Microclimate parameters determine the heat exchange of the human body and have a significant impact on the functional state various systems body, well-being, performance and health.

The microclimate of the premises of medical institutions is determined by a combination of temperature, humidity, air mobility, the temperature of the surrounding surfaces and their thermal radiation.

The requirements for the microclimate and air environment of the premises are established by SanPiN 2.1.3.1375-03 " Hygiene requirements to the placement, arrangement, equipment and operation of hospitals, maternity hospitals and other medical hospitals.

Heating and ventilation systems should provide optimal conditions microclimate and air environment premises of medical institutions.

The parameters of the design temperature, the frequency of air exchange, the category for the cleanliness of the premises of medical institutions regulated by SanPiN 2.1.3.1375-03 are shown in Table 3.1.

Table 3.1 - Temperature, air exchange rate, cleanliness category in the premises of the central hospital and medical unit

Relative air humidity should be no more than 60%, air speed - no more than 0.15 m / s.

Heaters of heating systems must have a smooth surface that allows easy cleaning, they should be placed at the outer walls, under the windows, without fences. It is not allowed to place heating devices near the inner walls in the chambers.

In operating rooms, preoperative, resuscitation rooms, anesthesia rooms, electrotherapy and psychiatric departments, as well as in intensive care and postoperative wards, heating devices with a smooth surface that is resistant to daily exposure to detergents and disinfectants should be used as heating devices, excluding adsorption of dust and accumulation of microorganisms.

As a heat carrier in systems central heating hospitals use water with a limiting temperature in heating devices of 85 ° C. The use of other liquids and solutions (antifreeze, etc.) as a heat carrier in the heating systems of medical institutions is not allowed.

Buildings of medical institutions should be equipped with systems supply and exhaust ventilation with mechanical impulse and natural exhaust without mechanical impulse.

In infectious departments, including tuberculosis departments, mechanically driven exhaust ventilation is arranged through individual channels in each box and semi-box, which must be equipped with air disinfection devices.

In the absence of supply and exhaust ventilation with mechanical stimulation in the infectious departments, natural ventilation must be equipped with the obligatory equipment of each box and half-box with a recirculation-type air disinfection device that ensures the efficiency of inactivation of microorganisms and viruses of at least 95%.

Design and operation ventilation systems should exclude the overflow of air masses from "dirty" areas to "clean" rooms.

The premises of medical institutions, except for operating rooms, in addition to supply and exhaust ventilation with mechanical stimulation, are equipped with natural ventilation(windows, folding transoms, etc.), equipped with a fixation system.

The intake of outdoor air for ventilation and air conditioning systems is carried out from a clean area at a height of at least 2 m from the ground. outside air, supplied air handling units, is subject to cleaning with coarse and fine filters in accordance with the current regulatory documentation.

The air supplied to operating rooms, anesthesia, resuscitation, postoperative wards, intensive care wards, as well as to wards for patients with skin burns, AIDS patients and other similar medical premises must be treated with air disinfection devices that ensure the effectiveness of inactivation of microorganisms and viruses located in the treated room. air at least 95% (filters high efficiency H11-H14).

Premises of operating rooms, intensive care wards, resuscitation, procedural and other rooms in which release into the air is observed harmful substances, must be equipped with local exhausts or fume hoods.

The levels of bacterial contamination of the indoor air environment depend on their functional purpose and cleanliness class and are also regulated by the requirements of SanPiN 2.1.3.1375-03.

Table 3.2 - Maximum Permissible Concentration and Hazard Classes medicines in the air of the premises of medical institutions

Air ducts of supply ventilation systems after high-efficiency filters (H11-H14) are made of stainless steel.

Split - systems installed in the institution must have a positive sanitary and epidemiological conclusion.

Air ducts, air-distributing and air-inlet grilles, ventilation chambers, ventilation units and other devices must be kept clean, must not have mechanical damage, traces of corrosion, leakage.

Fans and electric motors must not create extraneous noise.

At least once a month, the degree of contamination of filters and the efficiency of air disinfection devices should be monitored. Filter replacement should be carried out as it gets dirty, but not less often than recommended by the manufacturer.

General exchange supply and exhaust and local exhaust units should turn on 5 minutes before the start of work and turn off 5 minutes after the end of work.

In operating rooms and preoperative rooms, supply ventilation systems are first switched on, then exhaust, or both supply and exhaust.

In all rooms, air is supplied to the upper zone of the room. In sterile rooms, air is supplied by laminar or slightly turbulent jets (air velocity< = 0,15 м/с).

Air ducts for supply and exhaust ventilation (air conditioning) must have an inner surface that excludes the removal of air duct material particles into the premises or protective coating. The inner coating must be non-absorbent.

In rooms that are subject to the requirements of aseptic conditions, hidden laying of air ducts, pipelines, fittings is provided. In other rooms it is possible to place air ducts in closed boxes.

Natural exhaust ventilation is allowed for separate buildings with a height of no more than 3 floors (in reception departments, ward buildings, hydrotherapy departments, infectious diseases buildings and departments). At the same time, supply ventilation is provided with mechanical stimulation and air supply to the corridor.

Exhaust ventilation with mechanical stimulation without an organized inflow device is provided from the premises: autoclaves, sinks, showers, latrines, sanitary rooms, rooms for dirty linen, temporary storage of waste and pantries for storing disinfectants.

Air exchange in the wards and departments should be organized in such a way as to maximally limit the flow of air between the ward departments, between the wards, between adjacent floors.

Quantity supply air to the ward should be 80 m3/h per 1 patient.

The movement of air flows should be provided from operating rooms to adjacent rooms (preoperative rooms, anesthetic rooms, etc.), and from these rooms to the corridor. Exhaust ventilation is required in the corridors.

The amount of air removed from the lower zone of the operating rooms should be 60%, from the upper zone - 40%. Innings fresh air is carried out through the upper zone, while the inflow should prevail over the exhaust.

It is necessary to provide separate (isolated) ventilation systems for clean and purulent operating rooms, resuscitation, oncohematological, burn departments, dressing rooms, separate ward sections, X-ray and other special rooms.

Preventive inspection and repair of ventilation systems and air ducts must be carried out according to the approved schedule, at least twice a year. Elimination of current malfunctions, defects should be carried out without delay.

Monitoring of microclimate parameters and air pollution with chemicals, the operation of ventilation systems and the frequency of air exchange should be carried out in the following rooms:

In the main functional rooms of operating rooms, postoperative rooms, intensive care wards, oncohematological, burn, physiotherapy departments, rooms for storing potent and toxic substances, pharmacy warehouses, premises for the preparation of medicines, laboratories, department of therapeutic dentistry, special rooms of radiological departments and in other rooms, in offices, using chemicals and other substances and compounds that can have harmful effect on human health - 1 time in 3 months;

Infectious, incl. tuberculosis departments, bacteriological, viral laboratories, X-ray rooms - 1 time in 6 months; - in other rooms - 1 time in 12 months.

To disinfect the air and surfaces of rooms in medical institutions, ultraviolet bactericidal radiation should be used using bactericidal irradiators approved for use in the prescribed manner.

Methods for the use of ultraviolet germicidal radiation, rules for the operation and safety of germicidal installations (irradiators) must comply with hygienic requirements and instructions for the use of ultraviolet rays.

The assessment of the microclimate is carried out on the basis of instrumental measurements of its parameters (temperature, air humidity, speed of its movement, thermal radiation) at all places of stay of the employee during the shift.

Microclimate- a complex of physical factors internal environment premises, which affects the heat exchange of the body and human health. Microclimatic indicators include temperature, humidity and air velocity, the temperature of the surfaces of enclosing structures, objects, equipment, as well as some of their derivatives (air temperature gradient along the vertical and horizontal of the room, the intensity of thermal radiation from internal surfaces).

The impact of a complex of microclimatic factors is reflected in the heat sensation of a person and determines the characteristics of the physiological reactions of the body. Temperature effects that go beyond neutral fluctuations cause changes in the tone of muscles, peripheral vessels, the activity of sweat glands, and heat production. At the same time, constancy heat balance It is achieved due to the significant tension of thermoregulation, which negatively affects the well-being, working capacity of a person, his state of health.

The thermal state in which the tension of the thermoregulatory system is negligible is defined as thermal comfort. It is provided in the range of optimal microclimatic conditions, within which there is the least stress of thermoregulation and comfortable heat sensation. Optimal norms of M. have been developed, which should provide in medical and preventive and children's institutions, residential, office buildings, as well as at industrial facilities where optimal conditions are necessary for technological requirements. Sanitary norms for optimal M. are differentiated for the cold and warm periods of the year ( tab. one ).

Table 1

Optimal norms for temperature, relative humidity and air velocity in residential, public, administrative premises

For the premises of medical institutions, the design air temperature is normalized, while for premises for various purposes (wards, rooms and treatment rooms), these standards are differentiated. For example, in wards for adult patients, rooms for mothers in children's departments, wards for tuberculosis patients, the air temperature should be 20 °; in wards for new patients, postpartum wards - 22°; in wards for premature, injured, infants and newborns - 25 °.

In those cases when, for a number of technical and other reasons, the optimal norms of M. cannot be ensured, they are guided by permissible norms ( tab. 2 ).

table 2

Permissible standards for temperature, relative humidity and air velocity in residential, public, administrative and amenity premises

Permissible sanitary norms M. in residential and public buildings are provided with the help of appropriate planning equipment, heat-shielding and moisture-proof properties of enclosing structures.

When conducting current sanitary supervision in residential, public, administrative and medical institutions, the air temperature is measured at the level of 1.5 and 0.05 m from the floor in the center of the room and in the outer corner at a distance of 0.5 m from the walls; relative humidity air is determined in the center of the room at a height of 1.5 m from the floor; air speed is set at 1.5 and 0.05 m from the floor in the center of the room and at a distance of 1.0 m from the window; the temperature on the surface of enclosing structures and heating devices is measured at 2-3 points on the surface.

The air temperature gradient along the height of the room and horizontally should not exceed 2°. The temperature on the surface of the walls can be lower than the air temperature in the room by no more than 6 °, the floor - by 2 °, the difference between the air temperature and the temperature of the window glass in the cold season should not exceed an average of 10-12 °, and the thermal effect on the surface of the human body of the flux of infrared radiation from heated heating structures-0.1 cal/cm 2 × min.

Industrial microclimate. The industrial premises are significantly affected by the technological process, while the workplaces located in open areas are significantly affected by the climate and weather of the area.

At a number of industries, the list of which is established by industry documents agreed with the state sanitary supervision authorities, an optimal production microclimate is provided. In booths, on consoles and control posts for technological processes, in computer rooms, as well as in other rooms in which operator-type work is performed, optimal M values ​​\u200b\u200bshould be provided: air temperature 22-24 °, humidity - 40-60%, air speed - no more than 0.1 m/s regardless of the period of the year. Optimal standards are achieved mainly through the use of air conditioning systems. However, the technological requirements of some industries (spinning and weaving shops of textile factories, individual shops Food Industry), as well as technical reasons and economic capabilities of a number of industries (open-hearth, blast furnace, foundry, forging shops of the metallurgical industry, heavy engineering enterprises, glass production and food industry) do not allow for optimal production microclimate standards. In these cases, at permanent and non-permanent workplaces, in accordance with GOST, permissible norms of M.

Depending on the nature of the heat input and the prevalence of one or another indicator of M., shops are distinguished mainly with a convection (for example, food shops of sugar factories, machine rooms of power plants, thermal shops, deep mines) or radiation heating (for example, metallurgical, glass production) microclimate. Convection heating materials are characterized by high air temperatures, sometimes combined with high air humidity (dye departments of textile factories, greenhouses, and sinter shops), which increase the degree of overheating of the human body (see Fig. Overheating of the body ). Radiation heating M. is characterized by the predominance of radiant heat.

If preventive measures are not observed in people who work for a long time in heating M., dystrophic changes in the myocardium, asthenic syndrome, the immunological reactivity of the body decreases, which contributes to an increase in the incidence of workers with acute respiratory diseases, tonsillitis, bronchitis, om, mi. When the body overheats, the adverse effect increases chemical substances, dust, noise, fatigue sets in faster.

Table 3

Optimal values ​​of temperature and air velocity in the working area of ​​the production of other premises, depending on the category of work and periods of the year

Cooling M. in industrial premises can be predominantly convection ( low temperature air, for example, in separate preparatory workshops of the food industry), mainly radiation (low temperature of the fences in cold rooms) and mixed. Cooling contributes to the occurrence of respiratory diseases, exacerbation of diseases of the cardiovascular system. With cooling, coordination of movements and the ability to perform precise operations deteriorate, which leads to both a decrease in performance and an increase in the likelihood industrial injuries. When working outdoors in winter period there is an opportunity frostbite, the use of personal protective equipment is difficult (freezing of respirators when breathing).

Sanitary standards provide for the provision of optimal or acceptable parameters of M. industrial premises, taking into account 5 categories of work, characterized by different levels of energy consumption ( tab. 3 ). The standards regulate the temperature, humidity, air velocity and intensity of thermal exposure of workers (taking into account the area of ​​the irradiated body surface), the temperature of internal surfaces, structures (walls, floors, ceilings) enclosing the working area or devices (for example, screens), the temperature of the outer surfaces of the technological equipment, air temperature fluctuations in height and horizontal working area, its changes during the shift, and also provide necessary measures to protect workplaces from radiation cooling. emanating from the glass surface of window openings (during the cold season) and heating from direct sunlight (during the warm season).

Prevention of overheating of those working in the heating M. is carried out by reducing the external heat load by automating technological processes, remote control, use of collective and individual means protection (heat-absorbing and heat-reflecting screens, air showers, water curtains, radiation cooling systems), regulation of the time of continuous stay at the workplace and in the recreation area with optimal microclimatic conditions, organization of the drinking regime.

To prevent overheating of those working in the summer in an open area, overalls made of air- and moisture-permeable fabrics, materials with high reflective properties are used, and rest is organized in sanitary facilities with optimal temperature, which can be ensured by using air conditioners or radiation cooling systems. . Importance have measures aimed at increasing the body's resistance to thermal effects, including adaptation to this factor.

When working in a cooling M., preventive measures include the use of overalls in the first place (see. clothing ), shoes (see Shoes ), hats and mittens, the heat-shielding properties of which must correspond to meteorological conditions, the severity of the work performed. The time of continuous stay in the cold and breaks for rest in sanitary facilities, which are included in work time. These rooms are additionally equipped with devices for heating hands and feet, as well as devices for drying overalls, shoes, and mittens. To prevent freezing of respirators, devices for heating the inhaled air are used.

Bibliography: Hygienic regulation of factors of the production environment and labor process, ed. N.F. Measured and A.A . Kasparov, p. 71, M., 1986; Provincial Yu . D. and Korenevskaya E.I. Hygienic bases of microclimate conditioning of residential and public buildings, M., 1978, bibliogr.; Occupational Health Guide, ed. N.F. Izmerova, vol. 1, p. 91, M., 1987, Shakhbazyan G.X. and Shleifman F.M. Hygiene of industrial microclimate, Kyiv, 1977, bibliogr.

Microclimate Control Systems in Medical Institutions

A. P. Borisoglebskaya, Candidate of Engineering

keywords: medical and preventive treatment facility, air distribution, microclimate

Controlling of microclimate in Medical and Preventive Treatment Facilities is a complex task requiring special knowledge, experience and regulatory documents, since the same building includes rooms of different cleanness category and regulated air bacterial loads. Therefore, the design process requires serious discussions, studying of the best national practices and foreign experience.

Description:

Ensuring the microclimate in medical buildings or health care facilities is complex, requiring special knowledge, experience and normative documents problem due to the presence in the volume of one building of premises of various classes of cleanliness and standardized levels of bacterial contamination of the air. Therefore, the design process requires serious discussion, study of the best domestic practices and foreign experience.

A. P. Borisoglebskaya , cand. tech. Sci., editor of the issue on the topic "Organization of the microclimate of health care facilities"

Ensuring a microclimate in medical buildings or medical and preventive treatment facilities (HCF) is a complex task that requires special knowledge, experience and regulatory documents due to the presence in the volume of one building of premises of various cleanliness classes and normalized levels of bacterial contamination of the air. Therefore, the design process requires serious discussion, study of the best domestic practices and foreign experience.

Development of the domestic regulatory framework

Having analyzed the history of the design of healthcare facilities, it can be seen that until the beginning of the 90s, there was a production of projects of hospital buildings, the main share of which belonged to standard design. Medical technologies of the treatment process almost did not develop and did not require the modernization of architectural and planning and, accordingly, engineering solutions. Therefore, the projects were quite monotonous, the typification of planning decisions led to the typification of decisions in the field of design engineering systems such as ventilation and air conditioning. So, for a long time, planning decisions were made in projects for such basic structures as hospital wards without locks with direct access to the corridor of the ward section. And only at the very end of the 70s and the beginning of the 80s did the first projects appear with the installation of lock rooms at the wards, which led to a novelty in the adoption of sanitary and technical solutions. The design technology was based on the appropriate normative documentation. In 1970, SNiP 11-L.9-70 “Hospitals and polyclinics. Design Standards”, which for 8 years has been the main standard for designers in a narrow specialization “ medical institutions". It has not yet traced the requirement for the layout of wards with a lock, with the exception of wards for newborns and boxes, semi-boxes of infectious diseases hospitals. In 1978, it was replaced by SNiP 11-69-78 "Treatment and preventive care institutions", in which there is a reasonable requirement for the need to equip the wards with a gateway. Thus arose fundamentally new approach to the design of wards and ward sections. Moreover, joint architectural and planning and sanitary solutions are recommended as the main way to ensure the required microclimate. Also, by 1978, “Instructive and methodological guidelines for the organization of air exchange in ward departments and operating blocks hospitals”, where the requirement for the creation of an isolated air regime chambers due to planning solutions - the creation of gateways at the chambers. Both documents were the result of new research in the field of organization of air exchange in hospitals. Later, in 1989, SNiP 2.08.02–89 “Public Buildings and Structures” was published, which included requirements for the design of health facilities as types of public buildings, and in 1990, an addition to it in the form of a manual for the design of healthcare facilities. This document provided indispensable assistance to designers until 2014, despite the age of origin, until it was replaced by SP 158.13330.2014 “Buildings and premises medical organizations". Then came out sequentially in 2003 and 2010, replacing each other, SanPiN 2.1.3.1375-03 "Hygienic requirements for the placement, arrangement, equipment and operation of hospitals, maternity hospitals and other medical hospitals" and SanPiN 2.1.3.2630-10 "Requirements for organizations engaged in medical activities. Thus, an overview of the main regulatory documents that accompanied project activities in the field of medicine for several decades to the present.

The outbreak of interest in the hygienic aspects of the air environment was especially acute in the 70s. Not only specialists in the design of engineering systems, but also specialists in the field of sanitation and hygiene began to intensively study the quality of the air environment in medical facilities, the state of which was considered unsatisfactory. A large number of publications have appeared on the topic of organizing measures to ensure clean air in the premises of healthcare facilities. Among epidemiologists, for a long time it was believed that the quality of the air environment is determined by the quality of anti-epidemic measures. There is a concept of specific and non-specific infection prevention. In the first case, these are disinfection and sterilization (anti-epidemic measures), in the second case, ventilation and architectural and planning measures. Over time, studies have shown that against the background of specific prevention, current medical and technological processes in health facilities continue to be accompanied by the growth and spread of nosocomial infections. The emphasis began to be placed on sanitary and architectural and planning solutions, which among hygienists began to be considered the main method of non-specific prevention of nosocomial infection (HAI), and they began to play a dominant role.

Design features of health care facilities

During the entire period, especially from the mid-90s to the present, there has been a development of technologies to ensure clean air, starting with the sterilization of air and surfaces of premises and up to the application of modern technical solutions and the introduction the latest equipment in the field of microclimate provision. Appeared modern technologies, allowing to provide and maintain the required conditions of the air environment.

The design of engineering systems in health care facilities has always been and still is difficult task in comparison with the design of a number of other objects related, like health care facilities, to public buildings. Features of the technology for designing heating, ventilation and air conditioning systems in these buildings are directly related to the features of the health facilities themselves. Features of LPU are as follows. The first feature of LPU should be considered a wide range of their names. These are general hospitals and specialized hospitals, maternity hospitals and perinatal centers. The complex of health care facilities includes: infectious diseases hospitals, polyclinics and dispensaries, treatment and diagnostic and rehabilitation centers, medical centers for various purposes, dental clinics, research institutes and laboratories, dispensaries and sanatoriums, ambulance substations and even dairy kitchens and sanitary and epidemiological stations. This entire list of institutions of completely diverse purposes implies the same set of various medical technologies that accompany the operation of buildings. Behind last years medical technologies are growing rapidly: in operating rooms, laboratories and other premises, new and incomprehensible processes are carried out for a non-specialist, complex modern equipment. For design engineers, misunderstood names and abbreviations in the explication of premises become frightening, which cannot be understood without qualified technologists, with the presence of which, as a rule, there are difficulties. On the other hand, the improvement of medical and technological solutions requires new, directly related, engineering solutions, often unknown without the support of technologists or their lack of proper qualifications. All this adds to the complexity of production. design work and often even for an engineer with a long experience in the field of medicine, each new building being designed presents newly set, sometimes research, technological and engineering tasks.

The second feature of LPU should be considered a feature of the sanitary and hygienic state of the air environment of the premises, which is characterized by the presence in the air of the premises of not only mechanical, chemical and gas pollution but also microbiological contamination of the air. The standard criterion for the cleanliness of indoor air in public buildings is the absence of excess heat, moisture and carbon dioxide in it. In healthcare facilities, the main indicator for assessing air quality is nosocomial infection (HAI), which is of particular danger, the source of which is the staff and the patients themselves. It has the peculiarity, regardless of the planned disinfection measures, to accumulate, grow rapidly and spread throughout the premises of the building, and in 95% of cases by air.

The next feature is the nature of the architectural and planning solutions of medical facilities, which have changed qualitatively. There was a time when the hospital building assumed the presence of a group of different buildings located at a distance from each other and separated, respectively, by air from each other. This made it possible to isolate clean and dirty medical and technological processes and patient flows. Clean and dirty rooms were located in separate buildings, which helped to reduce the transmission of infection. AT modern times saving building space in the design, there is a tendency to increase the number of storeys, compactness in terms of and capacity of hospitals, which leads to a reduction in the length of communications and, of course, more economically. On the other hand, this leads to a close relative position of the premises with different classes cleanliness and the possibility of contamination from dirty rooms to clean buildings both vertically and in floor plan.

To justify the recommended requirements for the design of engineering systems in health facilities, it is necessary to dwell on the air regime of buildings (VRZ). Here it is necessary to consider the boundary value problem of VRZ regarding the nature of air movement through openings in the external and internal enclosures of buildings, which directly affects the sanitary and hygienic state of the air environment and can be considered as one of the features of health facilities. The air mode of the medical facility, as in any high-rise building, is unorganized (chaotic) in nature, that is, arising spontaneously due to natural forces. Under VRZ in this case it is necessary to understand the nature of the movement of air flows through the building envelope. On fig. 1 shows a schematic section of the building. The section shows a stairwell (elevator shaft), which, as a single high room, is a vertical connection between the floors of the building and is of particular danger, since it is a channel through which air flows are transferred. Through the leakage of external fences (windows, transoms) there is an unorganized movement of air due to the difference in pressure outside and inside the premises of the building. As a rule, the movement of air at the level of the lower floors occurs from the street into the building, and as the number of storeys increases, the amount of incoming air gradually decreases and approximately at the middle of the height of the building changes its direction to the opposite, and the amount of outgoing air increases by top floor becomes the maximum. In the first case, this phenomenon is called infiltration, in the second - ex-filtration. The same patterns are valid for the movement of air through the openings or their leaks in the internal enclosures of the building. As a rule, on the lower floors of the building, air flows move from the corridor of the floor to the volume of the staircase, and on the upper floors, on the contrary, from the staircase to the floors of the building. That is, the air coming from the premises of the lower floors of the building rises up and is distributed through stairwell to the upper floors. Thus, there is an unorganized flow of air between the floors of the building, and, consequently, the transfer of WFI with its flows. As the number of storeys increases, air pollution in the stair-elevator units increases, which, if the air exchange is not properly organized, leads to an increase in bacterial contamination of the air in the rooms of the upper floors.

There is also unorganized air flow between rooms located on the windward and leeward facades of the building, as well as between adjacent rooms in the floor plan or between sections of departments. On fig. 2 shows the plan of the ward section of the hospital and indicates (arrows) the direction of air movement between the rooms. This is how air flows from the rooms of the wards located on the windward facade of the building to the rooms of the wards located on the windward facade, bypassing the ward lock. It is also obvious that there is a flow from the corridor of one ward section to the corridor of another. The circle shows the required organization of the movement of air flows in the ward block, excluding the flow of air from the ward to the corridor, and from the corridor to the ward.

Under the floor plan there is a fragment of the corridor with the image of active locks - additionally provided rooms with supply or exhaust ventilation in them to prevent air from flowing between the corridors of different sections. In the first case, the gateway is considered “clean”, since flows from it clean air enter the corridor, in the second - "dirty": air from neighboring rooms will flow into the gateway. Thus, assessing the phenomenon of VRZ as a difficult task, it becomes necessary to solve it, which should be reduced to the organization of flows of overflowing air and their control.

The features of health care facilities buildings are taken into account as a whole, since all the considered parameters are interconnected and interdependent, and affect the requirements for the organization of air exchange, architectural planning and technical solutions, isolation of ward departments, sections, wards for patients and premises of operating units, which should be the prevention of nosocomial infection and measures to combat it.

When organizing a rational scheme for the distribution of air flows, it is necessary to take into account the purpose of the premises, especially such as ward departments and operating blocks.

Planning and sanitary-technical solutions of ward departments should exclude the possibility of air flows from stair-elevator nodes to departments and, conversely, from departments to stair-elevator nodes, in departments - from one ward section to another, in ward sections - from the corridor to wards for patients and, conversely, from the wards to the corridor. Such solutions in the field of organizing the movement of air flows presuppose the exclusion of air flow in an undesirable direction and the spread of infectious agents with air flows. On fig. 3 shows a diagram of the organization of air flows, excluding the flow of air between floors.

Thus, the tasks of designing heating, ventilation and air conditioning systems of health facilities should be as follows:

1) maintaining the required parameters of the microclimate of the premises (temperature, speed, humidity, required sanitary standard oxygen, given chemical, radiological and bacterial cleanliness of indoor air) and elimination of odors;

2) exclusion of the possibility of air flow from dirty areas to clean ones, creation of an isolated air regime of wards, ward sections and departments, operating rooms and generic blocks, as well as other structural divisions health care facilities;

3) preventing the formation and accumulation of static electricity and eliminating the risk of an explosion of gases used in anesthesia and other technological processes.

Literature

1. Borisoglebskaya A.P. Medical and preventive institutions. General requirements for the design of heating, ventilation and air conditioning systems. M.: AVOK-PRESS, 2008.
2. Borisoglebskaya A.P. // ABOK. - 2013. - No. 3.
3. Borisoglebskaya A.P. // ABOK. - 2010. - No. 8.
4. Borisoglebskaya A.P. // ABOK. - 2011. - No. 1.
5. // ABOK. - 2009. - No. 2.
6. Tabunshchikov Yu. A., Brodach M. M., Shilkin N. V. Energy efficient buildings. M.: AVOK-PRESS, 2003.
7. Tabunshchikov Yu. A. // ABOK. - 2007. - No. 4.