SANITARY-AND -ANTIEPIDEMIC REGIMEN OF MATERNUTY HOUSE
Sanitary-and-antiepidemic regimen is the system of measures aimed at prevention of mothers and their childrem contamination.
Sanitary-and-antiepidemic arrangements are regulated by Russion Federation Ministry of Public Health Order № 345 dated from 26.11.97. «Perfection of the measures on intrahospital infection prophylaxis in the obstetric hospital».
Intrahospital infection is any disease of infectious ethiology which affects a patient due to his staying at a hospital or his addressing for medical help as well as the illness of a medical employee due to his work at this hospital. The symptoms may appear before or after the patient is discharged from the hospital.
Intrahospital infection includes highly virulent straines as they cultivate passing through the organisms of newborns and mothers obtaining resistance to widely used antibiotics. Raising of intrahospital infections frequency can be explained by increased number of women and children in high-risk groups, dicreased organism resistancy poor material-and-technical basis of some hospitals.
System of admittance of medical personnel to job
1. Being taken to the job at an obstetrical hospital, the person should pass through the medical check which includes the examination of a theraputist, otolaryngologist, dentist, gynecologist and dermatovenerologist as well as some laboratory tests: fluorograhpy, blood analyses for HIV, lues, hepatitis B, smear from the genital tract.
2. Regular medical check takes place 2 times a year.
3. Daily admittance to job is carried out by specialist who has trained in dermatovenerological courses. This check inclides taking a temperature, examination of the skin and throat for pyo-inflammatory disease. The specialist bears the responsibility for the quality of the check and can be made answer for admittance to the job a someone with pyo-inflammatory or venerologic diseases.
Sanitary-and-antiepidemic regimen arragement
Microorganisms reside not only in human organism, on instruments and furniture but also on the walls of the building. That is why in some countries a maternity house removes in a new building every 10 years. Once a year the maternity house is closed for systematic desinfection with cleansing furniture and instruments, whitewashing and painting the walls to immure the infection in under the coat of paint and lime. Obstetric hospital can be also closed for epidemic cause in case of outbreak of in intrahospital infection. In the latter case the maternity house can be opened after getting negative bacteriological results with the permission of the Center of Sanitery-and-Epidemilolgical Supervision.
Rules of keeping of different departments of maternity house
Daily humid tyding up with cleansers is carried out in every department, once a day a desinfection solution should be used. After cleaning a quartz lamp should be switched on.
The question about to what department (physiologic or observation) the woman shoud be hospitalazed to demarkate health patients and patients with genital and extragenital infection.
In casualty ward the woman takes a shower, puts on a clean dress and shoes, gets a clean towel and a sanitary towel. She can use her own shoes and personal hygiene things.
If there are several prenatal wards and delivery rooms a cyclic regimen of there work takes place. One prenatal ward and corresponding delivery room operate for 3 days then they are closed for cleaning and the other rooms are opened.
Surfaces contaminated with biological liquids should desinfected in accordance with the regimen of viral hepatites prophilaxis.
To deliver a child a midwife prepares as for surgical operation. There are disposable complete set for delivery and a new-born skin preparation. Prevention of gonorrhea in newborns is conducted by means of 30% Albucide instillation into the eyes. A disposable cather is used to remove a musuc from the nose and mouth of a child.
It is advisable to begin a brest-feed during the first hour after delivery (if there is no contraindications). Early and permanent breast-feeding promotes to rapid bowel colonization with normal flora and getting a wide complex of non-specific factors of resistancy.
Joint stay of the mother and children in a ward has some advantages before separate one. It promotes to intrahospital infections morbidity, the intensity of hospital strain of microorganisms circulation, colonisation of different biotops of the child with mothers flora.
In the postnatal department the rooms are filled in cyclic regimen (one and the same room during 3 days) synchronously with the rooms in the nerwborn ward. When the puerperas are discharged the room is cleansed and prepared for the nexy filling.
The rooms are filled during 3 days synchronously with the rooms in the postnatal department.
In the rooms of joint stay the breast feeding is carried out by «request». No food for the child but human milk should be used except for medical-caised cases.
The children with infection manifestation must be removed from the hospital immediately.
To enter this department the staff should change the smosk and put on special shoes. There is a hang at the entrance with smocks and a box with shoes.
is conducted by the epidemiologist form the local Centre of State Sanitary-and-Epodeniologic Supervision. This contrile includes:
1) Revealing and registration of group intrahospital infections
The flash of intrahospital infecion of newborn and puerperas are 5 and more cases during 1 incubation period (maximal incubation period lasts 7 days) connected with one and the same surce of infecion and common ways of transmission.
Having registrated the flash the epidemiologist geives information to the maternity house which should be closed on epidemiologic cause.
2) Epidemiologic analysis – studing of the structure, frequency and dynamic of pyo-inflammatiry diseses.
3) Microbiological monitoring – studing of the intrahospotal infection ethiology, the hospital strain quality. This monitoring is conducted by the hospital laboratory once a month and by the Center – once a 3 months.
4) Revealing the risk groups among the mothers and children.
Indications for reception and moving women to observation department
1. Fever (body temperature 37,6 and higher without other clinic)
2. Duration of the perion between amniorrhea and birth of the child 24 hr and more.
3. Infectious pathology:
- inflammatory process in the kidney (pyelinephritis, cystitis, latent bacteriuria)
- inflammatiry diseases of an other localisation
- Skin diseases of infecional ethiology
- Infectional processes of generative passages
- Infections with high risk of pre-, intra- and postnatal contamination and high epidemiological danger of the staff contamination (HIV, syphilis, viral hepatitis B,C,D, gonorrhea)
- Infections with high risk of pre-, intra- and postnatal fetus contamination and less epidemiological danger for the staff (toxoplasmosis, lysteriosis, cytomegalia, genital herpes etc.)
- Tuberculosis (if there is no specialized maternity house)
- Prenatal fetus death
- Late abortion on medical or social indications
- Malignant tumors
- Congenital malformations of the fetus
- Labor out of the maternity house
- Women without medical documentation or non-examined during pregnancy
- body temperature 38 and higher (after thrice-repeated measuring every hour) in labor or in early puerperal period
- fever of unclear genesis (37,6 and higher) more than 24 hr
- postnatal inflammatory disease
- extragenital infectious diseases which doesn,t request moving to a specialized hospital
- moving of child to observation department