BOXES (English box a box, a box) — the rooms designed according to the special plan, or the fenced-off parts of the general rooms intended for isolation of patients or persons, suspicious on infectious diseases, and also rooms (camera) for the researches demanding special conditions or work with materials, dangerous to people around.
Boxes of medical institutions
Basic purpose of B. to lay down. institutions — isolation of patients for the purpose of prevention of an intrahospital infection. In children's policlinics and in receptions of hospitals (especially infectious and children's) B. are used not to allow contact between patients in the general ozhidalnyakh. In infectious diseases hospitals in B. isolate patients with the obscure diagnoses or with such forms of infectious diseases for which in hospital there is no relevant department, and also sick with a mikstinfektion and the children who had contact with sick other infectious diseases. In day nursery or kindergartens B. are quite often used as insulators for sick children before sending them home or in to lay down. establishment.
For reduction of intrahospital infections of J. Grancher suggested to isolate in 1888 patients in the general chambers by the device between beds of partitions from the panels attached to iron rods. Further these panels were replaced with the mobile or attached to a floor wooden or metal partitions 2 — 2,2 m high. From a floor up to the height of 0,8 — 1 m these partitions continuous, above — glazed; they are slightly longer than a bed. The parts of chamber isolated by such partitions are called open B. (fig. 1). Open B. sometimes arrange in ozhidalnyakh children's policlinics.
Isolation in open B. is imperfect and does not protect from distribution of droplet infections.
The closed B., or semi-boxes (fig. 2) — the parts of chamber separated by the glazed partitions reaching a ceiling with the door which is (usually glazed). Each such B. shall have natural lighting, a water tap with a sink or a wash basin for washing of hands, dressing gowns and caps (kerchiefs) which the personnel put on over usual dressing gowns and caps (kerchiefs) during the work in B. Vykhodya from B., personnel leaves these dressing gowns and headdresses in B., processes hands disinfecting solution and carefully washes them with water with soap. For each closed B. allocate the separate objects necessary for medical and consumer services of the patient. Patients come to the closed B. and are brought from them through the general corridor of department.
As the closed B. design also so-called. shlyuzovanny chambers. These are the isolated chambers leaving in the general corridor of department. In chambers partitions allocated the small room in the form of a lobby (lock); in a lock there are a water tap with a sink, second dressing gowns and headdresses for personnel. Isolation in the closed B. and shlyuzovanny chambers is more perfect, than in open B., however during the opening of doors to the closed B. or in shlyuzovanny chambers disease-producing factors can get to department with an air flow that is especially dangerous at measles, chicken and natural pox and other infections extending through air. Essential defect of this isolation method is also arrival of patients through a corridor of department.
The most perfect is isolation of patients in individual, or meltserovskikh, B. The plan of a design of B. providing full and individual isolation of patients was offered in 1906 by the St. Petersburg engineer E. F. Melzer. Philosophy of a design of meltserovsky B.: at patients all opportunities of contact with other patients completely are eliminated at receipt in B., in the time spent in it and during the escaping it. Each patient comes to B. intended for it directly from the yard and leaves it there. In each such B. there has to be only one patient (also isolation of several patients with precisely established homogeneous disease from one center, napr, family flash is allowed). New patients come to B. only after careful wet disinfection of the last. B., intended for survey of the arriving patients or for isolation of the patients who are on treatment are usually grouped on some together, forming the boxed receptions or insulating departments. Also necessary service and utility rooms are a part of such departments (fig. 3) (a staffroom or the room for the doctor on duty, linen, a still-room, a propusknik and a bathroom for personnel). Insulating B.' number shall make 25% of total number of the beds which are available in children's infectious diseases hospitals and 10% — in children's noninfectious hospitals. Also reception and viewing B. on 16 m are provided 2 everyone. In infectious departments for reception of patients it is necessary to provide reception and viewing B. from calculation: in department to 30 beds — 1 B., from 30 to 60 beds — 2, from 60 to 100 — 3, more than 100 — 3% of total quantity.
Each individual B. (fig. 4) usually consists of the following rooms: 1) the platform from a lobby (predboksnik); 2) chamber, or sick inspection room; here the patient remains for all the time of isolation or only looks round the doctor; 3) a bathroom with a water tap, a sink, a bathroom and a toilet bowl; 4) a lock for personnel. Sanitary cleaning of the arriving patients is made or in departments to which they go, or in viewing B. In the latter case it is reasonable to arrange viewing B. as sanitary inspection rooms (fig. 5) with odevalny and an additional exit outside.
The medical staff servicing patients in B. is in an internal corridor. The corridor is divided by partitions with doors into several parts. Width of a corridor shall make not less than 2 m. An exit of patients from B. in an internal corridor of department is forbidden. The personnel servicing B. are included into a lock from an internal corridor, densely close an outside door, wash hands, put on the second dressing gown, a cap or a kerchief, if necessary a gauze mask, and only after it pass gloves to the room, in Krom there is a patient. During the escaping of B. in a lock the personnel at first densely close an inside door, take off a dressing gown and a headdress (after survey of each arriving patient it is desirable to hand over the used dressing gown and a cap in disinfection), wash and disinfect hands and only then open an outside door of a predboksnik. For the prevention of spread of an infection through air it is necessary to watch that at the time of opening of a door from a lock in an internal corridor of department the door conducting to the room in Krom is the patient, it would be densely closed. For more reliable isolation of B. in which patients with the infections extending in the air way are placed the doors of locks leaving in an internal corridor of department tightly close, and glasses of doors sometimes stick with paper and the personnel are included into B. from the yard.
B.'s situation is limited only to the most necessary objects. In viewing B. usually there are only a table, a stool or a chair painted by an oil paint for the doctor and the trestle bed covered with a sheet for the patient. In B. in which sick isolate for treatment there are a bed, a bedstand, an easy portable screen, the stool or a chair and a tank or a box with well driven cover upholstered inside with galvanized iron for storage of dirty linen. Assign the objects necessary for medical and consumer services of the patient, and also harvest stock to each B. (brushes, rags etc.). The dirty linen, bedding and other objects which are subject to washing or chamber disinfection, and also allocation of patients (urine, excrements, a phlegm) directed for a research to laboratory take out from B. to the yard.
At individual (meltserovsky) B.' construction technical specifications are defined by the Construction Norms and Rules approved by the State committee of Council of ministers for construction on December 31, 1970. B. it has to be sufficiently provided with natural light (the light factor shall make 1:4). The vent system is arranged so that the fresh air purified in filters arrived directly outside, ventilating channels are brought out of each B. on a roof.
Central heating (as a rule, water). Cold and hot water is carried out to each B. Floors and walls are exposed to daily wet cleaning, and after a conclusion of the patient from B. — careful processing by disinfecting solutions; therefore floors shall be waterproof, smooth and not have the cracks allowing accumulation of dust and dirt. They also shall be warm and nonslipping. B.'s walls plaster, revet up to the height of 1,6 — 2 m with glazed ceramic tiles or (in the absence of them) metlakhsky tiles; above this level bleach lime on glue or paint an oil paint. For convenience of overseeing by patients the wall leaving in an internal corridor of department is done glazed.
The group B. intended for the simultaneous room of several (2 — 4) patients are sometimes designed. In group B. only the sizes of chamber for patients respectively increase; the size of all other rooms of B. remains same, as in individual. Group B. use for hospitalization of patients with such infectious diseases for which owing to their small number expansion of the whole department is inexpedient.
Approximate sizes of the area of individual B. following: predboksnik of 3,5 — 5 m 2 , chamber for sick 10 m 2 , bathroom of 8 — 9 m 2 (at installation of a small bathtub for children the area of a bathroom can be reduced), a lock for personnel of 1,5 — 2 m 2 . Thus, the total area of B. intended for isolation of one patient makes apprx. 25 m 2 . In group B. on each patient it is necessary on 5,5 m 2 . In B. constructed as the sanitary inspection room and used only for survey and sanitary cleaning of the arriving patients, the area of a sick inspection room can be reduced, but is constructed odevalnya.
Efficiency of box system in prevention of intrahospital infections is defined not only design features of B., but depends as well on degree of qualification of the personnel servicing B.
Neobkhodimost of the big area for individual isolation of patients and additional staff of paramedical staff for their service (1 doctor on 15 beds, 1 charge nurse on 8 children in the afternoon and on the 12th at night) is quite acquitted.
the Boxes microbiological — isolated, the glazed rooms with an entrance through the platform. Intend for work, the demanding special purity and sterility (resowings of bacterial cultures, work with high-pathogenic microorganisms, preparation of fabric cultures, pouring of sterile mediums, etc.). Usually microbiological B.' area makes 5 — 10 m 2 . B. shall be well lit (illumination of a surface of a desktop — 300 lx). In B. establish tables with an eyeliner of gas, stools, small cases for sterile ware, Wednesdays, etc. The furniture established in B. shall be simple on a design (better metal) that it simplifies its disinfecting.
In the platform (predboksnik) there has to be a water tap and a sink for washing of hands. B.'s walls either revet with tiles, or cover with an oil paint of light tones, cover a floor with smooth tiles or linoleum. B. equip with system of supply of sterile air (the forced ventilation supplied with special filters).
Before work of a wall, floors and all available equipment wipe with disinfecting solutions (carbolic to - you, chloroamine). Air will be sterilized germicidal (ultra-violet) lamps of stationary or figurative type or the special filtering devices. The mode of sterilization is defined by the power of the used germicidal lamps. Bakteriol, control of air is exercised by 2 times a week, leaving in B. for 15 min. open Petri dishes with Wednesdays. On 1 cup growth no more than 10 colonies of saprophytic microorganisms is allowed.
Before work all necessary material is at the same time brought in B.; work shall be carried out at strict observance of sterility. Upon termination of work make B.'s cleaning in the wet way.
In mikrobiol. laboratories, in addition to stationary B., it is possible to use the handheld desktop B. representing small glass cameras the size 100x X 70x70 of cm in which there are two openings for the hands supplied with oversleeves. Desktop B. also shall be supplied with germicidal lamps and have an eyeliner of gas.
Boxes radiation — special cameras for work with radioactive materials (see. Radiological laboratories ).
Bibliography: B. microbiological — Givental N. I. Ustroystvo of diagnostic microbiological laboratories, Mnogotomn. management of PO MIK. WEDGE, and epid, infekts. Bol., under the editorship of H. N. Shukova-Verezhnikova, t. 4, page 229, M., 1964; Sh at-ladze A. K. igaydamovichs. Ya. Short course of practical virology, M., 1954.
M. F. Andreyev, Yu. K. Fomichev.