Basics of the basics. Prevention of nosocomial infections. Central sterilization department: structure, functions The senior nurse organizer of the central sterilization department supervises the employees of the centralized sterilization department, exercises direct control over the work of the central sterilization department staff and coordinates

Having studied the structure of management and distribution of responsibilities for infection control in matters of prevention of nosocomial infections in hospitals. I have highlighted the following for my work. Junior and mid-level medical staff are assigned a very important role - this is controller, executive, and organizational. Daily, thorough and strict compliance with the requirements of the sanitary-hygienic and anti-epidemic regime, in the course of performing their professional duties, forms the basis of the list of measures for the prevention of nosocomial infections.

There are many professional areas of activity for a nurse. The role of the nurse in each area will be discussed further.

Nurses are divided according to their work profile:

Chief nurse- specialist with higher education medical education, graduating from the Faculty of Higher Nursing Education medical university. She deals with issues of rational organization of labor, advanced training of middle and junior medical staff of the hospital and monitors their work.

Senior nurse-- assists the head of a hospital (polyclinic) department in administrative and economic matters, organizes and controls the work of ward nurses and junior medical staff.

Sister-hostess- an employee of a medical institution responsible for the condition, maintenance and storage of linen, inventory and equipment of the institution or its department; works under the guidance of a senior nurse.

Ward (guard) nurse - carries out medical appointments for patients in the wards assigned to her, monitors the condition of patients, provides care for them and organizes their meals.

Procedural nurse- carries out medical appointments ( intravenous injections and infusions), helps with manipulations that only a doctor has the right to perform, and takes blood from a vein for research.

Operating room nurse- helps the surgeon with surgical interventions, prepares surgical instruments, suture and dressing material, and linen for the operation.

Community nurse- assists the local doctor in the reception of patients living in his assigned area, carries out as prescribed by the doctor healing procedures at home and participates in preventive measures.

Nurse of a preschool and school institution -

(ophthalmologist, otorhinolaryngologist, neurologist, etc.).

The role of the chief nurse

The chief nurse develops an individual plan to improve the efficiency of disinfection and sterilization activities in the institution, taking into account all the characteristics of the organization.

The chief nurse begins the development of measures to improve the quality of disinfection and sterilization measures by developing a general idea of how each manipulation is performed aimed at preventing nosocomial infections, identifying “problem areas” and building algorithms for personnel activities.

Information related to the prevention of nosocomial infections from the annual plan compiled by the head nurse

Sanitary and anti-epidemic work:

Participation in meetings of the commission on the prevention of nosocomial infections

Monitoring the timeliness of preventive medical examinations by healthcare facility personnel

Quality control of disinfection measures in structural divisions and work of the central sterilization department

Monitoring the correct admission of patients for hospitalization

Monitoring compliance with the linen regime in the structural units of a healthcare institution

Monitoring the sanitary condition of the territory of a healthcare institution

With regard to the prevention of nosocomial infections, personnel manipulations are systematic (washing hands, cleaning instruments, choosing a disinfectant), which complicates the task of improving the quality of a specific manipulation, as well as consolidating the acquired knowledge and skills, since the staff loses attention to the procedure during routine duties, the accuracy of following the developed algorithms decreases, at the same time, with proper organization, the systematic implementation of manipulations for the prevention of nosocomial infections allows the whole process to be brought to automation.

The role of the head nurse

He is an assistant to the chief nurse in many ways, including in carrying out sanitary education work among employees among patients and visitors.

Ensures timely replenishment of the department with medical instruments, medicines, items for the care of premature babies and newborns, controls their distribution and consumption

Monitors the quality of sanitary treatment of all newly admitted children by nurses.

Monitors the staff’s compliance with the established daily regimen of the department and compliance with anti-epidemic measures.

Ensures and strictly controls compliance with the rules of asepsis and antisepsis by department staff, especially in treatment rooms, manipulation rooms, etc.

Monitors the sanitary and hygienic condition of the department premises.

Monitors the implementation of the principles of the medical and protective regime.

The role of the hostess sister

Providing conditions for carrying out disinfection and sterilization measures (staff time, material and technical equipment, etc.) is the basis of the processor approach, because the initial lack of conditions for the implementation of preventive measures already suggests poor-quality prevention of nosocomial infections.

Job responsibilities related to the prevention of nosocomial infections:

Supervises the work of nurses and cleaners in keeping the premises of a healthcare institution (unit) clean and tidy, provides the serviced unit with household equipment, special clothing, hygiene items, stationery, detergents, bed and underwear for patients.

Complies with internal regulations, fire and safety regulations, and sanitary and epidemiological regulations.

The role of the guard (ward nurse

An integral part of the work of a guard nurse, which takes up a significant part of the time, is the layout and distribution of medicines. The use of a medicine case ("Tablet box-KRONT") will help improve the sanitary and epidemiological regime in the department and improve the culture of patient care.

Job responsibilities related to the prevention of nosocomial infections:

Provides sanitary and hygienic services to the physically weakened and seriously ill (washes, feeds, gives drinks, washes the mouth, eyes, ears, etc. as needed).

Receives and places patients in the ward, checks the quality of sanitary treatment of newly admitted patients.

If signs of an infectious disease are detected in a patient, he immediately informs the attending physician, upon his orders, isolates the patient and immediately carries out ongoing disinfection.

Monitors the sanitary maintenance of the wards assigned to her, as well as the personal hygiene of patients (skin care, mouth care, cutting hair and nails), timely taking hygienic baths, changing underwear and bed linen, records the change of linen in the medical history.

The role of the procedural nurse

Gives injections (including intravenous), takes blood from a vein, puts in IVs. All these are very difficult procedures - they require high qualifications and impeccable skills.

Especially if a procedural nurse works in a hospital where there may be seriously ill patients.

Job responsibilities related to the prevention of nosocomial infections:

Ensures strict adherence to all rules of asepsis and antisepsis in the office during procedures.

Sterilizes instruments and materials in accordance with current instructions.

Timely draws up requirements for instruments, equipment, medicines and dressings and receives what is needed in the prescribed manner.

Ensures sanitary and hygienic maintenance of the treatment room.

The role of the operating room nurse

Assists the surgeon and is responsible for ensuring that the operating room is always ready for work. For sterilization, instruments are taken to the sterilization department. The nurse working there operates special equipment: steam, ultraviolet chambers, autoclaves, etc.

Job responsibilities related to the prevention of nosocomial infections:

Monitors compliance with the rules of asepsis and antisepsis by all personnel in the operating room.

At the end of the operation, collects the instruments and counts them; carries out appropriate processing of instruments.

Prepares linen, dressings and suture material, clothing, masks, instruments and devices for sterilization; controls the quality of sterilization.

Accepts and hands over duty in the operating unit, checks the availability of sterile linen, materials, solutions, instruments, etc., necessary for duty, the serviceability of equipment, and the sanitary condition of the operating room. After the end of duty, he keeps a tally of the operating linen and materials used and what is left for the next shift.

The role of the community nurse

The work of a nurse in the department is not limited to procedures, manipulations and filling out documentation. One of the most important responsibilities of a nurse is conducting health education and outreach work among patients undergoing treatment in a hospital.

Organizes outpatient appointments with a local therapist.

-disinfection of the workplace, equipment,
-sterilization of instruments, preparation of disposable ones.

Ensures compliance with sanitary and hygienic conditions in the health care facility

- rules of asepsis and antiseptics,
- conditions for sterilization of instruments and materials,
-measures to prevent post-injection complications, serum hepatitis and AIDS in accordance with current regulatory documents.

The role of a nurse in a preschool and school institution

Medical workers in kindergartens and schools bear a huge responsibility for the health of children. Therefore, here the work of a nurse must be hyper-responsible. Preventive measures are practically the entire activity of a nurse.

Job responsibilities related to the prevention of nosocomial infections:

control of the sanitary and hygienic condition of the premises, including the catering unit;

immunoprophylaxis - preparation, conduct, evaluation of vaccination;

medical examination of children with chronic diseases;

conducting preventive medical examinations;

identifying sick and infected children, isolating them, informing parents, and, if necessary, transporting them to a medical facility;

analysis of the health status of children according to specified criteria.

Nurses working with specialist doctors to receive patients

Their role, in comparison with nurses working in inpatient hospitals, is no less important in the prevention of nosocomial infections.

There are quite a few narrow specialists and each of them has an assistant nurse. Job responsibilities differ slightly depending on the type of activity, but are similar in the rules of disinfection, sterilization, asepsis, and antiseptics.

Job responsibilities related to the prevention of nosocomial infections:

Creation of a protective treatment regime in the department;

Sterilization of medical instruments.

Participate in carrying out sanitary educational work among patients.

INFORMATION BLOCK

On the topic: “Sterilization and its role in the prevention of nosocomial infections”

Teacher: Natalya Mikhailovna Kruglova

Structure of the central sterilization department

The tasks of the central sterilization department (CSD) are to provide medical institutions with medical products and introduce modern methods of pre-sterilization cleaning and sterilization into practice.

Principles of placement and planning of CSO:

Isolation from other premises of the medical institution;

Functional zoning, that is, the purpose and placement of premises corresponds to the rational implementation of the technological process and does not violate the regime in the central processing center;

Zoning, that is, the division of all technological process premises into zones: sterile and non-sterile;

Threading with separate processing threads:

Ø linen and dressings;

Ø instruments, syringes, needles, thermolabile products;

Ø gloves in an isolated, impenetrable room.

Sterilization(from lat. sterilis - lat. sterilization) ensures the death of vegetative and spore forms of pathogenic and non-pathogenic organisms on sterilized products.

All products that come into contact with wound surface that come into contact with blood or injectable drugs, as well as medical instruments that, during operation, come into contact with the mucous membrane and can cause damage to it.

PHYSICAL STERILIZATION METHOD

Sterilization by air method (dry hot air)

Dry heat sterilization is carried out in air sterilizers, which operate on the principle of hot air circulation, with a fixed temperature conditions and the time required to complete the sterilization process.

Air sterilizer device:

The air sterilizer consists of a metal body (1) in which heating elements are located, a sterilization (working) chamber (2) with grid shelves (3) for placing sterilized objects on them, and a thermostat (4).
Air sterilizers can be horizontal, vertical, round, or rectangular in shape. Air sterilizers can be stationary or portable.

Sterilization rules

1. Products for sterilization are placed disassembled;

2. Large items should be placed on the top metal grill so that they do not obstruct the flow of hot air;

3. Sterilized products must be laid horizontally across the grooves of the cassettes and shelves, distributing them evenly;

4. Products should not touch each other

5. Be sure to place a sterility indicator in the sterilizer

6. It is advisable to carry out loading and unloading from air sterilizers at a temperature in the chamber of 40-50 °C.

Advantages The dry heat sterilization method is that when it is used, there is no corrosion of metals and instruments, glass surfaces are not damaged, and all objects are heated evenly.
Disadvantage of the dry heat method consists in a long cycle duration (2-4 hours depending on the volume of the sterilization chamber, the number of objects to be sterilized and the set temperature).

Chemical sterilization

Radiation method

The radiation method is necessary for sterilization of products made from thermolabile materials, biological (vaccines, serums) and medicines. The sterilizing agent is y (gamma) - and |3 (beta) - radiation.

GLOSSARY OF TERMS

Antiseptics- a set of therapeutic and preventive measures aimed at destroying microbes in a wound, other pathological formation or the body as a whole.

Asepsis- a system of measures aimed at preventing the introduction of infectious agents into the wound, tissues, organs, body cavities of the patient during surgical operations, dressings, endoscopy and other therapeutic and diagnostic procedures.

Bacteriostatic- the property of agents of a physical, chemical and biological nature to prevent the proliferation of bacteria and cause bacteriostasis.

Bactericidal- the property of agents of a physical, chemical and biological nature to cause the death of bacteria. "

Virucidity- the ability of a chemical substance or physical factor inactivate viruses.

Invasive procedures- manipulations in which the integrity of tissues, vessels, cavities is violated.

Infection control- a system of organizational, preventive and anti-epidemic measures aimed at preventing the occurrence and spread infectious diseases in a hospital, and based on the results of epidemiological diagnostics.

Controversy- a form of reproduction of some lower organisms, such as fungi; Some bacteria that are resistant to drying, high temperatures and chemicals take the form of spores.

Sterile field- a workspace free of microorganisms, containing only sterile objects.

Sterilants- chemical substances of various origins and composition, causing the death of all microorganisms, including bacterial spores

INFORMATION BLOCK

The central sterilization department for sterilization of instruments and autoclaving of dressings and linen was created on the basis of the mountains. Hospital No. 1 named after. N.I. Pirogov and began to function on April 1, 1995.

The CSC works taking into account the provision of sterile products to the entire medical institution.

The place of the CSC in the activities and structure of MMUGKB No. 1 named after. N.I. Pirogov is presented in Figure 7 of Appendix 2.

The central sterilization department includes the following departments:

1. Reception department

2. Washing compartment

3. Packaging department

4. Sterilization department

5. Expeditionary department

At the head of the work of the CSO MMUGKB No. 1 named after. N.I. Pirogov for the prevention of nosocomial infections is the deputy chief physician for work with nursing staff and the senior nurse of the department. The senior nurse is the organizer, executor and responsible controller of the correct actions of nursing staff. The prevention of occupational diseases among employees and the non-spread of nosocomial infections among patients depend on knowledge and practical skills, a conscientious attitude to work, and careful compliance with the requirements of the anti-epidemic regime by nurses.

The work of the head nurse of the center is regulated by the Regulations on the head nurse of the center, regulatory and organizational and methodological documents (Appendices 3-9).

The senior nurse of the central medical center reports directly to the deputy chief physician for work with nursing staff.

The senior nurse-organizer of the CSO supervises the employees of the centralized sterilization department, exercises direct control over the work of the CSO staff and coordinates the activities of the functional units of the CSO. In her work, the senior nurse organizer of the CSO is guided by:

a) the basics of labor legislation of the Russian Federation;

b) instructions, orders and guidelines of the Ministry of Health of the Russian Federation;

c) orders and instructions of regional health authorities;

d) instructions and orders of the Chief Physician of the hospital;

e) the work plan of the CSO;

f) job description;

g) hospital internal regulations;

h) safety and fire safety regulations.

Among the main documents regulating the activities of the CSO MMUGKB No. 1 named after. N.I. Pirogov are:

“Guidelines for epidemiological surveillance of nosocomial infections of the USSR Ministry of Health dated 09/02/87 No. 28-6/34.”

"About improvement medical care patients with purulent surgical diseases and strengthening measures to combat nosocomial infections.” Order of the USSR Ministry of Health dated July 31, 1978 No. 720.

“On measures to reduce morbidity viral hepatitis in the country". Order of the USSR Ministry of Health dated July 12, 1989 No. 408.

“On improving the work on identifying HIV-infected people, dispensary observation, organizing treatment of patients, preventing HIV infection in the Samara region” Order No. 16/9 of January 27, 2006.

The main functions of the senior nurse organizer of the quality management center medical services is:

a) provision of sterile materials and instruments to all departments of the hospital;

b) control over the correct storage and use of sterile materials and instruments in hospital departments;

c) ensuring the correct and effective use of medical equipment through its operation by qualified medical workers of the department and constant monitoring of the equipment by specialists;

d) equipping the central medical center with additional basic and auxiliary medical equipment and packaging materials to expand the scope of work of the central medical center and improve it;

e) training of personnel servicing the department’s equipment;

f) introduction of elements of information technology that contribute to increasing labor productivity;

j) control over the timely receipt of initially cleaned instruments and other equipment from hospital departments medical products and materials;

k) control over the quality of pre-sterilization treatment of medical instruments and products;

l) control over the quality of acquisition, packaging and sterilization of linen, dressings and instruments;

m) control over the issuance of sterile materials and medical instruments to medical institutions assigned for service to the central health care center;

o) control over the correct maintenance of accounting and reporting documentation;

o) annual preparation of vacation schedules for department employees;

The main task of the senior nurse-organizer of the CSO is to organize and manage all activities of the centralized sterilization room and ensure the high quality of its work.

The most important element management activities The nurse organizer is responsible for monitoring the professional activities of nurses, disinfectors and junior medical personnel. Strict and constant control allows you to effectively prevent the occurrence of nosocomial infections and occupational diseases in hospital departments. The presence of constant monitoring allows for timely correction of identified deficiencies. Control work must be constant and carried out both in a planned manner, which employees know about, as a rule, in advance, and without warning the controlled persons.

Scheduled monitoring is carried out daily. The order in the department is checked, a walk through the department is carried out to ensure compliance with the sanitary and epidemiological regime. Every day, nurses carry out quality control of pre-sterilization cleaning. Once a week, control is done by the organizing sister.

Full control of sterilization combines a significant number of positions, each of which is essential for the success of the entire sterilization process. Types of control and sterilization are presented in Table 1 of Appendix 10.

Modern medical institutions must be clean. And this postulate of Moidodyr is given special attention, since it is a well-known fact that insidious nosocomial infections find more sophisticated ways to penetrate health care facilities. How to prevent them? Which remedy is most effective in the use of preventive measures? What should be the logistical support for disinfection and sterilization measures? What role does nursing staff play? There are many questions. The answers to them are determined by the sanitary requirements for the organization of preventive and anti-epidemic measures, taking into account the profile of medical institutions, the types and number of manipulations performed. In this publication we will consider a special case. Or more precisely, we will go to one of the leading, specialized treatment and preventive institutions of the Republic of Tatarstan - the Republican Clinical Oncology Center, and using the example of the work of the nursing service, we will try to formulate several principles effective prevention VBI. Our expert on this issue was the chief nurse of the State Autonomous Institution of the Regional Clinical Clinical Hospital of the Ministry of Health of the Republic of Tajikistan Ramzia Ibragimovna Rakhimova, which spoke mainly about the measures and features of disinfection of those rooms in which cancer patients are located after surgical interventions.

— The spread of nosocomial infections (HAIs) in medical institutions is determined by a number of factors, such as: the type of institution, the etiological structure of nosocomial infections, the characteristics of their spread, the mechanism and routes of transmission, the organization of medical care, the level of sanitary-hygienic and anti-epidemic regime. All this, of course, significantly increases the role disinfection And sterilization activities included in the system of prevention of nosocomial infections. Yes, one of effective methods Prevention of nosocomial infections is ultraviolet irradiation aimed at suppressing the vital activity of microorganisms in the air and on surfaces. All manipulation rooms and wards of our hospital are equipped with stationary wall-mounted open-type ultraviolet bactericidal lamps. In addition to open-type wall-mounted bactericidal lamps, the mobile irradiator-recirculator “Dezar-4” is also used in dressing rooms for dressing patients and in postoperative wards of surgical departments. The operating unit and resuscitation and intensive care wards are equipped with wall-mounted irradiators-recirculators “Dezar-3” (closed type), which allow disinfecting the air in the presence of patients and staff.

- What role does disinfection play in the prevention of nosocomial infections?

- Huge, if not leading. The problem of preventing nosocomial infections is extremely relevant today. In the activities of the chief nurse of any health care facility, the prevention of nosocomial infections is one of the most important sections of work. Monitoring the implementation of measures to interrupt infection transmission routes, ensuring all dispensary services disinfectants, consumables single use, waste disposal from healthcare facilities, training staff to comply with the anti-epidemic regime, participation in the work of the anti-epidemic commission and much more are included in a number of her job responsibilities. This large and multifaceted work is carried out jointly with the epidemiological department and the Council of Sisters.

In the dispensary, nursing staff in terms of preventing nosocomial infections are assigned the role of organizer, responsible executor and supervisory authority.

Of course, contact between medical personnel and patients is carried out manually. That is why their protection is so necessary. Today, the dispensary is working to implement the European hand treatment standard EN - 1500. To resolve this issue, modern skin antiseptics, antibacterial soap have been purchased, practical lessons with medical staff to study hand treatment technology. In palliative care and emergency departments, single-use disinfectant wipes are used; their use facilitates and simplifies the technique of treating the skin of the injection field; in addition, the wipes are convenient for hygienic hand treatment.

— You have a disinfection and sterilization department. What is the essence of his work?

— 5 years ago, a disinfection and sterilization department (DSD) began functioning in our dispensary. This department included the following: central sterilization department ( CSO), disinfection chamber unit and hospital laundry. One of the main tasks of the department is, of course, the prevention of nosocomial infections in medical institution and preventing occupational diseases among personnel. The main task of the CSO is to provide the dispensary with sterile medical products and dressings. This greatly facilitates the work of medical personnel on site. Considering that our dispensary carries out high-tech operations where modern instruments are used, the CSO unit is equipped with high-quality equipment: walk-through washing and disinfection machines, heat-sealing machines, drying cabinets and walk-through steam sterilizers. Sterilizers are equipped with a computer device that allows you to constantly monitor temperature and pressure (this data is recorded on a chart by recorders). Of course, this procedure kills all pathogenic and non-pathogenic microorganisms. At the same time, the effectiveness of the carried out disinfection will be influenced by various physical and chemical factors: temperature, concentration of disinfectant solution, properties and quality of water, configuration of the products being processed, the severity of microbial contamination and the duration of treatment. This point is important; before processing, it is necessary to disassemble the tools to ensure access disinfectants agents to all surfaces of products. Special meaning there are traces of blood, purulent, medicinal and other contaminants on the instruments. In practical conditions, residues of organic contaminants should not be allowed to dry on instruments, so all used instruments are immediately immersed in a disinfectant solution after use.

- What is the role of the laundry? Are disposable underwear used, and in what cases?

— The staff changes the patient's bed linen as many times as necessary to maintain cleanliness in the room. The disinfection-chamber unit carries out full disinfection and disinfection of bedding and, if necessary, clothing in the disinfection room. camera. In this disinfection chamber, things to be processed are placed on a cart, the number of things is normalized by the volume of the cart, foam rubber, synthetic and cotton items can be processed at once. Bedding is processed after each patient is discharged and during intrahospital transfers. Arranging and equipping a laundry room is part of unified system prevention of nosocomial infections and is aimed at reducing the risk of their occurrence and spread through the introduction of perfect organization of linen regime and modern technologies processing of textile products. The equipment set includes barrier washing machines, drying drums, and ironing rollers. All linen from the departments (without pre-treatment) is delivered in packaged form to the laundry, where it is placed in walk-through washing machines, in which the linen is disinfected and washed simultaneously. The linen is returned to the operating rooms in sterile form. And one more important point— data on the work of the entire department (laundry, disinfection room, central treatment center) in the context of departments and offices is entered into the computer daily, which makes it possible to conduct a retrospective analysis for any period of time in order to prevent the occurrence and spread of nosocomial infections.

— What innovative methods are used for cleaning premises?

— Since March 2011, the Center for Nuclear Medicine began to introduce the bucketless method SWEP High Speed (Vileda). This method aims to provide a safe and appropriate sanitary environment. The main goal of professional cleaning is the thorough removal of dust and various organic contaminants. When cleaning, you must adhere to a certain order.

- Which one?

— cleaning should begin with a cleaner surface and gradually move to a dirtier one. The center is cleaned using the hospital's Multifunctional Integrated Cleaning System - an innovative cleaning system designed to meet specific needs and does not require the use of buckets of cleaning solution. The attachments are pre-impregnated with a disinfectant solution, used once and placed in a bag for used attachments for further washing and disinfection. Color coding is used for different cleaning zones, which eliminates the possibility of contamination of objects.

The introduction of this system leads to saving disinfectants and water, increasing labor productivity, and allows reducing physical activity on junior medical staff, effectively in order to prevent nosocomial infection of patients and staff.

In conclusion, it should be noted that the correctness of actions in the process of diagnosis, treatment and patient care will depend on the knowledge and practical skills of the staff. A conscious attitude and careful implementation by medical personnel of the anti-epidemic regime can prevent occupational illness among employees and nosocomial infection of patients.

Theoretical study of the problem of organizing improving the quality of medical services. Increasing the role of the nurse organizer in organizing the activities of healthcare institutions. Analysis of the use of modern technologies and equipment in the work of the central service center.

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· B - grows over time, since the financing of medicine, under the influence of social demands, gradually increases, but part of this increase is “eaten up” by inflation, and there are three components.

The first is general economic for the entire country and is associated with inflation and similar processes.

The second is a consequence of the increasing complexity and knowledge intensity of drugs, devices, technologies and treatment methods, and its growth is more intense.

For one of the large clinical hospitals in Moscow, the dependence of the cost budget can be expressed, as follows from Figure 2 of Appendix 1, by the following formula:

It is necessary to add to this dependence by multiplying the influence of inflation processes taking into account the source data, which are presented in Figure 3 of Appendix 1.

Cost of services medical profile L first falls over time and then increases, as evidenced by the data in Figure 4 of Appendix 1 for the same hospital. The dependence in Figure 4 is approximated by the expression: b 3 = 17 (t - 0.7) 4 + 0.03t + 0.3 (5)

Further calculations carried out in the research showed the need for preliminary accumulation of experience by the medical institution, “formation of a school”, i.e. accumulation of necessary traditions, skills and abilities, personnel acquisitions and establishment of appropriate relationships with other medical and scientific institutions(Figure 5 Appendix 1).

From Figure 5 it is clear that the dependence intersects the x-axis in the area of the point with the abscissa of 0.3, then the increase is almost linear, and the corresponding regression line is characterized by the expression 0.371t - 0.052. Then:

G =(0.371t -0.052)/k 2 w 1 h 1 s 1 m 1 (6)

k 2 and h 1 are constants. w 1 is also a constant, but its value is easy to measure, and for the one mentioned above clinical hospital, chosen by the authors as a basis for comparison, is 0.997. Obviously, the opportunities for its growth are not very large, and the effect this will give, compared to the influence of other factors, is quite insignificant.

Thus, the study authors conclude:

“For management, two factors remain in the hands of managers of a medical institution, determined by the indicators s 1 and m 1"

The first of them, although very important, requires significant costs and for the most part lies beyond the capabilities of management at this hierarchical level. Thus, it is clear that, in essence, the only control lever in the hands of managers remains staff motivation. Although this conclusion may seem obvious, this could probably be applied to any other organizations in any other field of activity, but there are also other factors that enhance activity, such as reconstruction, changes in structure, search for new markets, technological breakthroughs and much more. , due to the specific nature of their functioning, are inaccessible to medical institutions.

This confirms the conclusion about the need special attention to motivate staff of medical institutions.

It should be noted that there are a number of important distinctive features, starting with the talk of the town low wages, the actual erosion of the framework of “free medicine”, a general decline in the educational level of society and the professional level of graduates of medical universities, which can have irreparable and unpredictable consequences.

On the one hand, workers in medical institutions, especially large hospitals, are somewhat akin to soldiers in a large army. At the same time, what forces them to work is not the threat of prosecution, like soldiers and officers, but the threat of creating insufficient care for human life due to negligence. In addition, for many, the requirement of conscience will most likely be important. In fact, this is not just a non-economic motivation, but to a certain extent a continuation of the traditional approach for our country, according to which people are certain elements of a certain “system”, in this case the health care system, and must fulfill their responsibilities in order for this system to work, since , besides them, “there is no one else.”

At the same time, there are real sources of motivation, among which interaction with people plays an important role, despite the fact that it is tiring. Probably, this can be partially correlated with the social theory of E. Mayo, but the other part reflects the realization of people’s desire to care for someone, which, due to the traditions and history of the formation of the human community and each individual, is an integral feature of them, so that motivation is carried out in the form realizing this commitment to caring for people.

In addition, it should be noted that motivation works based on achievements according to the model of D. McClelland and J. Atkinson, since this is manifested in the fact that with successful actions, the result is that the medical worker has cured and achieved victory over the disease and human nature.

Material motivation, as already indicated, leaves “much to be desired,” but even here there has been an emerging last years some progress. Motivation by social position in society also plays an important role. It is probably possible to single out a special type of motivation specifically for medical workers, namely professional suitability. Perhaps it can be attributed to other areas of activity, but only doctors deal with the most complex object at the disposal of humanity - with a person.

One can probably distinguish a rather new approach, expressed in secret motivation, which, in essence, is an unconscious motivation. A medical worker, by force of circumstances, is forced to solve this mystery every day, and, in contrast to the theory of motivation by “logical traps,” the new theory suggests that such behavior among doctors is reinforced and becomes stereotypical. And this consolidation, stereotyping of cognitive behavior in relation to patients, essentially transferred to the subconscious level, becomes part of the personality, moves to the level of attitudes, and this means the strongest motivation possible.

All these mechanisms operate in parallel with each other and in parallel with the “incentive by the system”, which is noted above. In fact, in medical institutions, a hybrid model of motivation is being implemented, which equally includes the indicated “incentive by the system” and other mechanisms of motivation by realizing needs, such as: social theory, rational economic theory, model of motivation by achievement, model of motivation by the opportunity to care and the theory proposed above motivation by unconscious behavior. This can be taken into account by using an analogy with the parallel inclusion of resistances, considering that each of the coefficients describes the incompleteness of the application of the corresponding motivation mechanism. Then the completeness of application is described by the reciprocal of each of the coefficients.

A diagram of such an analysis is presented in Figure 6 of Appendix 1.

A check for one of the medical institutions with its real indicators at the end of the reporting time interval gave a G value equal to 0.282, i.e. the financial component of the efficiency of a large medical institution actually depends by 28.2% on the correct motivation of medical personnel.

Analysis of the possibilities of changing the coefficients included in the formula of the hybrid motivation model allows managers of large medical and treatment-and-prophylactic institutions to choose the ways of intensifying activities available to them and the most effective in their real situations medical organizations.

Chapter Conclusions

Analysis of theoretical material on the research problem showed that

The main criterion for increasing the efficiency of a healthcare institution is the quality of the medical services provided.

The quality of medical care in a large hospital depends on many different factors. However, the main activities to ensure the quality of medical services of a healthcare institution are:

· infection control;

· analysis of resource use;

· Review of accidents, injuries, patient safety and highest risk issues.

In recent years, the problem of nosocomial infections (HAIs) has become exclusively great importance for all countries of the world.

Successful infection control is the result of a proactive organization-wide program using effective measures to prevent, detect, and control infections originating in the health care facility or introduced externally.

An important area of activity in organizing quality management of medical care is the improvement of sanitary and epidemiological control and the prevention of nosocomial infections (HAI) in the activities of a clinical hospital. In this regard, it is necessary to note the importance of the activities of the Central Sterilization Department in the structure of the clinical hospital, as a unit responsible for the prevention of nosocomial infections.

In matters of preventing nosocomial infections in hospitals, junior and nursing staff are assigned the main, dominant role - the role of organizer, responsible executor, and controller.

Pre-sterilization treatment of medical products is carried out in the central processing center and consists of their disinfection and pre-sterilization cleaning.

At the head of all this multifaceted work on the prevention of nosocomial infections in health care facilities is a nurse - the main organizer, executor and responsible controller, the correctness of whose work depends on the knowledge and practical skills acquired during the training process to solve this problem. A conscientious attitude and careful compliance by medical personnel with the requirements of the anti-epidemic regime will prevent occupational illness among employees, which will significantly reduce the risk of nosocomial infections and preserve the health of patients.

In connection with the above, it should be especially emphasized:

1. The significance of the role of the nurse organizer of the clinical hospital;

2. The increasing role of the nurse organizer in improving the organization of the activities of the clinical hospital’s central medical center to prevent nosocomial infections, improve the quality of medical services and increase the efficiency of the entire medical institution.

Chapter 2. The role of the nurse organizer in improving the organization of the activities of the clinical hospital’s central medical care center to improve the quality of medical services

2.1 Characteristics of the professional activities of the nurse-organizer of the Center for Social Care of MMUGKB No. 1 named after. N.I. Pirogova

The central sterilization department for sterilization of instruments and autoclaving of dressings and linen was created on the basis of the mountains. Hospital No. 1 named after. N.I. Pirogov and began to function on April 1, 1995.

The CSC works taking into account the provision of sterile products to the entire medical institution.

The place of the CSC in the activities and structure of MMUGKB No. 1 named after. N.I. Pirogov is presented in Figure 7 of Appendix 2.

The central sterilization department includes the following departments:

1. Reception department

2. Washing compartment

3. Packaging department

4. Sterilization department

5. Expeditionary department

The work of the head nurse of the center is regulated by the Regulations on the head nurse of the center, regulatory and organizational and methodological documents (Appendices 3-9).

The senior nurse of the central medical center reports directly to the deputy chief physician for work with nursing staff.

The senior nurse-organizer of the CSO supervises the employees of the centralized sterilization department, exercises direct control over the work of the CSO staff and coordinates the activities of the functional units of the CSO. In her work, the senior nurse organizer of the CSO is guided by:

a) the basics of labor legislation of the Russian Federation;

b) instructions, orders and guidelines of the Ministry of Health of the Russian Federation;

c) orders and instructions of regional health authorities;

d) instructions and orders of the Chief Physician of the hospital;

e) the work plan of the CSO;

f) job description;

g) hospital internal regulations;

h) safety and fire safety regulations.

Among the main documents regulating the activities of the CSO MMUGKB No. 1 named after. N.I. Pirogov are:

“Guidelines for epidemiological surveillance of nosocomial infections of the USSR Ministry of Health dated 09/02/87 No. 28-6/34.”

“On improving medical care for patients with purulent surgical diseases and strengthening measures to combat nosocomial infections.” Order of the USSR Ministry of Health dated July 31, 1978 No. 720.

“On measures to reduce the incidence of viral hepatitis in the country.” Order of the USSR Ministry of Health dated July 12, 1989 No. 408.

“On improving the work on identifying HIV-infected people, dispensary observation, organizing treatment of patients, preventing HIV infection in the Samara region” Order No. 16/9 of January 27, 2006.

The main functions of the senior nurse organizer of the central social care center for quality management of medical services are:

a) provision of sterile materials and instruments to all departments of the hospital;

b) control over the correct storage and use of sterile materials and instruments in hospital departments;

c) ensuring the correct and effective use of medical equipment through its operation by qualified medical workers of the department and constant monitoring of the equipment by specialists;

d) equipping the central medical center with additional basic and auxiliary medical equipment and packaging materials to expand the scope of work of the central medical center and improve it;

e) training of personnel servicing the department’s equipment;

f) introduction of elements of information technology that contribute to increasing labor productivity;

j) control over the timely receipt of initially cleaned instruments and other medical products and materials from hospital departments;

k) control over the quality of pre-sterilization treatment of medical instruments and products;

l) control over the quality of acquisition, packaging and sterilization of linen, dressings and instruments;

m) control over the issuance of sterile materials and medical instruments to medical institutions assigned for service to the central health care center;

o) control over the correct maintenance of accounting and reporting documentation;

o) annual preparation of vacation schedules for department employees;

The main task of the senior nurse-organizer of the CSO is to organize and manage all activities of the centralized sterilization room and ensure the high quality of its work.

The most important element of the managerial activity of the nurse organizer is control of the professional activities of nurses, disinfectors and junior medical personnel. Strict and constant monitoring makes it possible to effectively prevent the occurrence of nosocomial infections and occupational diseases in hospital departments. The presence of constant monitoring allows for timely correction of identified deficiencies. Control work must be constant and carried out both in a planned manner, which employees know about, as a rule, in advance, and without warning the controlled persons.

Scheduled monitoring is carried out daily. The order in the department is checked, a walk through the department is carried out to ensure compliance with the sanitary and epidemiological regime. Every day, nurses carry out quality control of pre-sterilization cleaning. Once a week, control is done by the organizing sister.

Full control of sterilization combines a significant number of positions, each of which is essential for the success of the entire sterilization process. Types of control and sterilization are presented in Table 1 of Appendix 10.

2.2 Analysis of the qualitative and quantitative composition of the staff of the Central Clinical Hospital No. 1 named after. Pirogov

In the entire set of enterprise resources, labor resources occupy a special place. At the level of an individual enterprise, instead of the term “labor resources,” the terms “personnel” and “personnel” are more often used. The personnel of an enterprise is usually understood as the main (staff) composition of the enterprise’s employees.

Labor resources are the part of the population that has physical development, mental abilities and knowledge that is able to work.

There is an increasing need for knowledge of the technology underlying sterilization processes and apparatus, computer literacy, multifunctional use of an increasing number of workers, elimination of economic illiteracy, especially in the management of healthcare organizations.

All this requires skillful regulation of processes associated with the formation and use of labor resources in any industry, including healthcare. To a large extent, the problem of regulation is solved by skillful management of labor resources. The human resources management system is aimed at increasing the efficiency of personnel use.

The purpose of analyzing the efficiency of the use of labor resources is to reveal reserves for increasing the efficiency of healthcare and improving the quality of medical services through a more rational use of the number of employees and their working time.

In recent years, interest on the part of organizational leaders in technologies in the field of human resource management has increased significantly. The formation of personnel policy is very closely related to the plans and strategic objectives of the organization as a whole. Of the three components of any company, which are financial, human and technical resources, personnel is the most important and the main factor that can influence the rest of the company's resources. The human factor cannot be ignored, since PEOPLE are the main value of any organization.

A well-planned personnel policy can directly or indirectly affect a company’s income by:

· selection of qualified personnel that meets the company’s requirements;

· increasing the labor potential of the company’s personnel;

· increasing labor productivity;

· reducing staff turnover;

· improving the quality of services provided;

· reducing absenteeism due to temporary disability;

· strengthening labor discipline.

When planning all of these goals, methods and measures are developed to achieve them, which are called personnel management technology.

Personnel management technology is a set of techniques, methods and methods of influencing personnel in the process of their recruitment, use, development and release in order to obtain the best final results of work. Personnel management technology is regulated by specially developed regulatory and methodological documents.

HR management technology in the central social service center covers wide range functions from hiring to dismissal of personnel.

The main elements of personnel management technologies in the assets of the senior organizing sister include:

· personnel planning,

· recruitment and selection of personnel,

· determination of wages and benefits,

· career guidance and adaptation,

· education,

· performance assessment,

· reserve preparation and development management,

· industrial relations,

· health protection, social issues.

Personnel management technology is regulated by specially developed regulatory and methodological documents, including job descriptions. Job Descriptions allow, within the framework of a certain position, to perform job duties efficiently and professionally. The job responsibilities of the disinfector and the nurse-hostess of the center are presented in Appendix 11.

Each category of workers includes a number of professions, which in turn are represented by groups of specialties. Within a specialty, workers can be divided by skill level.

A profession is a set of special theoretical knowledge and practical skills necessary to perform a certain type of work in any industry.

Specialty is a division within a profession that requires additional skills and knowledge to perform work in a specific area of production.

The ratio of the listed categories of workers to their total number, expressed as a percentage, is called personnel structure. Or: “The ratio of different categories of workers in their total number is called the structure of personnel (personnel). It can be determined by the following criteria: age, gender, level of education, work experience, qualifications.”

The personnel structure of any enterprise changes over time, and these changes are caused by various factors. The classification of personnel of the Central Clinical Hospital of MMUGKB No. 1 is presented in Table 2 and Figure 8 of Appendix 12.

Indicators of the number and composition of personnel for the specified groups and categories are regulated in accordance with the Instructions on statistics of the number and wages of workers and employees.

The assessment of available labor resources, which makes it possible to judge the necessary changes in the number of workers, is based both on data on the volume of work performed and on an analysis of its content. The purpose of such an analysis is to clarify the tasks for individual groups of performers and formulate adequate qualification requirements, as well as to identify reserves for increasing labor productivity in each specific area of work.

The correspondence of the availability of personnel of the Central Clinical Hospital of MMUGKB No. 1 with the required number (according to the staffing table) is presented in Table 3 and in Figure 9 of Appendix 12.

Analysis of the qualitative and quantitative indicators of the CSC staff makes it possible to determine the professional skills of the staff and, accordingly, the quality of the medical service. Appendix 13 presents the structure of the CSO personnel according to qualitative criteria:

· According to the age

· By experience

· Of Education

The incentive system in the CSC is developed on the basis of the labor participation coefficient. The main provisions of the incentive system:

1. The size of the CTU may increase or decrease depending on the state of the employee’s labor, production, and performance discipline.

2. Categories that increase the KTU:

1. Systematic (three or more times a month performing work in an adjacent area).

2. Participation in the public life of the team, mentoring.

3. Continuous professional development.

4. Compliance with labor discipline.

5. Knowledge of orders No. 720, No. 408, No. 16/9. Compliance with sanitary, hygienic and anti-epidemic measures.

3. Categories that reduce the KTU:

1. Violation of labor, production and performance discipline.

2. Violation of the sanitary and epidemiological regime.

3. Defects in work, violation of tool processing technology.

Various indicators are used to account for and reflect changes in the number of personnel.

1. The average number of employees () is determined by the formula:

(7) ,

where P 1, P 2, P 3 ... P 11, P 12 - number of employees by month.

2. The recruitment rate (Kp) is determined by the ratio of the number of employees hired by the enterprise for a certain period of time to the average number of personnel for the same period:

Kp= 100 (8),

where R p is the number of hired employees, people;

- average number of personnel, people.

3. The staff attrition rate (Q) is determined by the ratio of the number of employees dismissed for all reasons for a given period of time to the average number of employees for the same period:

Kv= 100 (9),

where Ruv is the number of laid-off workers, people;

- average number of personnel, people.

For the CSO as a whole:

At the beginning of 2005 - 12 people.

At the end of 2005 - 12 people.

At the beginning of 2006 - 12 people.

At the end of 2006 - 12 people.

Average number of personnel: 12 people.

The indicators of personnel movement and the efficiency of using working time, presented in Tables 7-8 of Appendix 14, indicate that the CSO team is working stably and there is no staff turnover. During 2005-2006, the personnel potential was stable, there were no violations of labor discipline, and no absences from work without good reason.

This indicates the effectiveness of management in the department, and the proper motivation of the CSO staff.

2.3 Analysis of the use of modern technologies and equipment in the work of the central medical care center of MMUGKB No. 1 to improve the quality of medical services

Medical devices that penetrate during manipulation into normally sterile tissues of the patient’s body and come into contact with blood and injectable drugs are classified as so-called “critical”, representing high risk patient infection in case of microbial contamination of these products. Given the available data on outbreaks of infections associated with inadequate processing of products used in surgical practice, an important role is assigned to the sterilization of products, in particular, surgical instruments, dressings and linen.

Consequently, the quality of medical services is influenced by modern technologies and equipment used in the work of the CSC.

To solve the problem of improving the quality of pre-sterilization treatment and sterilization, the Central Medical Center of Moscow Medical Clinical Hospital No. 1 uses modern equipment:

Sterilizers

· Washing machines

The requirements for pre-sterilization treatment in modern conditions provide for a differentiated approach to the selection of the necessary pre-sterilization treatment process and are extremely higher than ever.

To solve the problem of improving the quality of pre-sterilization treatment, in the central processing center of MMUGKB No. 1, mechanical washing and manual washing are used. For mechanical washing, Italian-made machines such as INNOVA M 3 are used, which are characterized by the following parameters:

· economical/effective

· safety

· easy and convenient use

· easy care of the device

INNOVA M 3 is (Figure 1 Appendix 15) a compact machine with a built-in dosing system for supplying detergents and neutralizing agents, drying " high pressure"and opportunities wide application. Machines of this class are characterized by flexible programming, which allows the device to be adapted to all user requirements. Thanks to new management technology, control over the pre-sterilization treatment process and many other innovations, the CSO managed to achieve high quality pre-sterilization treatment.

Quality control of pre-sterilization treatment is assessed by performing an azopyram test for the presence of residual amounts of blood and a phenolphthalein test for the presence of alkaline components detergents based on the Guidelines for pre-sterilization cleaning of medical products (No. 28-6/13 dated 06/08/82).

1% of simultaneously processed products (but not less than 3 units) are subject to control. The results of pre-sterilization treatment control are recorded in the “Pre-sterilization cleaning quality log” (form No. 366/u).

According to the “Logbook for recording the quality of pre-sterilization cleaning” in 2006, 20,600 units of products were tested. The test results are negative.

Traditional thermal methods of sterilization - steam and air - still occupy a leading position in health care facilities due to such undoubted advantages as the ability to sterilize packaged products and the absence of the need to remove (by washing or degassing) residual sterilizing agent.

New generation devices implement sterilization modes characterized by a smaller spread of temperature parameters, and in some cases, a shorter sterilization holding time. Such sterilizers are equipped with automatic systems for achieving and maintaining the required values of parameters of sterilization modes, systems for indicating the process, as well as its blocking (if the achieved values do not correspond to the specified ones).

Among modern steam sterilizers, we can characterize “Sterimatic” - series 2000; 4000.

Autoclaves of this type are stationary, fully automatic devices. Control of the passage of cycles is carried out by processor control with information displayed on the built-in monitor.

Sterimatic 4000, representing a new generation of sterilizers, is equipped with a software system that allows you to flexibly change the sterilization program and select the menu language (French, English, Russian).

Autoclaves are produced in one or two-door versions (TsSO MMUGKB No. 1 uses two-door autoclaves). Rectangular chamber with double shell. The doors are sealed using pneumatic gaskets. The doors are controlled automatically. Type of Sterimatik sterilizer - series 2000; 4000 are presented in Figure 2 and 3 of Appendix 15.

In 2006, the following was sterilized at the Central Medical Center of the Moscow Medical Clinical Hospital No. 1:

· Tools -12176 bix

· Rubbers - 9040 bix

· Linen - 26,724 knots

· Dressing material - 13132 bix

In the central medical center of the Moscow Medical Clinical Hospital No. 1, they use means of monitoring the sterilization process in accordance with GOST R 519350-2002:

· For normal mode - urea with phenol red, IS 132.

· For a gentle regime - benzoic acid with fuchsin, IS 120.

To control the quality of sterilization, the CSO uses sterility culture. In 2006, 179 cultures were taken for sterility - the result: the cultures were sterile.

2.4 Recommendations for improving the organization of activities of the Central Clinical Hospital of Moscow Medical Clinical Hospital No. 1

Improving the organization of the activities of the CSC will significantly improve the quality of medical services provided by MMUGKB No. 1, which will ultimately increase the efficiency of health care facilities.

For this purpose, the head of the hospital named after. N.I. Pirogova, together with the sister-organizer of the CSO, must conduct constant monitoring of infectious safety. In addition, it is necessary to develop an infection safety assessment system that allows monitoring the activities of departments according to such parameters as:

· registration of infectious diseases and transmission of information on it;

· implementation of sanitary and epidemiological regulations by medical staff;

· collection of epidemiological analysis and preventive studies;

· compliance with the rules for collection, storage and transportation of bacterial samples;

· training of personnel in the principles of infectious safety of the treatment and diagnostic process.

The increased role of sterilization control is important in improving the quality of sterilization of medical devices, especially in connection with the development of various chemical indicators belonging to various classes (from 1 to 6) according to GOST R ISO 11140-1-2000 and allowing for implementation in sterilizers different types operational external (in the sterilizer chamber) and internal (inside packages with products and in products) control.

It is necessary to prohibit any on-site processing and sterilization of medical devices in treatment and diagnostic departments, delegating this work to central processing centers equipped with modern sterilization and washing equipment that provides a full medical and technological cycle: preliminary disinfection, pre-sterilization cleaning, packaging, sterilization, storage and delivery of sterilized products to points of use.

It is economically more expedient to equip a large central health care center with modern, expensive and high-performance equipment rather than dispersing funds to small health care facilities.

Steam sterilizers installed in the central processing center must comply with the new standard for this equipment GOST R 51935-2002, which came into force on July 1, 2003.

The CSO must carry out comprehensive quality control of sterilization and the operation of sterilizers: physical (using instrumentation), chemical (using chemical indicators according to GOSTR ISO 11140-1-2000) and bacteriological (according to the “Guidelines for disinfection, pre-sterilization cleaning and sterilization of medical products”, approved by the Ministry of Health of the Russian Federation No. MU-287-113 dated December 30, 1998).

Sterilizers with fore-vacuum pumping must undergo a test for the tightness of the chamber and the Vacuum Test system, as well as a test for the completeness of air removal from the chamber, the Bowie-Dick Test.

Packaging of medical products must meet the requirements of the new state standard GOST R ISO 11607-2002.

May be allowed to sterilize medical devices medical workers who have completed advanced training courses for nurses at the Center for Social Care under programs approved by the Ministry of Health of the Russian Federation.

When licensing the activities of a hospital in the sterilization section, the following indicators must be taken into account:

· Availability of a central processing center equipped with sterilization and washing equipment that meets the requirements stated above, providing pre-treatment and disinfection, pre-sterilization cleaning, packaging, sterilization, means of storage and delivery to places of consumption of sterile products.

· In the absence of such a CSO, the healthcare facility must have an agreement for the sterilization of medical devices with another hospital that has a CSO that meets the requirements stated above.

Sterilizers must be automatically programmed with a process documentation system. Steam sterilizers must have fore-vacuum pumping and programs for conducting the “vacuum test” and “Bovy-Dick test”.

Washing equipment must cover all types and materials of medical products, for which it is necessary to have a full set of washing machines. Equipment for pre-sterilization cleaning of medical devices must also be automatic and program-controlled.

The CSC must be equipped with means of packaging medical products in accordance with GOST R ISO 11607-2002.

The CSO must have means of monitoring the sterilization process and the operation of sterilizers with the possibility of documentation in accordance with GOST R 519350-2002.

Medical workers involved in the processing and sterilization of medical devices must have an appropriate certificate of completion of advanced courses in sterilization.

It is necessary to develop a unified Technological Regulation for the sterilization of medical devices in health care facilities and adopt it in the form of a law of the Russian Federation.

The central medical care center must be included in the nomenclature of health care facilities.

Improving the organization of CSO activities should follow the path of standardization and quality management. Only then will the sterilization of medical products from a spontaneous, uncontrolled process turn into a standardized system that will provide a reliable barrier to parenteral nosocomial infections.. Therefore, in order to improve the organization of the activities of the CSC and improve the quality of staff work, it is necessary to develop a list of basic new national standards for the sterilization of medical products (Appendix 16 ).

Chapter Conclusions

CSO MMU City Clinical Hospital No. 1 named after. N.I. Pirogova works taking into account the provision of sterile products to the entire medical institution.

At the head of the work of the CSO MMUGKB No. 1 named after. N.I. Pirogov is the head nurse of the department for the prevention of nosocomial infections. She is the main organizer, executor and responsible controller of the correct actions of nursing staff. The prevention of occupational diseases of employees and the non-spread of hospital-acquired infections among patients depend on knowledge and practical skills, a conscientious attitude to work, and careful compliance with the requirements of the anti-epidemic regime by nurses, which significantly affects the quality of medical services.

The senior nurse-organizer of the CSO supervises the employees of the centralized sterilization department, exercises direct control over the work of the CSO staff and coordinates the activities of the functional units of the CSO. The effectiveness of organizing the activities of the CSO personnel depends on her knowledge, professional, business and personal qualities.

The most important element of the managerial activity of the organizer’s sister is:

· control of the professional activities of nurses, disinfectors and junior medical personnel

·motivating staff to work effectively

· creation of a favorable psychological climate in the department, conducive to effective and high-quality work of staff.

The development of science and technology causes changes in the technology of influence on the subject of labor, which in turn changes the content of work activity and places high demands on the composition and quality of personnel.

There is an increasing need for knowledge of the technology underlying sterilization processes and devices, computer literacy, and the multifunctional use of an increasing number of workers.

Therefore, the role of the senior nurse-organizer for personnel management of the central social service center in the field of training and monitoring the professional knowledge of personnel is increasing. The role of briefing and knowledge of the basic orders and instructions regulating the activities of the Central Security Service is increasing.

Indicators of the quality composition of the CSO staff, the movement of personnel and the efficiency of using working time indicate that the CSO team works stably, there is no staff turnover, which indicates the effectiveness of management in the department and its proper motivation.

Improving the organization of CSO activities should follow the path of standardization and quality management. Only then will the sterilization of medical devices turn from a spontaneous, uncontrolled process into a standardized system that will provide a reliable barrier to parenteral nosocomial infections.

Conclusion

The problem of improving the quality of medical care is now particularly pressing for Russian healthcare. In this regard, it is necessary to fundamentally solve managerial, organizational and economic problems in order to create a mechanism for the effective functioning of this most important social sphere.

From the point of view of national interests, it is necessary to ensure the national economic efficiency of healthcare as the most important social sphere. The quality of medical care in a large hospital depends on many different factors.

It is necessary to optimize the work on creating safe conditions stay of patients and work of medical personnel in healthcare institutions. The sister organizer does most of the work in this direction.

To improve prevention methods, reduce morbidity and mortality from nosocomial infections, and reduce economic damage, it is necessary to introduce modern epidemiological surveillance systems and sets of effective organizational measures into healthcare practice.

In recent years, society's need for highly qualified medical care has increased. Nurses constitute the largest category of health care workers. They ensure the operation of various services and, of course, the quality and effectiveness of medical care depend on them.

Proper organization of sterilization services in medical institutions - important event, aimed at preventing nosocomial infections, and, above all, with a parenteral transmission mechanism: viral hepatitis, AIDS, etc.

Pre-sterilization treatment of medical products is carried out in the central processing center and consists of their disinfection and pre-sterilization cleaning. For these purposes, modern equipment is used: washing machines and sterilizers.

It is also necessary to note the increasing role of the nurse organizer in improving the organization of the activities of the clinical hospital's central medical center to prevent nosocomial infections, improve the quality of medical services and increase the efficiency of the entire medical institution.

The role of the senior nurse-organizer for personnel management of the central social service center in the field of training and monitoring the professional knowledge of personnel is increasing.

Improving the organization of CSO activities should follow the path of standardization and quality management. Only then will the sterilization of medical devices turn from a spontaneous, uncontrolled process into a standardized system that will provide a reliable barrier to parenteral nosocomial infections and improve the quality of medical services.

Bibliography

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Applications

Annex 1

Appendix 2

Appendix 3

CALCULATION OF THE NEED FOR STERILIZABLE PRODUCTS AND EQUIPMENT

2.1. A centralized sterilization room works with the provision of sterile products to the entire medical and preventive institution or group of institutions.

2.2. The centralized sterilization room must be able to store a minimum daily supply of products.

2.3. Calculation of the needs of medical institutions for the required quantities of sterilized products according to the nomenclature must be carried out based on the specific needs of specific medical institutions served by a given centralized sterilization station, taking into account:

Profile of the medical institution;

Number of beds in the department;

Volume of surgical interventions;

The nature and number of visits to outpatient clinics;

The presence of three shifts of products (one shift in the department, the second in the sterilization room, the third spare).

2.4. The calculation of the required number of commonly used products is carried out according to the formulas given in the "Methodological recommendations for the calculation and selection of basic technological equipment for various departments of the hospital", developed by GiproNIIZdrav of the USSR Ministry of Health, Moscow, 1988:

Consumption of syringes per day, Shs, pcs. Shs = 3 p,

Consumption of needles per day, IS, pcs. Is = 6 p,

Linen consumption per day, Rbs, kg Rbs = 0.6 p,

Consumption of dressing materials per day, taking into account emergency operations and the needs of the clinic, Rpms, kg Rpms = 0.4 p,

Consumption of gloves per day, Ps, steam,

Ps = Qi x 24,

where P = hospital bed capacity,

Qi= number of operating tables in the hospital.

Notes:

Calculation formulas are given taking into account the need for sterile products for emergency operations and the outpatient department of the hospital. Without taking into account the latter, the estimated consumption of sterile products should be reduced by 1.4 times;

Calculation formulas are given for single-shift operation of the central heating system. For other shifts, appropriate adjustments should be made. In the case of a central station operating with two days off, the entire consumption of materials (linen, syringes, needles, etc.) should be increased by 7/5 - 1.4 times.

2.5. The selection of equipment for a centralized sterilization room is carried out in accordance with current catalogs, reference books and order requests, taking into account the amount of work performed by the CA.

In some cases, the types of sterilizers are selected depending on the layout and area of the room. It is preferable to use large-capacity sterilizers of the same type.

To carry out air sterilization, it is advisable to use electric double-sided air sterilizers with forced air circulation, which ensures the most uniform temperature distribution throughout the chamber volume.

2.6. When calculating the number of sterilizers, the need for repairs and inspection should be taken into account. For this purpose, a (minimum) backup sterilizer is allocated.

2.7. Number of machines for processing surgical instruments, syringes, etc. determined based on the performance of the machine and the volume of work performed. For processing blood transfusion systems, catheters, etc. Additionally, there are baths for soaking, washing, rinsing and two tables.

Drying cabinets for drying products are installed on the basis of: one - for tools; the other is for other products.

2.8. To calculate the number of steam and air sterilizers and auxiliary equipment, you must use methodological recommendations(clause 2.4).

When installing steam sterilizers, you should be guided by the "Rules for operation and safety precautions when working on autoclaves", M., 1971.

2.9. The quantity of containers and packaging materials is not standardized. Calculation of the need for them is carried out taking into account the volume of work performed.

Appendix 4

Application proceduresettlementnormaltimeonsterilizationproductsmedicalappointmentsVtreatment and prophylacticinstitutions

The number of medical personnel positions is calculated based on the volume of work performed per shift, taking into account the estimated time standards for processing medical products by manual and mechanized methods.

Theoretical study of the problem of organizing improving the quality of medical services. Increasing the role of the nurse organizer in organizing the activities of healthcare institutions. Analysis of the use of modern technologies and equipment in the work of the central service center.

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· B - grows over time, since the financing of medicine, under the influence of social demands, gradually increases, but part of this increase is “eaten up” by inflation, and there are three components.

The first is general economic for the entire country and is associated with inflation and similar processes.

The second is a consequence of the increasing complexity and knowledge intensity of drugs, devices, technologies and treatment methods, and its growth is more intense.

For one of the large clinical hospitals in Moscow, the dependence of the cost budget can be expressed, as follows from Figure 2 of Appendix 1, by the following formula:

It is necessary to add to this dependence by multiplying the influence of inflation processes taking into account the source data, which are presented in Figure 3 of Appendix 1.

Cost of services medical profile L first falls over time and then increases, as evidenced by the data in Figure 4 of Appendix 1 for the same hospital. The dependence in Figure 4 is approximated by the expression: b 3 = 17 (t - 0.7) 4 + 0.03t + 0.3 (5)

From Figure 5 it is clear that the dependence intersects the x-axis in the area of ​​the point with the abscissa of 0.3, then the increase is almost linear, and the corresponding regression line is characterized by the expression 0.371t - 0.052. Then:

G =(0.371t -0.052)/k 2 w 1 h 1 s 1 m 1 (6)

Thus, the study authors conclude:

“For management, two factors remain in the hands of managers of a medical institution, determined by the indicators s 1 and m 1"

This confirms the conclusion about the need special attention to motivate staff of medical institutions.

A diagram of such an analysis is presented in Figure 6 of Appendix 1.

A check for one of the medical institutions with its real indicators at the end of the reporting time interval gave a G value equal to 0.282, i.e. the financial component of the efficiency of a large medical institution actually depends by 28.2% on the correct motivation of medical personnel.

Chapter Conclusions

Analysis of theoretical material on the research problem showed that

The main criterion for increasing the efficiency of a healthcare institution is the quality of the medical services provided.

The quality of medical care in a large hospital depends on many different factors. However, the main activities to ensure the quality of medical services of a healthcare institution are:

· infection control;

· analysis of resource use;

· Review of accidents, injuries, patient safety and highest risk issues.

In recent years, the problem of nosocomial infections (HAIs) has become exclusively great importance for all countries of the world.

Successful infection control is the result of a proactive organization-wide program using effective measures to prevent, detect, and control infections originating in the health care facility or introduced externally.

In matters of preventing nosocomial infections in hospitals, junior and nursing staff are assigned the main, dominant role - the role of organizer, responsible executor, and controller.

Pre-sterilization treatment of medical products is carried out in the central processing center and consists of their disinfection and pre-sterilization cleaning.

In connection with the above, it should be especially emphasized:

1. The significance of the role of the nurse organizer of the clinical hospital;

2. The increasing role of the nurse organizer in improving the organization of the activities of the clinical hospital’s central medical center to prevent nosocomial infections, improve the quality of medical services and increase the efficiency of the entire medical institution.

Chapter 2. The role of the nurse organizer in improving the organization of the activities of the clinical hospital’s central medical care center to improve the quality of medical services

2.1 Characteristics of the professional activities of the nurse-organizer of the Center for Social Care of MMUGKB No. 1 named after. N.I. Pirogova

The central sterilization department for sterilization of instruments and autoclaving of dressings and linen was created on the basis of the mountains. Hospital No. 1 named after. N.I. Pirogov and began to function on April 1, 1995.

The CSC works taking into account the provision of sterile products to the entire medical institution.

The place of the CSC in the activities and structure of MMUGKB No. 1 named after. N.I. Pirogov is presented in Figure 7 of Appendix 2.

The central sterilization department includes the following departments:

1. Reception department

2. Washing compartment

3. Packaging department

4. Sterilization department

5. Expeditionary department

The work of the head nurse of the center is regulated by the Regulations on the head nurse of the center, regulatory and organizational and methodological documents (Appendices 3-9).

The senior nurse of the central medical center reports directly to the deputy chief physician for work with nursing staff.

The senior nurse-organizer of the CSO supervises the employees of the centralized sterilization department, exercises direct control over the work of the CSO staff and coordinates the activities of the functional units of the CSO. In her work, the senior nurse organizer of the CSO is guided by:

a) the basics of labor legislation of the Russian Federation;

b) instructions, orders and guidelines of the Ministry of Health of the Russian Federation;

c) orders and instructions of regional health authorities;

d) instructions and orders of the Chief Physician of the hospital;

e) the work plan of the CSO;

f) job description;

g) hospital internal regulations;

h) safety and fire safety regulations.

Among the main documents regulating the activities of the CSO MMUGKB No. 1 named after. N.I. Pirogov are:

“Guidelines for epidemiological surveillance of nosocomial infections of the USSR Ministry of Health dated 09/02/87 No. 28-6/34.”

“On improving medical care for patients with purulent surgical diseases and strengthening measures to combat nosocomial infections.” Order of the USSR Ministry of Health dated July 31, 1978 No. 720.

“On measures to reduce the incidence of viral hepatitis in the country.” Order of the USSR Ministry of Health dated July 12, 1989 No. 408.

“On improving the work on identifying HIV-infected people, dispensary observation, organizing treatment of patients, preventing HIV infection in the Samara region” Order No. 16/9 of January 27, 2006.

The main functions of the senior nurse organizer of the central social care center for quality management of medical services are:

a) provision of sterile materials and instruments to all departments of the hospital;

b) control over the correct storage and use of sterile materials and instruments in hospital departments;

c) ensuring the correct and effective use of medical equipment through its operation by qualified medical workers of the department and constant monitoring of the equipment by specialists;

d) equipping the central medical center with additional basic and auxiliary medical equipment and packaging materials to expand the scope of work of the central medical center and improve it;

e) training of personnel servicing the department’s equipment;

f) introduction of elements of information technology that contribute to increasing labor productivity;

j) control over the timely receipt of initially cleaned instruments and other medical products and materials from hospital departments;

k) control over the quality of pre-sterilization treatment of medical instruments and products;

l) control over the quality of acquisition, packaging and sterilization of linen, dressings and instruments;

m) control over the issuance of sterile materials and medical instruments to medical institutions assigned for service to the central health care center;

o) control over the correct maintenance of accounting and reporting documentation;

o) annual preparation of vacation schedules for department employees;

The main task of the senior nurse-organizer of the CSO is to organize and manage all activities of the centralized sterilization room and ensure the high quality of its work.

Full control of sterilization combines a significant number of positions, each of which is essential for the success of the entire sterilization process. Types of control and sterilization are presented in Table 1 of Appendix 10.

2.2 Analysis of the qualitative and quantitative composition of the staff of the Central Clinical Hospital No. 1 named after. Pirogov

Labor resources are the part of the population that has physical development, mental abilities and knowledge that is able to work.

There is an increasing need for knowledge of the technology underlying sterilization processes and apparatus, computer literacy, multifunctional use of an increasing number of workers, elimination of economic illiteracy, especially in the management of healthcare organizations.

The purpose of analyzing the efficiency of the use of labor resources is to reveal reserves for increasing the efficiency of healthcare and improving the quality of medical services through a more rational use of the number of employees and their working time.

A well-planned personnel policy can directly or indirectly affect a company’s income by:

· selection of qualified personnel that meets the company’s requirements;

· increasing the labor potential of the company’s personnel;

· increasing labor productivity;

· reducing staff turnover;

From Figure 5 it is clear that the dependence intersects the x-axis in the area of the point with the abscissa of 0.3, then the increase is almost linear, and the corresponding regression line is characterized by the expression 0.371t - 0.052. Then:

Specialty is a division within a profession that requires additional skills and knowledge to perform work in a specific area of production.