CHILDREN'S HOSPITAL in the USSR - the state treatment and prevention facility rendering to children from the birth up to 14 years inclusive free stationary medical care.
Before Great October socialist revolution stationary help to children would be given preferential in for adults by doctors of the general profile. This help was extremely limited, paid, unavailable to most of the population. By the beginning of 19 century in St. Petersburg and Moscow at the initiative of the advanced doctors on charitable means in for adults would begin to open children's departments on 6 — 7 beds. Special chambers for isolation and treatment of children would be created in some educational houses in connection with high incidence and mortality of children in them.
The first independent Must be in Russia began to organize in 30 — the 40th are 19 century: in St. Petersburg — Nikolaev and Elisavetinsky (nowadays of N. F. Filatov and of L. Pasteur), in Moscow — Sofia (nowadays of N. F. Filatov). In 1869 K. A. Raukhfus constructed in St. Petersburg Oldenburg Must be (nowadays of K. A. Raukhfus). As this would be constructed Morozovsky, Vladimir, Olginsky Must be in Moscow.
In children's hospitals children were accepted generally 8 years are more senior. Intrahospital infectious diseases of children were a scourge Must be. The hospital lethality in separate years (1864 — 1889) reached 22 — 28%, a lethality at pneumonia — 41 — 55%.
After Great October socialist revolution with creation of nation-wide system of protection of motherhood and the childhood special attention was paid to stationary medical aid to children. Growth of hospital beds happened as due to opening of children's departments in the general and specialized-tsakh for adults, and due to construction independent Must be, expansions and reconstruction existing. If in Russia in 1913 in there would be only 750 children's beds, then in RSFSR (without Yakutia and the Far East region) in 1933 were 37 independent Must be on 5159 beds and 95 departments in-tsakh for adults on 3470 beds; in 1940 the quantity of children's beds in hospitals of the USSR reached 89,7 thousand, and in 1975 — 529,3 thousand. The quantity independent multi-profile increased Must be also large children's departments in-tsakh for adults. Much attention is paid to specialization of bed fund: cardiorheumatological, pulmonary, otolaryngologic, surgical and other children's specialized departments are created. Security of the population with children's beds in 1975 made 14,7 on 10 thousand population.
According to the resolution of the Central Committee of the CPSU and Council of ministers of the USSR of July 5, 1968 No. 517 «About measures for further improvement of health care and development of medical science in the country» development of the fixed network is carried out due to construction according to standard projects of large republican, regional, regional, city multi-profile children's BCs on 300 — 600 and more beds with advisory policlinics, hospitals for recovery treatment on 420 beds and children's infectious BCs on 240 beds. In many cities of the Soviet Union construction is carried out Must be at the expense of the means received from communistic community work days.
Must be can be: on a profile — multi-profile and specialized; on system of the organization — combined and not integrated with policlinic; on the volume of activity — various categorization, depending on bed power; depending on administrative division — regional, city, regional (regional), republican.
Dignity. norms and rules of construction Must be according to standard projects are approved by the State Committee for Construction of the USSR. Norms on 1 bed in children's noninfectious departments — 6 m 2 , in children's infectious — 6,5 m 2 , in departments of recovery treatment — 7 m 2 . The hospital Must be (departments) everyone consists of the ward sections isolated from each other on 30 beds, and for children aged till 1 year — on 24 beds.
In Must be the prevention of infections and reinfections among the children who are in chambers is especially necessary (see. Intrahospital infections, in children's hospitals ), therefore in all standard Must be there is a system boxes (see) and separate sections.
Ward sections shall not be checkpoints. In walls and partitions of children's chambers it is recommended to do glass apertures. Chambers for children of the first year of life are provided boxed — on 1 — 2 beds in each boxing. In chambers for children no more than 4 beds have to be more senior than 1 year. The system of boxes and separate sections helps to eliminate idle time of beds in connection with a drift of infections, allows to use separate sections for hospitalization of patients with homogeneous infections.
In children's department near chambers for babies the room for mothers, and also the room for decantation of breast milk is surely allocated. The number of beds for mothers makes 20% of total quantity of beds in a children's hospital.
In all Must be (children's departments of BC) special rooms for reception of sick children are allocated. The reception consists of a lobby-ozhidalni, reception and viewing boxes, insulating boxes on 1 bed, the sanitary inspection room, an office of the doctor, laboratory for urgent analyses, dressing-procedural, rooms of medical staff, the bathroom and other rooms. The number of reception and viewing boxes shall make 3% of quantity of beds in children's department, and the number of boxes on 1 bed is established at the rate of 5% to total quantity of beds in children's department.
More than 60 it is desirable to place children's department with quantity of beds in the separate case. For children aged till 1 year it is necessary to provide separate section; in it it is necessary to divide chambers into separate boxes, on 1 — 2 beds in everyone. Chambers for children up to 7 years should be placed not above the second floor.
Rooms for mothers should be placed out of ward departments, but near chambers for children aged till 1 year. Norms of the sizes of certain rooms Must be are specified in table.
At reconstruction existing Must be (departments) it is necessary to adhere to the norms stated above.
Children's infectious department is designed on the norms which are stated above, but shall consist of meltserovsky boxes (see. Boxes ), boxes and half of boxes. Walls, partitions, doors, glory-holes shall exclude a possibility of penetration of an infection. In walls, in partitions between chambers and corridors devices for transfer of linen, food and medicines from a corridor are provided in chambers.
Experience of activity of children's hospitals confirmed expediency of the organization large multi-profile Must be in which the bed fund is fullestly and rationally used. Such hospitals have the best technical equipment, doctors-siyetsialistov, conditions for use of modern methods and diagnostic aids of diseases and treatment of sick children. In them creation of specialized departments of a therapeutic and surgical profile is possible: pathologies of newborn and premature children, rheumatological, pulmonary, neurologic, hematologic, urological, nephrological, ortopedo-traumatologic, intensive care units and intensive care, etc.
In Must be children in the direction of doctors of out-patient and polyclinic institutions, fast and acute medical aid are hospitalized, and also patients according to vital indications without the direction to lay down. - professional, institutions. At the direction of the child in a hospital at it shall be prenatal record (see) or an extract from stories of development of the child (see) with the indication of the diagnosis of a disease, the anamnestic data which are carried out to lay down. actions, inoculations, the postponed diseases, and also data on contacts of the child with infectious patients of the house or in child care facility.
In reception of the child the doctor examines, in case of need to it there is the emergency medical aid, depending on age and a state the issue of the admission of mother to care of the child is resolved. At suspicion of an infectious disease or existence of contact with the infectious patient of the child send to the cubicle. After survey, rendering to lay down. send to the help of the child to the relevant department.
In case of arrival of children without the knowledge of parents employees of reception immediately inform parents.
Feature of a children's hospital is the mode providing a complex not only to lay down., recreational and dignity. - a gigabyte., but also educational actions taking into account anatomo-fiziol, and age features of a children's organism.
Manager. department performs direct management of activity of medical staff of department, bears full responsibility for quality to lay down. process and culture of work in department, provides the correct organization of feeding and to lay down. food of children, educational and pedagogical work with children, individual care for seriously ill patients, are checked by correctness and validity of issue of sick-lists to mothers hospitalized with children; at detection of infectious diseases will organize immediate isolation of the patient and together with the epidemiologist resolves an issue of imposing of a quarantine and accommodation of the patients who were in contact; provides necessary conditions of reception of again arriving patients, including hospitalization of seriously ill children; carries out work on professional development of doctors and paramedical staff.
The intern of a hospital renders to children medical aid using necessary diagnostic testings and methods of treatment; appoints drug treatment, to lay down. procedures, food, corresponding leaving; carries out special types of researches, a daily bypass of sick children, advises them with the manager of department and other specialists, conducts case histories, controls all appointments which are carried out by nurses. The correct organization of work allows the doctor-intern at most of time to give to the sick child.
The senior nurse carries out control of activity of the medical staff, of providing ought a dignity. - a gigabyte. the mode in department, timeliness of providing patients with medicines, food, linen, holding medical procedures, observance of a day regimen, exercises control of educational work with children.
The nurse carries out patient care by children, carries out medical appointments.
In many children's hospitals there is a position of the teacher who is carrying out educational work with children.
In a complex of therapeutic actions Must be an integral part the medical and guarding mode creating the good emotional tone at the child mobilizing an organism for fight against a disease enters. The cordial attitude of personnel towards patients, educational work with children, availability of game material and books are important elements of process of treatment of children. In necessary cases to leaving, especially for children of younger age, mother is allowed. The issue of the admission of mother is resolved by the managing department, the chief physician-tsy. Mothers who are with children in-tse are provided with food, for them special rooms for rest and a dream are allocated.
Cooking for children is carried out due to special allocations, taking into account age and features of disease. In for adults food for children's department would prepare separately according to the special item of expenditure; for children of the first year of life food can arrive from milk kitchen (I eat. Milk kitchen).
At an extract of the child from a hospital the final epicrisis from a case history and the recommendation about further treatment and overseeing by it is completely transferred to the prenatal record. The written-out child is transferred to the relatives or persons who brought him in-tsu. It is forbidden to release the written-out children of one.
Established posts of doctors and medical staff Must be are established by the Ministry of Health of the USSR.
The chief physician Must be submits to appropriate authority of health care, performs administrative functions, would bear responsibility for activity, carries out actions for upgrading of treatment, selection and placement of personnel, systematic professional development of doctors and all personnel-tsy.
Indicators of activity of BC are: implementation of the plan koykodny, duration of work of a bed in a year, average terms of stay of patients in a hospital, a hospital lethality, including and less than 24 hours, quality to lay down. and diagnostic work.
Table. Floor area of ward section and ward department of children's hospital
Bibliography Manannikova N. V. Health protection of children in the USSR, M., 1973, bibliogr.; Fifty years of the Soviet health care, 1917 — 1967, under the editorship of B. V. Petrovsky, page 102, 470, M., 1967, bibliogr.; Turova F. D. Children's hospital with policlinic, M., 1964.
I. I. Grebesheva, H. M. Melkumova, L. K. Skornyakov.