of January 17, 2012 No. 87
About approval of Health regulations "Sanitary and epidemiologic requirements to health care facilities"
According to the subitem 2) of article 6 of the Code of the Republic of Kazakhstan of September 18, 2009 "About health of the people and health care system" the Government of the Republic of Kazakhstan DECIDES:
1. Approve the enclosed Health regulations "Sanitary and epidemiologic requirements to health care facilities".
Prime Minister of the Republic of Kazakhstan
Approved by the Order of the Government of the Republic of Kazakhstan of January 17, 2012 No. 87
1. These Health regulations "Sanitary and epidemiologic requirements to health care facilities" (further - Health regulations) are developed according to the Code of the Republic of Kazakhstan of September 18, 2009 "About health of the people and health care system" and establish sanitary and epidemiologic requirements to health care facilities.
2. These Health regulations contain sanitary and epidemiologic requirements to health care facilities in case of:
1) the choice of the parcel of land under construction;
2) designing, construction, reconstruction;
3) content of rooms and equipment;
4) collection, neutralization, transportation, storage and burial of medical waste;
5) catering services of patients, and also under working condition of medical personnel;
6) carrying out sterilization and disinfection of products of medical appointment;
7) organization and holding sanitary and anti-epidemic (preventive) actions.
3. In these Health regulations the following concepts are used:
1) antiseptics - the chemical antimicrobic agent intended for application on skin or fabric for the purpose of destruction of microbes;
2) antiseptics - set of methods of destruction or suppression of activity of potentially dangerous microorganisms on skin, mucous membranes, wounds and cavities for the purpose of ensuring treatment and the prevention of development of infectious process;
3) the aseptic mode - complex of the sanitary and sanitary and hygienic actions preventing hit of microbes in wound;
4) aseptic department - rooms for delivery of health care in case of absence at the patient of purulent infection;
5) the box - the room having separate entrance for arrival of the patient from the outside. Are its part: chamber, bathroom, bathtub and lock;
6) individual maternity chamber or chamber of joint stay - the equipped room with bathroom for carrying out childbirth for one woman in labor in whom the woman in childbirth with the newborn are to the statement from hospital;
7) container for safe collection and utilization of medical waste (further - KBSU) - the waterproof and not punctured disposable reservoirs for collection and safe utilization of medical waste;
8) medical waste - the waste which is formed in the course of rendering medical services and carrying out medical manipulations:
9) harmless waste - similar to municipal solid waste, not having contact with biological liquids of patients, infectious patients (the office supplies, packaging, furniture, stock which lost consumer properties, garbage from cleaning of the territory, food wastes of the central catering departments, and also all divisions of the medical organization performing medical activities except infectious, including ftiziatrichesky) - class A;
10) epidemiologically dangerous wastes - the infected and potentially infected waste (the materials and tools, objects polluted by blood and other biological liquids, pathoanatomical waste, organic operational waste: bodies, fabrics, food wastes from infectious departments, waste from microbiological, kliniko-diagnostic laboratories, the pharmaceutical, immunobiological productions working with microorganisms of 3-4 groups of pathogenicity, the biological waste of vivariums, live vaccines unsuitable to use) - class B;
11) extremely epidemiologically dangerous wastes - the materials contacting to sick infectious diseases which can lead to origin extraordinary situations in the field of sanitary and epidemiologic wellbeing of the population and require holding actions for sanitary protection of the territory, waste of laboratories, the pharmaceutical and immunobiological productions working with microorganisms of 1 - 2 groups of pathogenicity, waste of medical and diagnostic divisions of ftiziatrichesky hospitals, waste from patients with anaerobic infection, waste of the microbiological laboratories which are carrying out work with causative agents of tuberculosis - class B;
12) toxicological dangerous wastes - waste (medicinal, including cytostatics, diagnostic, disinfectants) not subject to use, mercury-containing objects, devices and the equipment, waste of raw materials and products of pharmaceutical productions, waste from operation of the equipment, transport, systems of lighting) - class G;
13) radioactive waste - all types of waste, in any aggregate state in which content of radionuclides exceeds the admissible levels established by regulations of radiation safety - class D;
14) the medical organization giving out-patient and polyclinic help - the business entities of health care performing preventive activities for the prevention and decrease in incidence, identification of patients, medical examination, rendering the qualified medical care which is not connected with stationary observation, inspection, treatment and isolation of patients;
15) the sanitary and anti-epidemic mode - complex of actions for the prevention and distribution on health care facilities of infectious and parasitic diseases;
16) portable medical object - the mobile consulting and diagnostic health care facility placed based on vehicles (automobile, railway, sea, river) with the installed special medical equipment, offices of specialists doctors;
17) partner childbirth - presence and participation in families of persons close to the woman in labor;
18) health care facilities - objects on which perform the organization activity of health care and physical persons practising medicine in the field of health care;
19) lock - part of the room between chamber, department and general corridor.
4. Approval of the project documentation on construction and reconstruction, commissioning of again constructed, reconstructed health care facilities is allowed in the presence of the sanitary and epidemiologic conclusion about compliance to requirements of these Health regulations.
5. When designing under construction it is not allowed to allocate the parcel of land in the territories which were earlier used under dumps, fields of cesspool cleaning, cattle mortuaries, cemeteries having pollution of the soil of organic, chemical, radiation nature.
6. Health care facilities shall be located in the territory of the housing estate, green or suburban zones at distance from subjects to industrial and civil function according to requirements of regulatory legal acts for the layout and building of city, settlement and rural settlements and these Health regulations.
7. Specialized health care facilities for patients with specific mode of stay (psychiatric, tubercular, narcological) and complexes capacity over 1000 beds for stay of patients should be placed in residential suburb or suburban areas, whenever possible for a long time - in green massifs, with observance of gaps from the selitebny territory at least 500 meters (further - m).
It is at least to provide continuous barrier on perimeter in antitubercular hospitals height m 2,5, check-point, protection.
8. Passing of the main engineering communications (water supply, water disposal, heat supply, electric utility service) through the territory of health care facilities is not allowed.
In the rural zone it is allowed to place medical out-patient clinics, medical and obstetrical centers, medical aid stations in residential and public buildings taking into account servicing of one or several settlements. In case of placement in residential buildings it is necessary to provide separate entrance from the street.
To residential and public buildings, it is built-in - to the rooms attached to them, in the presence of separate entrance it is allowed to place the organizations giving out-patient and polyclinic help capacity no more than 100 visits per shift including with day hospitals, except for, the infectious patients and persons having alcoholic and drug addiction intended for servicing.
10. It is not allowed to place in the residential and public building: hospital with the round-the-clock stay of patients, microbiological, (virologic, parasitological) laboratory, departments of magnetic and resonant tomography.
The room for magnetic and resonant tomography is not allowed to be placed adjacently (across and verticals) with chambers for pregnant women, children and cardiological patients.
11. The infectious, psychiatric, skin and venereologic, antitubercular departments which are part of multi-profile hospitals are placed in separate buildings.
In the territory of antitubercular hospitals the separate protected walking platforms for patients with bakteriovydeleniye, without bakteriovydeleniye are provided.
12. In infectious and antitubercular departments it is necessary to provide separate entrance (entrance) and the platform for disinfection of transport.
13. It is not allowed to place in ground and basement stores of buildings reception and ward departments for patients, offices electro-sveto - treatments, patrimonial, operational, dressing, procedural, handling, x-ray offices, workshops, warehouses of poisonous, strong, flammable and combustible liquids.
It is not allowed to place dental objects in basement and first floors of public and residential buildings.
14. In septic and aseptic operational blocks (departments) strict zoning of internal rooms (sterile zone, zone of high security, zone of "dirty" rooms) is provided. In case of placement of the operational block it is necessary to provide the warmed transitions in other medical cases. Operating rooms for urgent surgery can be placed as a part of receptions.
15. In case of arrangement of operating rooms one above another septic operating rooms are placed above aseptic.
16. Operational blocks (departments) shall not be checkpoints. Entrances for personnel are provided through sanitary propusknik, for patients through locks.
17. Sanitary propusknik for personnel are designed as a part of three adjacent rooms. The first room is equipped with shower, the bathroom. The second room is used for putting on of net surgical suits, footwear, boot covers. After carrying out transaction the personnel return to the sanitary inspection room through the third room which is intended for collection of the used linen.
18. To provide movement of flows in the operational block (department): "sterile" (the operating and assisting surgeons, the scrub nurse), "net" (anesthesiologists, younger and technicians, deliveries of sick, fresh linen, medicines), "dirty" (removal of medical waste, the used linen, dressing).
19. Aseptic departments (blocks) will organize on the health care facilities which are going in for intensive chemotherapy of patients with malignant new growths, transplantation of marrow and other bodies against the background of preliminary immunosuppressive treatment, treatment of patients with sharp radiation sickness, agranulotsitozy, the diseases proceeding with immunodeficiency and also in other organizations of health care providing specialized and highly specialized medical care.
20. Aseptic departments (blocks) include: chambers with toilet, bathroom or shower, procedural, office of the doctor, still-room, rooms of storage of sterile material and other rooms depending on profile of department.
21. No. 450 is excluded according to the Order of the Government of the Republic of Kazakhstan of 04.05.2014
22. Divisions with the aseptic mode, departments of radiodiagnosis and therapy, division with the closed production cycle: the laboratory, catering department, centralized sterilizing departments (further - TsSO), drugstore, laundry shall not be checkpoints.
23. No. 450 is excluded according to the Order of the Government of the Republic of Kazakhstan of 04.05.2014
24. In the organizations of service of blood, production rooms are designed on function blocks with respect for the technological sequence, the "net" and "conditionally dirty" flows excluding crossing.
25. On objects of maternity welfare and the childhood, in surgical departments of multi-profile hospitals, infectious hospitals (departments) it is necessary to provide zoning of departments.
26. In receptions of gynecologic, maternity departments and reception of children's hospital sanitary propusknik for personnel with wardrobe and shower are equipped.
27. In infectious departments, except general chambers, it is necessary to provide boxes and semi-boxes. The structure of boxes and semi-boxes includes the bathroom consisting of toilet and bathroom, chamber and lock between chamber and corridor. The boxing shall have the platform with exit outside.
28. In all objects giving stationary help, the ward section shall be chanceless.
29. Chambers of bed are established in strict accordance with the area.
Hospitalization and distribution of flows of patients in antitubercular hospitals is carried out according to the epidemiological status (results of microscopy of dab of phlegm, the medicinal sensitivity test, the treatment mode) in order to avoid crossing of flows.
30. In children's departments it is necessary to provide the dining room for children over three years.
31. The day hospital is placed in the independent block and includes the following set of rooms: the waiting area of 10,0 of square meters (further - m 2), office of the doctor of 10,0 of m 2, procedural office of 10,0 of m 2, chambers of day stay taking into account sq.m 6,0 on one bed for the adult, sq.m 4,5 on one bed for the child, bathroom.
32. In each department of the antitubercular organization the room for collection of phlegm which part used for direct collection of phlegm separates on all height of the room the partition made of material steady to washing and to disinfectants is allocated.
33. Each department of antitubercular hospitals is divided into "net" and "dirty" zones, with the lock device between them supplied with devices on air disinfecting, sink for washing of hands.
Hermetic doors of lock need to be placed on all perimeter of the room, to arrange on diagonal, with opening towards "dirty" zone and to equip with the self-closed mechanisms.
34. In bacteriological laboratory of antitubercular dispensaries (departments) for accomplishment of bakterioskopichesky researches it is necessary to determine three separate sections:
1) for preparation and coloring of dabs;
2) for bacterioscopy;
3) for registration and storage of medicines.
35. The reshaping of the medical organizations in hospitals for treatment of TB patients is not allowed.
36. Departments of physical therapy are subdivided into "dry" zone (offices electro-, sacred, heattreatments) and "damp" zone (balneotherapy, mud cure). For holding procedures for each type of treatment certain rooms are equipped. Placement of the equipment for electrotreatment and phototherapy in one room is allowed.
37. In department of acupuncture it is necessary to provide: office of the doctor, procedural office, recreation room for patients and sanitary and household rooms.
38. For contrast bathtubs it is necessary to provide two adjacent pools the sizes 1, in m x 1,75 of m and depth of 1,2 (m 1,3). Transition from one pool to another is performed on ladder between pools.
39. The mud-medical hall consists of separate cabins with the shower cabins and two cabins adjoining them for undressing of patients. The entrance for patients is located only through cabins for undressing and shower.
40. Electromud procedures are carried out in the certain isolated room, being part of rooms of mud cure.
41. The sizes of mirror of water of medical swimming pools are accepted from calculation of 6,0 of sq.m on one engaged.
42. On objects the centralized sterilizing department (further - TsSO), set and which floor area, is accepted according to appendix of 4 these Health regulations is provided. Premises of TsSO are divided into three zones:
1) dirty (acceptance of dirty material, sorting, bookmark in the disinfection jet washer);
2) net (unloading from the disinfection jet washer of the purified, disinfected and dry-through material, packaging, bookmark in sterilizer). For packaging of medical linen there shall be certain room;
3) sterile (intake of sterile material from sterilizers and its storage).
The entrance to the room of net and sterile zones is performed through sanitary propusknik.
Additional rooms: expedition (issue of sterile material), bathrooms and household rooms for medical personnel.
42-1. It is at least to provide in independently organized medical and dental offices washing and sterilizing the area sq.m 6,0 to three workplaces, sq.m 8,0 for four and more workplaces suffices.
Installation of the sterilizing equipment according to the maintenance instruction directly on workplaces is allowed.
43. When designing laundry its performance is accepted at the rate of washing of 2,3 of kilogram (further - kg) dry linen in days on one bed in hospital and 0,4 of kg of dry linen in days on one visit of the out-patient and polyclinic organization.
On health care facilities of small capacity the mini-laundry device (for washing of overalls, towels, napkins) as a part of two rooms is allowed (one for collection and washing, another - for drying and ironing).
44. Provide disinfection department in hospitals (the structure and the areas are determined by capacity of hospital). In the absence of own disinfection department disinfection of bedding can be carried out in the organizations having disinfection cameras.
45. Buildings more than two floors high are equipped with elevators.
At the same time it is necessary to determine elevators on crossings of "dirty" and "net" flows, "conditionally dirty" and "conditionally net" for the prevention, transportation of patients, visitors, deliveries of food of patients.
46. In reception of infectious hospital (including antitubercular) at least two reception and viewing boxes are provided.
In intensive care unit and intensive therapy hospitalization of patients is allowed, passing reception.
47. It is not allowed to place near chambers for sick, medical and diagnostic and procedural offices, the medical and engineering equipment which is source of noise and vibration.
48. For the patients moving on carriages ramps are equipped.
49. For blind and visually impaired ladders above and below, sites of hand-rail of the first and last steps of ladder, are designated by corrugation and contrast coloring.
50. On objects it is necessary to provide separate toilets with wash basins for patients and personnel.
51. The number of sanitary devices (cranes, sinks, bathtubs, toilet bowls, urinals) for patients in ward departments of somatic hospitals if they are not provided under chambers, are accepted at the rate of one device on fifteen people in men's bathrooms and on ten people in women's. The number of urinals in men's rooms is accepted on number of toilet bowls.
Bathrooms of female ward sections are equipped with sink, shower cabin or bathroom with supply of hot and cold water via mixers, toilet bowl and bidet.
52. In sanitary and household rooms for personnel it is necessary to provide:
1) the number of sanitary devices in each department at the rate of one device for women and one device for men;
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