2 of the processing stages. 20. The medical establishment ensure that avoid the sterile and sterile medical devices contact (one direction principle "no way back"). The sterilization process is separated from the cleaning process. 21. Medium potential risk of contamination of medical devices and hollow high risk of contamination of medical devices in the group stages of document processing, ensuring the traceability of the processing stage. Processing stages performed manually or with a cleaning and disinfecting equipment, which is not the parameter notation, document, indicating the stage of processing, the equipment number (if there are multiple installations), start and end time, and take notes on the treatment of the relevant criteria: 21.1. the active substance and the concentration of the active substance; 21.2. the temperature; 21.3. the exposure time. 22. Sterilization of high infection risk groups packed medical device sterilization packaging in line so that after sterilization it is not kontaminēj to be freely removed from sterilizers. Set in the same package, the one medical device manipulation or operation.
23. Medical Device marking the unit supports the process of sterilization quality traceability on a sterile medical device use, and it contains at least the following information: 23.1. the contents of the package or the package name (number or other medical institution accepted), if the packaging is not transparent; 23.2. sterilization, if the medical device is sent to another hospital; 23.3. sterilization equipment number if the medical establishment uses several sterilization equipment; 23.4. sterilization method, if the medical establishment uses several methods of sterilization; 14.6. the cycle number, if medical institution uses multiple cycles of sterilization in one day; 14.7. sterile medical device expiration date determined in accordance with the provisions of annex 1; 23.7. indicator, which shows that the package has been sterilized. 24. Sterile medical device stores in accordance with the treatment plan requirements, ensuring that they are not stored in direct sunlight or housed nearby. 25. The Person responsible for the processing of medical devices, sterilization equipment supports: 25.1. after sterilization equipment installation; 15.7. after sterilization equipment for repair or maintenance that is associated with the equipment change parameters that affect the sterilization process and quality; 25.3. organizing the sterilization equipment effectiveness check (every day in each cycle) with the physical, chemical, physical or biological methods, applying appropriate indicators of class simulation process or cycle parameter autonomous control.
V. requirements for laundry and bed accessories 26. Medical establishment prevents dry contamination of storage, transport, cleaning and disinfecting. 27. Medical couch (including infant rewind tables, gynecological Chair, dental chair) before each patient health care cover with disposable drapes or disinfected. If medical squab is contaminated with a patient's biological fluids or isolation, it cleaned and disinfected. 28. The patient bed mattress and pillow is covered over with waterproof material covers that you wash or disinfect after each patient's discharge or transfer. 29. After the patient's discharge or transfer blanket disinfection Chamber or in disinfected, sanitized and washed laundry, using technology that provides disinfection. 30. Laundry wash laundry in a medical institution or outside the hospital. The laundry's washing machines, which are washing and disinfecting the required parameters and the technology that supports automatic disinfection (temperature, detergent and disinfectant dosage and exposure). The laundry is separate dirty and clean laundry. 31. If the medical establishment to provide laundry service, another person, the hospital's Manager is responsible for washing in compliance with this provision in paragraph 30.
Vi. Action in case of infectious diseases

32. If patient has found infectious disease or its agent that spreads in the air drop aerogēn or contact, or are having a professional a reasonable suspicion that the person is infected with it (hereinafter referred to as infectious patients), the treating doctor: 32.1. inform the patient, other infectious at the same court on patients, staff and visitors about the risk of infection and pretepidēmij measures of the spread of communicable diseases; 32.2. take measures to ensure the isolation mode, according to the infectious diseases spreading way in accordance with the provisions of annex 4.
33. Infekciozo patient with the same infectious diseases cause, if not by this infectious disease sick again, allowed to put one in the Chamber. Infectious patients with control group command, or responsible person. 34. Infectious patients forbidden to insert in one ward with patients who have an increased risk of infection, including patients with immune deficiency, patients with wounds and patients, which is expected in the long-term treatment of the fixed medical institution.
VII. Closing questions 35. Be declared unenforceable in the Cabinet of Ministers of 11 July 2006, Regulation No 574 "rules on hygiene and pretepidēmisk in essential medical institution" (Latvian journal, 2006, 111. no; 2009, no. 189). 36. the hospital's hygiene and pretepidēmisk in the plan in accordance with these rules developed by 2016 July 1. 37. This provision, section 4.2 shall enter into force on January 1, 2018. To create the control commands the medical establishment shall designate a responsible person. 38. the provisions of This annex relating to paragraph 3.1 of the saturated steam sterilization (autoklavēšan) the practice of dentistry shall enter into force on January 1, 2018. Prime Minister Māris kučinskis Health Minister Guntis Belēvič annex 1 Cabinet 2016 16. Regulation No. 104 of February Sterile medical devices for the determination of the period of validity of a points method i. outer layer of packaging 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 transportation authorities in the territory 250 4. Container for transportation outside the authority of the territory of 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. p. k.   Points expiration date 1. The tissue paper packaging 2 x oven procedure room: 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 (outer layer), non-woven material (internal) packaging operation sterile 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 the table dressings: 3.1. paper-plastic bag 80 3.2. table dressings in 0 Chapter 3.3. the procedure room 50 total 130 2 months Health Minister Lynne Belēvič annex 2 Cabinet 2016 16. Regulation No. 104 of February the medical devices Division for possible infection risk and the processing stages of no. p. k. A group of medical devices medical devices the potential risk of contamination for the processing of medical devices phase 1. Low risk of contamination – medical devices with a low risk of contamination by possible contact with the whole (intact) patient's skin 1. cleaning (washing) 2.2 Disinfection. Medium contamination risk group: 2.1. not hollow medical devices with moderate potential risk of infection to contact with mucous membranes and skin, damaged or contaminated 1. Pre-treatment 2. cleaning (washing) 3. Disinfection * Sterilization 4.2.2. the hollow of the medical device with medium potential risk of infection to contact with mucous membranes and skin, damaged or contaminated 1. Pre-treatment 2. cleaning (washing) 3. Disinfection Sterilization 4 3. High infection risk groups: 3.1. not hollow and hollow medical devices with a high potential risk of contamination enters the subcutaneous tissue, Mucosa, in contact with blood or other body fluids 1. Pre-treatment 2. cleaning (washing) 3. Disinfecting 4. Packaging and labelling 5. Sterilization of saturated water vapor (autoklavēšan) 3.2. medical devices which are not sterilisable saturated water vapour (not autoklavējam), with a high potential risk of contamination enters the subcutaneous tissue, Mucosa, in contact with blood or other body fluids 1. Pre-treatment 2. automated cleaning 3. Automated disinfection 4. Packaging and labelling 5. Sterilization note. * If necessary. Health Minister Guntis Belēvič annex 3 Cabinet 2016 16. Regulation No. 104 of February epidemiological significance of bacterial form of stationary medical institutions institution name code reference period (year) (quarter) the total number of patients with a first in the isolated bacteria including. intensive care of t. see sick newborn chapter including the sample screening study of Methicillin resistant (MRSA) Staphylococcusaure Against vancomycin-resistant Staphylococcus aureus (BRING) against vancomycin resistant Enterococcus (VRE) Clostridium difficile Against Acinetobacter spp. resistant to karbapenēm/Acinetobacter a wide spectrum but baumanni-laktamāz (ESBL), karbapenemāz, gramnegatīv of rods produced other ____ _____ together notes. 1. the first positive sample. 2. High risk group of patients.
          (position)   (name, surname)   (phone number) 20 __. year. ____ ____ ____ ____ ___ signature _____ _____ _____ _____ Health Minister Guntis Belēvič in annex 4 of the Cabinet of Ministers of February 2016 16. Regulations No 104 requirements to ensure the isolation mode, if the patient is found aerogēn in the air drop or contact the way distributed infectious disease or its agents or are having a professional a reasonable suspicion that the person is infected with it to

Nr. p. k. The name of the claim to isolation mode measures the aerogēn distributed infectious disease case air drop towards distributed infectious disease case contact the way distributed infectious diseases 1. Requirements for infectious patient isolation and the isolation of infectious patients Chamber into the isolation ward (if possible, providing a lower air pressure than other premises and air exchange in at least 12 times per hour). Isolation Chamber provides air disinfection with ultraviolet bactericidal screened the lamp of infectious patients in isolation wards in place or (in conjunction with a command or control on the hospital's plan responsible person), the Court outlined the screen the patient's bed, and with at least two metres between patient beds infectious patient inserts the isolation ward or (in conjunction with a command or control on the hospital's plan responsible person) room by providing at least one meter distance between patient beds. Infectious patient who has intestinal upsets, with accelerated bowel emptying, inserts in court room 2. Requirements to the employee the employee uses the appropriate size respirator with high-efficiency filters against biological agents (FFP2 or FFP3 (N99) (N95)) an employee in the Court or the patient isolation of isolation of the area once used gown dress (pinafore), disinfect their hands and put on gloves. A staff before leaving the House or isolation of isolation zones takes off gloves, overalls (apron) and removes infectious waste container. Disinfect their hands. The employee uses the mask to the isolation ward Staff or patient isolation zone pulls on coveralls used once (apron), disinfect their hands and put on gloves. A staff before leaving the House or isolation of isolation zones takes off gloves, overalls (apron) and removes infectious waste container. Disinfected hands. Treatment plan used in the cases specified in the mask 3. Requirements for visitors Visitors will use the appropriate size respirator with high-efficiency filters against biological agents (FFP2 or FFP3 (N99) (N95)) visitor use visitor mask healing authority in the cases specified in the plan uses the mask 4. Requirements for transporting infectious patient Infectious patient, if it is necessary to move the (transport), use a mask. The employee to move the (transport) infectious patients, use respiratory infectious patient, if it is necessary to move the (transport), use a mask. The employee before the patient transport infectious imposes or changes the mask and disinfect their hands Infectious patient, if it is necessary to move the (transport), cover the infected or potentially infected part of the body. The employee before the patient transport infectious imposes or changes the mask when you need to use it, and disinfect their hands 5. Requirements for medical devices, storage and processing, medical devices (including stethoscope, tonometr) with low potential risk of contamination use only infectious patient and kept in isolation ward or isolation area. Other patients before use the sanitized. Medical devices that cannot be disinfected, discarded as infectious waste medical devices (including stethoscope, tonometr) with low potential risk of contamination use only infectious patient and kept in isolation ward or isolation area. Other patients before use the sanitized. Medical devices that cannot be disinfected, discarded as infectious waste Health Minister Guntis Belēvič in