Infectious Department and Hospital

Infectious departments and hospitals are intended for isolation of infectious patients for the time during which they remain dangerous to the surrounding people, and also for treatment of such patients after the diagnosis is established.

An infectious hospital has two major divisions: the diagnostic unit and the therapeutic department. An infectious hospital must be provided with units for intensive therapy and reanimation (resuscitation), a surgical department, laboratories for clinical, bacteriologic, serologic, virologic and biochemical studies, a pathologico-anatomic department and mortuary.

Each hospital must also have a unit where all medical tools and instruments can be sterilized.

The admittance unit must have separate cubicles, with their separate entrances and exits, for patients with different infectious diseases. Each cubicle should be provided with separate conveniences, such as cloak-room, showers, baths, etc.

During admittance to an infectious hospital, after establishing a tentative diagnosis, material should be taken from the patient for its laboratory examination. The ambulance car in which the patient was brought to the hospital and the cubicle should be disinfected with a 0.5-1 per cent chloramine solution.

Patients with mixed infections or dubiour. diagnosis, should be placed in isolated wards or rooms provided with all facilities and conveniences.

In order to prevent nosocomial infections, infectious patients of general hospitals should be kept in a separate building. (Patients with similar diseases should preferably be placed in separate buildings.) Rooms for critical patients should be provided. Medical and paramedical personnel should have all facilities separately from the patients (lavatories, canteens, etc.).

Rooms, where infectious patients are kept, should be regularly aired and treated with ultraviolet rays (3 times a day for 40 minutes)..

Rooms should be cleaned with a 0.5 per cent chloramine solution at least three times a day. Lavatories should be cleaned at least 4 times a day with a 0.5 per cent solution of chlorinated lime. Soiled lavatory pans should be cleaned immediately.

Table dishes should be boiled in a 2 per cent sodium hydrocarbonate solution for 15-30 minutes after each meal; chloramine solution can also be used, but after such treatment all dishes should be rinsed in hot (100 °C) water. Food residue should be treated with dry chlorinated lime.

Only rubber or plastic toys can be given to children since these are easy to disinfect. Medical personnel must see to it that the patients observe individual hygiene rules.

Critical patients should be given a separate nurse for 24-hour observation. A signal button must be provided at bedside of each patient in all wards.

A patient can be discharged from an infectious hospital only for special indications (favourable results of laboratory examinations, termination of therapeutic course, normal body temperature, etc.).

Before leaving a hospital, the patient takes bath or shower and puts on clean and disinfected clothes.

The room where the patient remained during his stay in the hospital should be given a final disinfection. Soiled linen should be sent in a special bag to the disinfection chamber. The concentration of chloramine solution by which the room is disinfected depends on a particular infection.

Hygiene requirements for medical personnel. Medical and paramedical personnel of an infectious hospital must keep their clothes in separate boxes. The personnel must wear special overalls and keep them clean. Nails must be cut short.

Materials for laboratory examinations (blood, urine, faeces, vomi-tus, cerebrospinal fluid) should be taken and handled in conditrSns that exclude infection of the personnel or other patients.

After inspection and examination of the patient, or after a iny o*her

(ST mu 'or manipulation associated with patient's care, the personnel must wash their hands with a 0.5 per cent chloramine solution and then with warm water.

Prevention of nosocomial infection. A nosocomial infection is an infection that develops in a patient inside a hospital in a lapse of time that exceeds the duration of the incubation period of a given infection, or an infection that develops in a patient after his discharge from the hospital in a period of time that is shorter than the incubation period for a given infection.

Extrahospital infection implies cases of infection before hospitalization (the patient is admitted to the hospital during the incubation period of a given infection). Among nosocomial infections, most common are air-borne infections, such as influenza and acute respiratory diseases, chickenpox, rubella, epidemic parotitis, scarlet fever, or measles.

Nosocomial infections result from admittance to the hospital of patients with unrevealed diseases.

Anti-epidemic measures should be taken in cases of development of nosocomial infections. These measures are aimed at prevention of infection spread. Quarantine should be established whenever necessary. During this period, only those patients can be admitted to the hospital who have already sustained this particular disease.

The first patient with a nosocomial infection should be isolated from the others or placed in a mixed-infection ward, while the room and objects that were used by this patient must be disinfected.

Other patients and personnel who had contacts with the nosocomial infection patient should be observed during the incubation period. Depending on the disease, they should be given immunoglobulin (prophylactic therapy) and tested for the carrier state.

Care and Nutrition of Infectious. Patients

Proper care is an important curative and preventive factor. It is decisive in children and critical patients. Considerate care strengthens the patient's belief in his recovery and restoration of the working capacity.

The medical and paramedical personnel should take care of patient's hygiene and the condition of his bedding. The patient must be given a bath at least once a week. If the patient's condition is critical, his body should every day be rubbed with a wet tow Patient's underwear and linen should be changed each wee' necessary, every day or immediately. All patients must be wa the morning. Children and critical patients should have their faces and hands washed with warm water.

To prevent bedsores, the skin of patients with severe diseases should be coated with vegetable oil or camphor alcohol at sites where bedsores are more likely to develop. The patient must be helped to turn from side to side; inflatable cushions should be placed under the patient, if necessary.

Body temperature should be taken twice a day. The configuration of the temperature curve is important diagnostically. Great temperature variations indicate complications or change in the course of the disease.

If symptoms of toxaemia develop (headache, delirium, high body temperature), ice should be applied to the patient's forehead for 20 minutes (at 25-30 minute intervals).

If the patient complains of insomnia, he should be given a hypnotic an hour before night sleep. The condition of the patient must be constantly observed. His cardiovascular system should be controlled (pulse frequency and strength). The function of the respiratory system (frequency of respiratory excursions per minute, the character of respiration, the presence of cough, expectoration of sputum), of the alimentary system (inflation of the abdomen, constipation, diarrhoea, vomiting), and of the urinary system (frequency of urination, the character of the urine, its colour and other properties) should be controlled.

Nutrition is an important curative factor. Patients and convalescents should be given at least 4 meals a day. Food must be adequate, i.e., contain all necessary nutrients, salts, vitamins; it must be caloric. The patient must be given fresh vegetables, fruits, berries, fruit juices.

When prescribing a diet, it is necessary to consider the pathogenesis and the course of the disease. For example, a patient with typhoid fever should be given a sparing diet because df the ulceration in the intestine. Food must be liquid or semiliquid. Meat broth, kissels, dried bread, curds, kefir, boiled steamed-cured chopped meat, porridge rubbed through a sieve, and fruit juices should be given. Dietary restrictions should be gradually removed in shigellosis and typhoid fever patients during the recovery phase; the caloric value of the diet should be increased. Food must be sparing mechanically. All dishes should be chopped or rubbed through a sieve. Dietary habits and the appetite of the patient must be considered as well,-The appearance of food is also important.

Liquid must be given in adequate amount in order to ensure x;- & r .„ . a ^jr withdrawal of pathogenic microbe metabolites from the patient's body. Patients must be given tea with lemon, stewed fruits and berries, and juices.

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