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       Ñîäåðæàíèå áèáëèîòåêè:

 

Óòâåðæäàþ

Íà÷àëüíèê Ãëàâíîãî

ñàíèòàðíî-ýïèäåìèîëîãè÷åñêîãî

óïðàâëåíèÿ Ìèíçäðàâà ÑÑÑÐ

Â.Ã.ÊÎÂØÈËÎ

4 ìàÿ 1979 ã. N 1980-79

 

Íà÷àëüíèê

Ãëàâíîãî óïðàâëåíèÿ

ëå÷åáíî-ïðîôèëàêòè÷åñêîé

ïîìîùè Ìèíçäðàâà ÑÑÑÐ

È.Â.ØÀÒÊÈÍ

4 ìàÿ 1979 ã. N 10-8/39

 

ÌÅÒÎÄÈ×ÅÑÊÈÅ ÓÊÀÇÀÍÈß

ÏÎ ÊËÀÑÑÈÔÈÊÀÖÈÈ Î×ÀÃΠÒÓÁÅÐÊÓËÅÇÍÎÉ ÈÍÔÅÊÖÈÈ,

ÏÐÎÂÅÄÅÍÈÞ È ÊÎÍÒÐÎËÞ ÊÀ×ÅÑÒÂÀ ÄÅÇÈÍÔÅÊÖÈÎÍÍÛÕ

ÌÅÐÎÏÐÈßÒÈÉ ÏÐÈ ÒÓÁÅÐÊÓËÅÇÅ

 

Íàñòîÿùèå "Ìåòîäè÷åñêèå óêàçàíèÿ" ðàçðàáîòàíû:

Âñåñîþçíûì íàó÷íî-èññëåäîâàòåëüñêèì èíñòèòóòîì äåçèíôåêöèè è ñòåðèëèçàöèè Ìèíèñòåðñòâà çäðàâîîõðàíåíèÿ ÑÑÑÐ.

Öåíòðàëüíûì íàó÷íî-èññëåäîâàòåëüñêèì èíñòèòóòîì òóáåðêóëåçà Ìèíèñòåðñòâà çäðàâîîõðàíåíèÿ ÑÑÑÐ.

Ìåòîäè÷åñêèå óêàçàíèÿ ïðåäíàçíà÷åíû äëÿ ïðîòèâîòóáåðêóëåçíûõ ó÷ðåæäåíèé, äåçèíôåêöèîííûõ ñòàíöèé, ýïèäåìèîëîãè÷åñêèõ è äåçèíôåêöèîííûõ îòäåëîâ (îòäåëåíèé) ñàíèòàðíî-ýïèäåìèîëîãè÷åñêèõ ñòàíöèé.

 

1. ÎÁÙÈÅ ÏÎËÎÆÅÍÈß

 

1.1. Îñíîâíûì èñòî÷íèêîì çàðàæåíèÿ òóáåðêóëåçîì ÿâëÿåòñÿ áîëüíîé ÷åëîâåê, à ïðè íåáëàãîïðèÿòíîé ýïèçîîòîëîãè÷åñêîé ñèòóàöèè - æèâîòíûå è ïòèöû, áîëüíûå òóáåðêóëåçîì. Çàðàæåíèå òóáåðêóëåçîì ïðîèñõîäèò àýðîãåííûì, àëèìåíòàðíûì, êîíòàêòíûì ïóòÿìè. Áèîëîãè÷åñêèå îñîáåííîñòè ñòðîåíèÿ ìèêîáàêòåðèé òóáåðêóëåçà ïîçâîëÿþò èì ñîõðàíÿòü âèðóëåíòíûå ñâîéñòâà íà îáúåêòàõ âíåøíåé ñðåäû äëèòåëüíîå âðåìÿ (äî ãîäà è áîëüøå).

1.2. Ýïèäåìèîëîãè÷åñêàÿ îïàñíîñòü î÷àãîâ òóáåðêóëåçíîé èíôåêöèè íåîäèíàêîâà.  ñâÿçè ñ ýòèì îáúåì è ñîäåðæàíèå ïðîôèëàêòè÷åñêèõ ìåðîïðèÿòèé, ïðîâîäèìûõ â î÷àãàõ, ìåíÿþòñÿ â îïðåäåëåííûõ ïðåäåëàõ.  ïðåäëàãàåìîé êëàññèôèêàöèè î÷àãîâ òóáåðêóëåçíîé èíôåêöèè îáúåì ïðîôèëàêòè÷åñêèõ ìåðîïðèÿòèé çàâèñèò îò ñòåïåíè ìàññèâíîñòè áàöèëëîâûäåëåíèÿ ó áîëüíîãî òóáåðêóëåçîì ëåãêèõ ñ ó÷åòîì ïðîæèâàíèÿ äåòåé, íàëè÷èÿ ðÿäà ôàêòîðîâ, áëàãîïðèÿòíûõ èëè îòÿãîùàþùèõ ýïèäåìèîëîãè÷åñêîå ñîñòîÿíèå î÷àãà.

1.3. Êîìïëåêñ ïðîôèëàêòè÷åñêèõ ìåðîïðèÿòèé â î÷àãàõ òóáåðêóëåçíîé èíôåêöèè âêëþ÷àåò: ïðîâåäåíèå òåêóùåé è çàêëþ÷èòåëüíîé äåçèíôåêöèè, èçîëÿöèþ äåòåé îò áàöèëëîâûäåëèòåëåé ïóòåì ãîñïèòàëèçàöèè áîëüíîãî èëè ïîìåùåíèÿ äåòåé â äåòñêèå ó÷ðåæäåíèÿ, âàêöèíàöèþ íîâîðîæäåííûõ è ðåâàêöèíàöèþ íåèíôèöèðîâàííûõ êîíòàêòèðóþùèõ ñ áîëüíûì ëèö âàêöèíîé ÁÖÆ, ðåãóëÿðíîå îáñëåäîâàíèå êîíòàêòíûõ, ïðîâåäåíèå èì õèìèîïðîôèëàêòèêè, ñàíèòàðíî-ãèãèåíè÷åñêîå âîñïèòàíèå áîëüíûõ è ÷ëåíîâ èõ ñåìåé, óëó÷øåíèå æèëèùíî-áûòîâûõ óñëîâèé, ïåðååçä èç îáùåæèòèÿ, èíòåíñèâíîå ëå÷åíèå áîëüíîãî â óñëîâèÿõ ñòàöèîíàðà ñ ïîñëåäóþùèì ïðîâåäåíèåì êîíòðîëèðóåìîé õèìèîòåðàïèè íà àìáóëàòîðíîì ýòàïå.

Ïðîâåäåíèå âñåãî êîìïëåêñà ïðîôèëàêòè÷åñêèõ ìåðîïðèÿòèé, â òîì ÷èñëå äåçèíôåêöèè, èìååò áîëüøîå çíà÷åíèå äëÿ ïðåäóïðåæäåíèÿ çàáîëåâàíèÿ ëèö, íàõîäÿùèõñÿ â îêðóæåíèè áîëüíîãî àêòèâíîé ôîðìîé òóáåðêóëåçà.

 

2. ÊËÀÑÑÈÔÈÊÀÖÈß Î×ÀÃΠÒÓÁÅÐÊÓËÅÇÍÎÉ ÈÍÔÅÊÖÈÈ

 

2.1. Î÷àãè òóáåðêóëåçíîé èíôåêöèè äåëÿò íà òðè ãðóïïû. Îñíîâàíèåì äëÿ îòíåñåíèÿ î÷àãà â òó èëè èíóþ ãðóïïó ÿâëÿþòñÿ ñëåäóþùèå êðèòåðèè: ìàññèâíîñòü áàöèëëîâûäåëåíèÿ, íàëè÷èå äåòåé è ïîäðîñòêîâ â î÷àãå, æèëèùíûå óñëîâèÿ è ñîáëþäåíèå â î÷àãå ñàíèòàðíî-ãèãèåíè÷åñêèõ ïðàâèë.

2.2. Ìàññèâíîñòü áàöèëëîâûäåëåíèÿ îöåíèâàþò:

à) êàê îáèëüíîå - ïðè îáíàðóæåíèè ìèêîáàêòåðèé òóáåðêóëåçà ìåòîäîì áàêòåðèîñêîïèè èëè ïîñåâà (åñëè îïðåäåëÿþò ðîñò áîëåå 20 êîëîíèé);

á) êàê ñêóäíûå - ïðè âûÿâëåíèè ìèêîáàêòåðèé òîëüêî ìåòîäîì ïîñåâà, íî íå áîëåå 20 êîëîíèé;

â) ôîðìàëüíûì (óñëîâíûì) áàöèëëîâûäåëèòåëåì ïðè âïåðâûå äèàãíîñòèðîâàííîì òóáåðêóëåçå ëåãêèõ è ðåöèäèâå ñ÷èòàþò áîëüíîãî, ó êîòîðîãî ïðåêðàùåíèå áàöèëëîâûäåëåíèÿ, äîñòèãíóòîå â ðåçóëüòàòå ëå÷åíèÿ, ïîäòâåðæäåíî äâóõêðàòíûì è ïîñëåäîâàòåëüíûìè îòðèöàòåëüíûìè áàêòåðèîñêîïè÷åñêèìè è êóëüòóðàëüíûìè èññëåäîâàíèÿìè ñ ïðîìåæóòêîì â 2 - 3 ìåñÿöà (â òå÷åíèå 4 - 6 ìåñÿöåâ îò ìîìåíòà ïåðâîãî îòðèöàòåëüíîãî èññëåäîâàíèÿ).

Ôîðìàëüíûì áàöèëëîâûäåëèòåëåì ïðè õðîíè÷åñêîì äåñòðóêòèâíîì òóáåðêóëåçå ëåãêèõ ñ÷èòàþò áîëüíîãî, ó êîòîðîãî äîñòèãíóòîå â ðåçóëüòàòå ëå÷åíèÿ ïðåêðàùåíèå áàöèëëîâûäåëåíèÿ ïîäòâåðæäåíî ìíîãîêðàòíûìè ïîñëåäîâàòåëüíûìè áàêòåðèîñêîïè÷åñêèìè è êóëüòóðàëüíûìè èññëåäîâàíèÿìè ñ ïðîìåæóòêîì â 2 - 3 ìåñÿöà â òå÷åíèå 1,5 ëåò îò ìîìåíòà ïåðâîãî îòðèöàòåëüíîãî èññëåäîâàíèÿ.

2.3. Æèëèùíûå óñëîâèÿ â î÷àãå îöåíèâàþò êàê íåóäîâëåòâîðèòåëüíûå: ïðè ñûðîì è òåñíîì ïîìåùåíèè; äàæå ïðè íåïðîäîëæèòåëüíîì ïðîæèâàíèè áîëüíîãî â îáùåæèòèè; êîììóíàëüíîé êâàðòèðå èëè â îòäåëüíîé, íî â îäíîé êîìíàòå ñ äåòüìè è ïîäðîñòêàìè.

2.4. Ê ïåðâîé - ýïèäåìèîëîãè÷åñêè íàèáîëåå îïàñíîé ãðóïïå îòíîñÿò âñå î÷àãè, â êîòîðûõ ïðîæèâàþò áîëüíûå ñ îáèëüíûì (ïîñòîÿííûì èëè ïåðèîäè÷åñêèì) áàöèëëîâûäåëåíèåì. Ê ýòîé æå ãðóïïå ïðè÷èñëÿþò è òàêèå î÷àãè, â êîòîðûõ ó áîëüíîãî îáíàðóæèâàþò ñêóäíîå êîëè÷åñòâî ìèêîáàêòåðèé òóáåðêóëåçà, íî ïðè óñëîâèè, ÷òî â î÷àãå ïðîæèâàþò äåòè è ïîäðîñòêè, ëèáî èìååò ìåñòî õîòÿ áû îäèí èç ñëåäóþùèõ îòÿãîùàþùèõ ôàêòîðîâ: ïëîõèå æèëèùíûå óñëîâèÿ, íåñîáëþäåíèå ñàíèòàðíî-ãèãèåíè÷åñêèõ ïðàâèë. Ýòî êàñàåòñÿ îñîáåííî òåõ î÷àãîâ, ãäå áîëüíûå çëîóïîòðåáëÿþò àëêîãîëåì.

2.5. Êî âòîðîé - ýïèäåìèîëîãè÷åñêè ìåíåå îïàñíîé ãðóïïå îòíîñÿò î÷àãè, â êîòîðûõ ïðîæèâàþò áîëüíûå ñî ñêóäíûì áàöèëëîâûäåëåíèåì (ïîñòîÿííûì, ïåðèîäè÷åñêèì) è òîëüêî âçðîñëûå êîíòàêòèðóþùèå ëèöà ïðè óñëîâèè îòñóòñòâèÿ â î÷àãå ïåðå÷èñëåííûõ âûøå îòÿãîùàþùèõ ôàêòîðîâ. Ê ýòîé ãðóïïå ïðè÷èñëÿþò è òàêèå î÷àãè, â êîòîðûõ áîëüíîé ïðèçíàí ôîðìàëüíûì (óñëîâíûì) áàöèëëîâûäåëèòåëåì, íî â íèõ ïðîæèâàþò äåòè èëè ïîäðîñòêè, ëèáî èìååò ìåñòî õîòÿ áû îäèí èç îòÿãîùàþùèõ ôàêòîðîâ.

2.6. Ê òðåòüåé - ýïèäåìèîëîãè÷åñêè ïîòåíöèàëüíî îïàñíîé ãðóïïå îòíîñÿò î÷àãè, â êîòîðûõ ïðîæèâàþò áîëüíûå ñ ôîðìàëüíûì (óñëîâíûì) áàöèëëîâûäåëåíèåì è òîëüêî âçðîñëûå êîíòàêòèðóþùèå ëèöà ïðè îòñóòñòâèè â î÷àãå îòÿãîùàþùèõ ôàêòîðîâ <*>.

--------------------------------

<*> Ïðè âûÿâëåíèè òóáåðêóëåçà ñåëüñêîõîçÿéñòâåííûõ æèâîòíûõ â ÷àñòíîì ñåêòîðå òàêîé î÷àã ïðèçíàåòñÿ ýïèäåìèîëîãè÷åñêè îïàñíûì è âêëþ÷àåòñÿ â òðåòüþ ãðóïïó. Êîíòàêòíûå íàáëþäàþòñÿ â òàêîì î÷àãå â òå÷åíèå ãîäà ïîñëå çàáîÿ áîëüíîãî æèâîòíîãî. Ïîñëå ñäà÷è æèâîòíîãî íà çàáîé ïðîâîäÿò çàêëþ÷èòåëüíóþ äåçèíôåêöèþ.

 

2.7. Ïåðåâîä î÷àãà òóáåðêóëåçíîé èíôåêöèè èç îäíîé ýïèäåìèîëîãè÷åñêîé ãðóïïû â äðóãóþ îñóùåñòâëÿþò âðà÷-ýïèäåìèîëîã ñîâìåñòíî ñ ó÷àñòêîâûì ôòèçèàòðîì ïðè èçìåíåíèè â î÷àãå óñëîâèé, ïîíèæàþùèõ èëè ïîâûøàþùèõ åãî îïàñíîñòü.

 ñîîòâåòñòâèè ñ êëàññèôèêàöèåé î÷àãè èç ïåðâîé ãðóïïû, êàê ïðàâèëî, íå ìîãóò ïåðåâîäèòüñÿ âî âòîðóþ, òàê êàê â ñëó÷àå ñòîéêîãî ïðåêðàùåíèÿ áàöèëëîâûäåëåíèÿ ó áîëüíîãî î÷àã ïîäëåæèò ïåðåâîäó íåïîñðåäñòâåííî â òðåòüþ ãðóïïó î÷àãîâ. Âîçâðàùåíèå î÷àãà â ïåðâóþ èëè âòîðóþ ãðóïïó èç òðåòüåé îñóùåñòâëÿþò ïðè ïîÿâëåíèè â íåì ñîîòâåòñòâóþùèõ ïîêàçàòåëåé ïîâûøåíèÿ åãî ýïèäåìèîëîãè÷åñêîé îïàñíîñòè.

Î÷àã ïåðåñòàåò ñ÷èòàòüñÿ áàöèëëÿðíûì, êîãäà âðà÷-ýïèäåìèîëîã è ó÷àñòêîâûé ôòèçèàòð ñíèìàþò áîëüíîãî ñ ýïèäåìè÷åñêîãî ó÷åòà. Èñêëþ÷åíèå ïðåäñòàâëÿþò î÷àãè, ãäå îñòàâëÿþò êîíòàêòèðóþùèõ ëèö ïîä íàáëþäåíèåì â IV ãðóïïå äèñïàíñåðíîãî ó÷åòà íà ïðîòÿæåíèè 2 ëåò ñ ìîìåíòà âûåçäà èëè ñìåðòè áàöèëëîâûäåëèòåëÿ (â òîì ÷èñëå áîëüíûõ, íåèçâåñòíûõ äèñïàíñåðó, ó êîòîðûõ äåñòðóêòèâíûé òóáåðêóëåç îáíàðóæèâàþò òîëüêî ïðè âñêðûòèè).

 

3. ÒÅÊÓÙÀß ÄÅÇÈÍÔÅÊÖÈß Â Î×ÀÃÀÕ ÒÓÁÅÐÊÓËÅÇÍÎÉ ÈÍÔÅÊÖÈÈ

 

3.1. Òåêóùóþ äåçèíôåêöèþ íà äîìó îðãàíèçóþò ñîòðóäíèêè ïðîòèâîòóáåðêóëåçíûõ ó÷ðåæäåíèé. Îñóùåñòâëÿþò åå ïîñòîÿííî â î÷àãàõ, ãäå ïðîæèâàþò áîëüíûå, ñîñòîÿùèå íà ó÷åòå ýïèäåìèîëîãà è ó÷àñòêîâîãî ôòèçèàòðà.

3.2. Ìåäèöèíñêèé ïåðñîíàë ïðîòèâîòóáåðêóëåçíûõ äèñïàíñåðîâ îáó÷àåò áîëüíîãî è ÷ëåíîâ ñåìüè, óõàæèâàþùèõ çà íèì, ïðàâèëàì ëè÷íîé ãèãèåíû, ìåòîäàì òåêóùåé äåçèíôåêöèè, âûäàåò ïëåâàòåëüíèöû è äåçèíôèöèðóþùèå ñðåäñòâà.

3.3. Âðà÷ ôòèçèàòðè÷åñêîãî ó÷àñòêà íà îñíîâàíèè äàííûõ ëàáîðàòîðíûõ èññëåäîâàíèé óñòàíàâëèâàåò ñòåïåíü îáèëüíîñòè áàöèëëîâûäåëåíèÿ. Çàòåì ñîâìåñòíî ñ âðà÷îì-ýïèäåìèîëîãîì ñàíèòàðíî-ýïèäåìèîëîãè÷åñêîé ñòàíöèè îïðåäåëÿåò ãðóïïó ýïèäåìèîëîãè÷åñêîé îïàñíîñòè êîíêðåòíîãî î÷àãà òóáåðêóëåçíîé èíôåêöèè.

3.4.  òàáëèöå 1 óêàçàíà ÷àñòîòà ïðîôèëàêòè÷åñêèõ ïîñåùåíèé è îáúåì äåçèíôåêöèîííûõ ìåðîïðèÿòèé â î÷àãàõ â çàâèñèìîñòè îò ïðèíàäëåæíîñòè èõ ê òîé èëè èíîé ãðóïïå.

 

Òàáëèöà 1

 


 

ÊËÀÑÑÈÔÈÊÀÖÈß Î×ÀÃΠÒÓÁÅÐÊÓËÅÇÍÎÉ ÈÍÔÅÊÖÈÈ

È ÏÐÎÂÅÄÅÍÈÅ Â ÍÈÕ ÏÐÎÔÈËÀÊÒÈ×ÅÑÊÈÕ ÌÅÐÎÏÐÈßÒÈÉ

 

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                                 │ýïèäåìèî-│ ôòèçèàòðè÷åñêîãî│                       │ äåçèíôåêöèè 

                                 │ëîãîì         ó÷àñòêà                                         

                                 │ÑÝÑ, íå  ├────────┬────────┤                                    

                                 │ìåíåå    │ âðà÷îì,│ñåñòðîé,│                                     

                                          │íå ìåíåå│íå ìåíåå│                                    

├───────────┼──────────────────────┼─────────┼────────┼────────┼───────────────────────┼──────────────┤

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├───────────┼──────────────────────┼─────────┼────────┼────────┼───────────────────────┼──────────────┤

│I.         │à) îáíàðóæåíèå ó      │1 ðàçà â │1 ðàçà â│1 ðàçà â│Îáåççàðàæèâàíèå        │Íå ìåíåå 2 ðàç│

│Ýïèäåìèîëî-│ïðîæèâàþùåãî â î÷àãå  │êâàðòàë  êâàðòàë │ìåñÿö   │îáúåêòîâ: ïëåâàòåëüíèö,│â ãîä        

│ãè÷åñêè    │áîëüíîãî îáèëüíîãî                             │ïîñóäû, áåëüÿ, ìîêðîòû,│             

│íàèáîëåå   │(ïîñòîÿííîãî èëè                               │ïðåäìåòîâ óáîðêè                    

îïàñíàÿ    │ïåðèîäè÷åñêîãî)                                │ïîìåùåíèé. Åæåäíåâíàÿ               

           │áàöèëëîâûäåëåíèÿ                               │âëàæíàÿ óáîðêà                      

           │á) îáíàðóæåíèå ó                               │ïîìåùåíèé ñ                         

           │áîëüíîãî ñêóäíîãî                              îáÿçàòåëüíûì                        

           │áàöèëëîâûäåëåíèÿ ïðè                           │èñïîëüçîâàíèåì                      

           ïðîæèâàíèè â î÷àãå                             │äåçèíôèöèðóþùèõ ñðåäñòâ│             

           │äåòåé è ïîäðîñòêîâ èëè│                         │ïðè îáðàáîòêå ìåñò                  

           íàëè÷èè â íåì                                  │îáùåãî ïîëüçîâàíèÿ, à               

           │îòÿãîùàþùèõ ôàêòîðîâ                           │ïî ïîêàçàíèÿì - âñåé                

           │(íåóäîâëåòâîðèòåëüíûå │                         │êâàðòèðû (â î÷àãàõ                  

           │æèëèùíûå óñëîâèÿ,                              │áîëüíûõ ñ îáèëüíûì                  

           │íåñîáëþäåíèå                                   │áàöèëëîâûäåëåíèåì)                  

           │ñàíèòàðíî-ãèãèåíè÷åñ- │                                                             

           │êèõ ïðàâèë)                                                                        

                                                                                              

│II.        │à) îáíàðóæåíèå ó      │1 ðàçà â │1 ðàçà â│1 ðàçà  │Îáåççàðàæèâàíèå        │Íå ìåíåå 1   

│Ýïèäåìèîëî-│áîëüíîãî ñêóäíîãî     │ïîëãîäà  ïîëãîäà │â 2     │îáúåêòîâ (êàê â I      │ðàçà â ãîä   

│ãè÷åñêè    │áàöèëëîâûäåëåíèÿ ïðè                   │ìåñÿöà  │ãðóïïå).                            

│ìåíåå      │ïðîæèâàíèè â î÷àãå                             Åæåäíåâíàÿ âëàæíàÿ                  

│îïàñíàÿ    │òîëüêî âçðîñëûõ è                              │óáîðêà ïîìåùåíèé, à ïî             

           │îòñóòñòâèè â íåì                               │ïîêàçàíèÿì - ñ                      

           │îòÿãîùàþùèõ ôàêòîðîâ                          │èñïîëüçîâàíèåì                      

           │á) óñòàíîâëåíèå ó                              äåçèíôèöèðóþùèõ                     

           │áîëüíîãî ôîðìàëüíîãî                           │ðàñòâîðîâ ïðè îáðàáîòêå│              

           │áàöèëëîâûäåëåíèÿ ïðè                           │ìåñò îáùåãî ïîëüçîâàíèÿ│             

           │ïðîæèâàíèè â î÷àãå                             │â î÷àãàõ áîëüíûõ ñî                 

           │äåòåé è ïîäðîñòêîâ èëè│                         ñêóäíûì                             

           íàëè÷èè â íåì õîòÿ áû │                         │áàöèëëîâûäåëåíèåì                   

           │îäíîãî èç îòÿãîùàþùèõ │                                                             

           │ôàêòîðîâ                                                                           

                                                                                              

│III.       │Ôîðìàëüíîå (óñëîâíîå) │1 ðàçà â │1 ðàçà â│1 ðàçà â│Åæåäíåâíàÿ âëàæíàÿ     │Íå ïðîâîäèòñÿ │

│Ýïèäåìèîëî-│áàöèëëîâûäåëåíèå ó    │ãîä      ãîä     │ïîëãîäà │óáîðêà ïîìåùåíèÿ                    

│ãè÷åñêè    │áîëüíîãî ïðè                                                                       

│ïîòåíöèàëü-│ïðîæèâàíèè â î÷àãå                                                                 

│íî îïàñíàÿ │òîëüêî âçðîñëûõ è                                                                  

           îòñóòñòâèè â íåì                                                                   

           │îòÿãîùàþùèõ ôàêòîðîâ                                                               

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Ðåçóëüòàòû íàáëþäåíèÿ çà î÷àãîì òóáåðêóëåçíîé èíôåêöèè è ïðîâåäåííûå â íåì ìåðîïðèÿòèÿ ñèñòåìàòè÷åñêè âíîñÿò â êàðòó ó÷àñòêîâîé ìåäñåñòðû ïðîòèâîòóáåðêóëåçíîãî äèñïàíñåðíîãî ó÷ðåæäåíèÿ (ôîðìà 93), êîíòðîëüíóþ êàðòó äèñïàíñåðíîãî íàáëþäåíèÿ (ôîðìà Ô-Ó-30-4) è â êàðòó ýïèäåìèîëîãè÷åñêîãî îáñëåäîâàíèÿ î÷àãà òóáåðêóëåçà ñàíèòàðíî-ýïèäåìèîëîãè÷åñêîé ñòàíöèè.

3.5. Ïðè ïîñåùåíèè î÷àãà îñîáîå âíèìàíèå îáðàùàþò íà ñîáëþäåíèå áîëüíûì ïðàâèë ëè÷íîé ãèãèåíû: ÷èñòîòó ðóê, ÷àñòîòó ìûòüÿ èõ ñ ìûëîì, ñâîåâðåìåííóþ ñìåíó áåëüÿ.

3.6.  öåëÿõ ìàêñèìàëüíîé èçîëÿöèè áîëüíîìó âûäåëÿþò: êîìíàòó èëè ÷àñòü åå, îòãîðîæåííóþ øèðìîé, êðîâàòü, âåøàëêó äëÿ âåðõíåé îäåæäû, ïîëîòåíöå, ïîñóäó, áåëüå.

 êîìíàòå áîëüíîãî ìàêñèìàëüíî îãðàíè÷èâàþò ÷èñëî ïðåäìåòîâ, íåîáõîäèìûõ äëÿ ïîâñåäíåâíîãî ïîëüçîâàíèÿ, óáèðàþò êîâðû, îñòàâëÿþò òîëüêî âåùè, ëåãêî ïîääàþùèåñÿ ìûòüþ, î÷èñòêå, îáåççàðàæèâàíèþ. Ìÿãêóþ ìåáåëü çàêðûâàþò ÷åõëàìè. Êðîâàòü áîëüíîãî óñòàíàâëèâàþò íà ðàññòîÿíèè íå ìåíåå 0,5 ì îò ñòåíû, à îò êðîâàòåé äðóãèõ ÷ëåíîâ ñåìüè - íå ìåíåå 1,5 ì.

3.7. Âî âðåìÿ óõîäà çà áîëüíûì è ïðîâåäåíèÿ îáåççàðàæèâàíèÿ îáúåêòîâ íàäåâàþò òåõíè÷åñêèå ïåð÷àòêè, õàëàò, êîñûíêó èëè êîëïàê, à ïðè ñáîðå áåëüÿ - ìàðëåâóþ ïîâÿçêó (èç 4 ñëîåâ).

3.8. Ìîêðîòó áîëüíîé ñîáèðàåò â îäíó ïëåâàòåëüíèöó, à äðóãóþ, çàïîëíåííóþ ìîêðîòîé (Ïðèëîæåíèå 1), îáåççàðàæèâàåò. Ïðè âûõîäå èç äîìà âêëàäûâàåò â êàðìàí ôóòëÿð èç ìÿãêîé òêàíè äëÿ ïðåäîõðàíåíèÿ îò âîçìîæíîãî çàãðÿçíåíèÿ êàðìàíà ïðè ñáîðå ìîêðîòû â ïëåâàòåëüíèöó.

3.9. Îñòàòêè ïèùè ñîáèðàþò â åìêîñòè, çàêðûâàþò êðûøêîé è îáåççàðàæèâàþò.

3.10. Ïîñóäó áåç ïðåäâàðèòåëüíîãî ìûòüÿ îáåççàðàæèâàþò ïîñëå êàæäîãî ïðèåìà ïèùè. Çàòåì ìîþò â ïðîòî÷íîé âîäå.

3.11. Ãðÿçíîå áåëüå, ñïåöîäåæäó ïîìåùàþò â áàê ñ ïëîòíîé êðûøêîé èëè ìàòåð÷àòûé ìåøîê èç ïðî÷íîé òêàíè, îòäåëüíî îò áåëüÿ ÷ëåíîâ ñåìüè. Îáåççàðàæèâàþò â åìêîñòÿõ èç ðàñ÷åòà íà 1 êã ñóõîãî áåëüÿ 5 ë äåçèíôèöèðóþùåãî ðàñòâîðà èëè âîäû (ïðè êèïÿ÷åíèè). Çàòåì ïðîïîëàñêèâàþò è ñòèðàþò.

3.12. Êâàðòèðó áîëüíîãî åæåäíåâíî óáèðàþò âåòîøüþ, ñìî÷åííîé â ìûëüíî-ñîäîâîì èëè äåçèíôèöèðóþùåì ðàñòâîðå, ïðè îòêðûòûõ äâåðÿõ è îêíàõ. Ïðè íàëè÷èè â ïîìåùåíèè ìóõ äî äåçèíôåêöèè ïðîâîäÿò äåçèíñåêöèîííûå ìåðîïðèÿòèÿ.

3.13. Ïðåäìåòû óõîäà çà áîëüíûìè è óáîðî÷íûé èíâåíòàðü îáåççàðàæèâàþò â îòäåëüíûõ åìêîñòÿõ ïîñëå êàæäîãî èõ èñïîëüçîâàíèÿ.

 

4. ÇÀÊËÞ×ÈÒÅËÜÍÀß ÄÅÇÈÍÔÅÊÖÈß

 Î×ÀÃÀÕ ÒÓÁÅÐÊÓËÅÇÍÎÉ ÈÍÔÅÊÖÈÈ

 

4.1. Çàêëþ÷èòåëüíóþ äåçèíôåêöèþ ïðîâîäÿò ñîòðóäíèêè äåçèíôåêöèîííîé ñòàíöèè, äåçèíôåêöèîííîãî îòäåëà (îòäåëåíèÿ) ñàíèòàðíî-ýïèäåìèîëîãè÷åñêîé ñòàíöèè â òå÷åíèå 6 (ãîðîä) èëè 12 ÷àñîâ (ñåëî) ñî âðåìåíè ïîëó÷åíèÿ çàÿâêè îò ïðîòèâîòóáåðêóëåçíîãî äèñïàíñåðà.

4.2. Çàêëþ÷èòåëüíóþ äåçèíôåêöèþ îñóùåñòâëÿþò âî âñåõ ñëó÷àÿõ âûáûòèÿ áîëüíîãî èç î÷àãà â áîëüíèöó, ñàíàòîðèé è ïð.; ïðè ïåðåìåíå ìåñòà æèòåëüñòâà äî ïåðååçäà (îáðàáîòêà êâàðòèðû èëè êîìíàòû ñ âåùàìè) è ïîâòîðíàÿ - ïîñëå ïåðååçäà (îáðàáîòêà ïóñòîé êîìíàòû, êâàðòèðû); ïåðåä âîçâðàùåíèåì ðîäèëüíèö èç ðîääîìîâ; ïåðåä ñíîñîì ñòàðûõ äîìîâ, ãäå ïðîæèâàëè áîëüíûå òóáåðêóëåçîì; â ñëó÷àå ñìåðòè áîëüíîãî îò òóáåðêóëåçà íà äîìó.

4.3. Ïðè íåâûåçäå áîëüíîãî èç î÷àãà â òå÷åíèå ãîäà êðàòíîñòü ïðîâåäåíèÿ çàêëþ÷èòåëüíîé äåçèíôåêöèè çàâèñèò îò ãðóïïû ýïèäåìèîëîãè÷åñêîé îïàñíîñòè î÷àãà (òàáëèöà 1).

4.4. Ïåðåä íà÷àëîì ðàáîòû â î÷àãå íàäåâàþò ñïåöèàëüíóþ îäåæäó, óíè÷òîæàþò ìóõ â êâàðòèðå, ãîòîâÿò äåçèíôèöèðóþùèå ðàñòâîðû, îáåççàðàæèâàþò ïëåâàòåëüíèöû ñ ìîêðîòîé, ïîñóäó, îñòàòêè ïèùè, áåëüå. Ïðîâîäÿò ñáîð è îôîðìëåíèå äîêóìåíòîâ íà âåùè, ïîäëåæàùèå êàìåðíîìó îáåççàðàæèâàíèþ.

4.5. Ïðè îáðàáîòêå ïîìåùåíèÿ îáðàùàþò âíèìàíèå íà ìåñòà ñêîïëåíèÿ ïûëè (ïëèíòóñà, êàðíèçû, îòîïèòåëüíûå áàòàðåè). Ñíà÷àëà ðàâíîìåðíî îðîøàþò ñòåíû íà óðîâíå 1,5 ì îò ïîâåðõíîñòè ïîëà, à çàòåì ïîë, ïåðåõîäÿ îò íàèáîëåå óäàëåííûõ îáúåêòîâ ê äâåðè.

4.6. Ïî îêîí÷àíèè ðàáîòû ñíèìàþò ñïåöîäåæäó, ñêëàäûâàþò åå â îòäåëüíûå ìåøêè, êîòîðûå îòïðàâëÿþò â äåçêàìåðó.

 

5. ÒÅÊÓÙÀß ÄÅÇÈÍÔÅÊÖÈß Â ÏÐÎÒÈÂÎÒÓÁÅÐÊÓËÅÇÍÛÕ Ó×ÐÅÆÄÅÍÈßÕ

 

5.1. Ãëàâíûé âðà÷ ïðîòèâîòóáåðêóëåçíîãî ó÷ðåæäåíèÿ íåñåò îòâåòñòâåííîñòü çà íàäåæíóþ è ñâîåâðåìåííóþ îðãàíèçàöèþ òåêóùåé äåçèíôåêöèè, íàçíà÷àåò ïðèêàçîì âðà÷à îòäåëåíèÿ, îòâåòñòâåííîãî çà ïðàâèëüíîå åå ïðîâåäåíèå.

5.2.  ïðîòèâîòóáåðêóëåçíîì ó÷ðåæäåíèè íå äîïóñêàþò âûäà÷ó íåîáåççàðàæåííûõ âåùåé èç ñòàöèîíàðà ðîäñòâåííèêàì áîëüíîãî.

5.3. Ñïåöèàëüíî ïîäãîòîâëåííûé ïåðñîíàë îñóùåñòâëÿåò ñáîð, òðàíñïîðòèðîâêó, îáåççàðàæèâàíèå è âûäà÷ó ïëåâàòåëüíèö. Ñíà÷àëà ðàçäàþò áîëüíûì ÷èñòûå, çàïîëíåííûå íà îäíó òðåòü âîäîé, ïëåâàòåëüíèöû. Íàäåâàþò ñïåöîäåæäó, ïåð÷àòêè è ñîáèðàþò â òàðó ñ êðûøêîé ïëåâàòåëüíèöû, çàïîëíåííûå ìîêðîòîé. Îáåççàðàæèâàþò èõ íà "ãðÿçíîé" ïîëîâèíå ïîìåùåíèÿ, ïðåäíàçíà÷åííîãî äëÿ äåçèíôåêöèè ìîêðîòû.

5.4. Ãðÿçíóþ ïîñóäó ñîáèðàþò â ïåð÷àòêàõ íà ïðîìàðêèðîâàííûé ñòîë â áóôåòíîé, îñâîáîæäàþò åå îò îñòàòêîâ ïèùè, îáåççàðàæèâàþò áåç ïðåäâàðèòåëüíîãî ìûòüÿ â îòäåëüíûõ åìêîñòÿõ, çàòåì ìîþò è, íå âûòèðàÿ, ñóøàò â ñóøèëüíîì øêàôó èëè íà îòäåëüíîì ñòîëå. Ïîñëå ñáîðà ãðÿçíîé ïîñóäû ñòîëû ïðîòèðàþò âåòîøüþ, ñìî÷åííîé â äåçèíôèöèðóþùåì ðàñòâîðå.

Ïðè íàëè÷èè ëîêàëüíûõ î÷èñòíûõ ñîîðóæåíèé ñ õëîðàòîðíîé ïîñóäó ìîþò â ìîå÷íûõ ìàøèíàõ è îáåççàðàæèâàþò â ñóøèëüíî-ñòåðèëèçàöèîííîì øêàôó.

Îñòàòêè ïèùè çàñûïàþò ïðåïàðàòîì èëè çàëèâàþò äåçèíôèöèðóþùèì ðàñòâîðîì â îòäåëüíûõ åìêîñòÿõ. Ïðè òåðìè÷åñêîì ìåòîäå îñòàòêè ïèùè êèïÿòÿò â ïàðîâàðî÷íûõ êîòëàõ, ïîñëå ÷åãî îíè ìîãóò áûòü ñêîðìëåíû ñêîòó.

5.5. Ñîðòèðîâêó ãðÿçíîãî áåëüÿ ïðîâîäÿò â ñïåöîäåæäå, ðåñïèðàòîðàõ, ïåð÷àòêàõ, ðåçèíîâîé îáóâè â êîìíàòå, ñòåíû êîòîðîé âûëîæåíû êàôåëåì íà âûñîòó 1,5 ì.  ýòîé êîìíàòå ïðåäóñìàòðèâàþò óñòðîéñòâî âûòÿæíîé âåíòèëÿöèè. Áåëüå ñîáèðàþò â ìåøêè èç ïëîòíîé òêàíè, íàïðàâëÿþò â ïðà÷å÷íóþ, ãäå åãî îáåççàðàæèâàþò, à çàòåì ñòèðàþò. Ïðè îòñóòñòâèè îòäåëüíîé ïðà÷å÷íîé áåëüå, ïðåäâàðèòåëüíî îáåççàðàæåííîå, îòïðàâëÿþò â ñïåöèàëèçèðîâàííûå ïðà÷å÷íûå, ãäå åãî ñòèðàþò â îòäåëüíûõ ìàøèíàõ â óñòàíîâëåííûå äíè. Ïîñëå ñîðòèðîâêè ãðÿçíîãî áåëüÿ ïîìåùåíèå îáðàáàòûâàþò äåçèíôèöèðóþùèì ðàñòâîðîì.

5.6. Âåùè ãîñïèòàëèçèðîâàííûõ áîëüíûõ îáåççàðàæèâàþò â äåçèíôåêöèîííîé êàìåðå è ñêëàäûâàþò â îòäåëüíóþ êîìíàòó, îòêóäà èõ âûäàþò áîëüíûì íà âðåìÿ äíåâíûõ ïðîãóëîê. Ïåðåä âûïèñêîé áîëüíîãî âñå åãî âåùè îáåççàðàæèâàþò â äåçèíôåêöèîííîé êàìåðå.

5.7. Ïîìåùåíèå è ïðåäìåòû îáñòàíîâêè â ïðîòèâîòóáåðêóëåçíûõ ó÷ðåæäåíèÿõ ïîäâåðãàþò äâóêðàòíîé åæåäíåâíîé âëàæíîé óáîðêå (ìîæíî ïðè îòêðûòûõ äâåðÿõ è îêíàõ). Äåçèíôèöèðóþùèå ñðåäñòâà ïðè âëàæíîé óáîðêå ïðèìåíÿþò òàì, ãäå ìîãóò íàõîäèòüñÿ áîëüíûå, âûäåëÿþùèå ìèêîáàêòåðèè òóáåðêóëåçà (ïàëàòû, êàáèíåòû, ñòîëîâàÿ, ìåñòà îáùåãî ïîëüçîâàíèÿ), èëè ïðîâîäÿò ðàáîòó ñ ìàòåðèàëîì, îáñåìåíåííûì ìèêîáàêòåðèÿìè (áåëüåâàÿ, áàêòåðèîëîãè÷åñêàÿ ëàáîðàòîðèÿ è ò.ä.).

 

6. ÇÀÊËÞ×ÈÒÅËÜÍÀß ÄÅÇÈÍÔÅÊÖÈß

 ÏÐÎÒÈÂÎÒÓÁÅÐÊÓËÅÇÍÛÕ Ó×ÐÅÆÄÅÍÈßÕ

 

6.1. Çàêëþ÷èòåëüíóþ äåçèíôåêöèþ â ïðîòèâîòóáåðêóëåçíûõ ó÷ðåæäåíèÿõ ïðîâîäÿò ñîòðóäíèêè äåçèíôåêöèîííîé ñòàíöèè èëè äåçèíôåêöèîííîãî îòäåëà (îòäåëåíèÿ) ñàíèòàðíî-ýïèäåìèîëîãè÷åñêîé ñòàíöèè ïî çàÿâêå ãëàâíîãî âðà÷à ïðîòèâîòóáåðêóëåçíîãî ó÷ðåæäåíèÿ íå ðåæå îäíîãî ðàçà â ãîä è âî âñåõ ñëó÷àÿõ ïåðåïðîôèëèðîâàíèÿ, ïåðååçäà, ðåìîíòà èëè ñëîìà çäàíèÿ.

6.2. Ìîêðîòó, ïîñóäó, áåëüå îáåççàðàæèâàþò, êàê ïðè òåêóùåé äåçèíôåêöèè. Ïîâåðõíîñòè ïîëà, ñòåí, äâåðåé, ïðåäìåòû îáñòàíîâêè îðîøàþò äåçèíôèöèðóþùèì ðàñòâîðîì, íà÷èíàÿ ñ âåðõíèõ ýòàæåé è íàèáîëåå óäàëåííûõ ìåñò îò âõîäà ïàëàò (êàáèíåòîâ).

6.3. Ïðè àýðîçîëüíîì ìåòîäå äåçèíôåêöèè ïîìåùåíèÿ è ïðåäìåòîâ îáñòàíîâêè îêîííûå è äâåðíûå ïåðåïëåòû çàêëåèâàþò, îòêðûâàþò äâåðè øêàôîâ, âûäâèãàþò ÿùèêè ñòîëîâ.

6.4. Ïî óñìîòðåíèþ ãëàâíîãî âðà÷à ïîñëå çàêëþ÷èòåëüíîé äåçèíôåêöèè ïðîâîäÿò òåêóùèé ðåìîíò. Íà òåððèòîðèè ïðîòèâîòóáåðêóëåçíîãî ó÷ðåæäåíèÿ îáèëüíî îðîøàþò 10% õëîðíî-èçâåñòêîâûì ìîëîêîì ïî÷âó â ðàäèóñå 1 ì îò óðí, áåëÿò óðíû, îêðàøèâàþò ñêàìåéêè.

 

7. ÌÅÐÛ ÏÐÅÄÎÑÒÎÐÎÆÍÎÑÒÈ ÏÐÈ ÐÀÁÎÒÅ Ñ ÄÅÇÈÍÔÈÖÈÐÓÞÙÈÌÈ

ÑÐÅÄÑÒÂÀÌÈ È ÎÊÀÇÀÍÈÅ ÏÅÐÂÎÉ ÄÎÂÐÀ×ÅÁÍÎÉ ÏÎÌÎÙÈ

 

7.1. Ïðè òåêóùåé è çàêëþ÷èòåëüíîé äåçèíôåêöèè â î÷àãàõ òóáåðêóëåçà ñîáëþäåíèå ìåð ïðåäîñòîðîæíîñòè èñêëþ÷àåò âîçìîæíîñòü îòðàâëåíèÿ ÿäîõèìèêàòàìè.

7.2. Ïåðåä ðàáîòîé ïðîâåðÿþò öåëîñòíîñòü ïåð÷àòîê, ïðèãîäíîñòü ðåñïèðàòîðîâ, èñïðàâíîñòü ñïåöîäåæäû. Äëÿ çàùèòû îðãàíîâ äûõàíèÿ ïðè ðàñôàñîâêå ïðåïàðàòîâ ïðèìåíÿþò ïðîòèâîïûëåâûå ðåñïèðàòîðû Ô-46Ê; Ó-Ê; Ô-62-111. Äëÿ çàùèòû êîæíûõ ïîêðîâîâ íàäåâàþò õëîï÷àòîáóìàæíûå ïåð÷àòêè (ÊÐ), à ãëàç - ãåðìåòè÷åñêèå î÷êè ÏÎ-2.

7.3. Ïðè îðîøåíèè ïîìåùåíèé ðàñòâîðàìè îðãàíû äûõàíèÿ çàùèùàþò ðåñïèðàòîðàìè ÐÓ-60Ì; ÐÏÃ-67 ñ ïàòðîíîì ìàðêè Â, íà ðóêè íàäåâàþò òåõíè÷åñêèå ïåð÷àòêè, à ãëàçà çàùèùàþò î÷êàìè ÏÎ-2.

7.4. Ïðè çàìî÷êå áåëüÿ, ïîãðóæåíèè ïîñóäû, ïðîòèðàíèè ïîâåðõíîñòåé íà ðóêè íàäåâàþò òåõíè÷åñêèå ïåð÷àòêè.

7.5. Ïðè ïîïàäàíèè äåçèíôèöèðóþùåãî ñðåäñòâà íà êîæíûå ïîêðîâû åãî óäàëÿþò ñòðóåé òåïëîé âîäû ñ ìûëîì.

7.6. Ïðè ðàçäðàæåíèè ãîðëà åãî ïðîïîëàñêèâàþò 2% ðàñòâîðîì ïèòüåâîé ñîäû. Íàçíà÷àþò ùåëî÷íûå èíãàëÿöèè: 1 - 2 ÷àéíûå ëîæêè ïèòüåâîé ñîäû ñ 15 êàïëÿìè íàøàòûðíîãî ñïèðòà íà ñòàêàí êèïÿ÷åíîé âîäû. Ïðè êàøëå ñòàâÿò êðóãîâûå áàíêè, ãîð÷è÷íèêè. Ïðè ðàçäðàæåíèè ãëàç çàêàïûâàþò 2% ðàñòâîð àëüáóöèäà, ïðè áîëåçíåííîñòè - 2% ðàñòâîð íîâîêàèíà.

 

8. ÊÎÍÒÐÎËÜ ÊÀ×ÅÑÒÂÀ ÒÅÊÓÙÅÉ È ÇÀÊËÞ×ÈÒÅËÜÍÎÉ ÄÅÇÈÍÔÅÊÖÈÈ

 

8.1. Âèçóàëüíûé êîíòðîëü êà÷åñòâà òåêóùåé äåçèíôåêöèè â ïðîòèâîòóáåðêóëåçíûõ ó÷ðåæäåíèÿõ ïðîâîäèò âðà÷, îòâåòñòâåííûé çà ïðîòèâîýïèäåìè÷åñêèé ðåæèì, åæåäíåâíî, à ñîòðóäíèê ñàíèòàðíî-ýïèäåìèîëîãè÷åñêîé è äåçèíôåêöèîííîé ñòàíöèè - åæåêâàðòàëüíî.  êâàðòèðíûõ î÷àãàõ ÷àñòîòà ïîñåùåíèé ñâÿçàíà ñ ãðóïïîé èõ ýïèäåìèîëîãè÷åñêîé îïàñíîñòè (òàáëèöà 1).

8.2. Õèìè÷åñêèé êîíòðîëü êà÷åñòâà òåêóùåé äåçèíôåêöèè âûïîëíÿþò ðàáîòíèêè äåçèíôåêöèîííîãî îòäåëà (îòäåëåíèÿ) ñàíèòàðíî-ýïèäåìèîëîãè÷åñêîé è äåçèíôåêöèîííîé ñòàíöèé. Ïðè î÷åðåäíîì ïîñåùåíèè êâàðòèðíîãî î÷àãà èëè ïðîòèâîòóáåðêóëåçíîãî ó÷ðåæäåíèÿ îíè îòáèðàþò ïðîáû ñóõîãî ïðåïàðàòà è äåçèíôèöèðóþùèõ ðàñòâîðîâ, äîñòàâëÿþò â ëàáîðàòîðèþ, ãäå îïðåäåëÿþò â ïðîáàõ ñîäåðæàíèå àêòèâíî äåéñòâóþùåãî âåùåñòâà è äåëàþò çàêëþ÷åíèå î êà÷åñòâå äåçèíôèöèðóþùåãî ñðåäñòâà èëè î ïðàâèëüíîñòè ïðèãîòîâëåíèÿ ðàñòâîðîâ.

8.3. Âèçóàëüíûé è õèìè÷åñêèé êîíòðîëü çàêëþ÷èòåëüíîé äåçèíôåêöèè îñóùåñòâëÿþò ñîòðóäíèêè äåçèíôåêöèîííîé ñòàíöèè èëè äåçèíôåêöèîííîãî îòäåëà (îòäåëåíèÿ) ñàíèòàðíî-ýïèäåìèîëîãè÷åñêîé ñòàíöèè â ïðèñóòñòâèè äåçèíôåêöèîííîé áðèãàäû âíåçàïíî èëè âñëåä çà îòúåçäîì áðèãàäû èç î÷àãà.

8.4. Áàêòåðèîëîãè÷åñêèé êîíòðîëü ñàíèòàðíî-ãèãèåíè÷åñêèõ è äåçèíôåêöèîííûõ ìåðîïðèÿòèé ïðîâîäÿò ñîòðóäíèêè äåçèíôåêöèîííûõ è ñàíèòàðíî-ýïèäåìèîëîãè÷åñêèõ ñòàíöèé â îáúåìå, óêàçàííîì â òàáëèöàõ 2 è 3. Ìèêîáàêòåðèè òóáåðêóëåçà èùóò â êîíòðîëüíûõ ñìûâàõ â ïîìåùåíèÿõ, ãäå ìîãóò íàõîäèòüñÿ áîëüíûå, âûäåëÿþùèå îáèëüíîå êîëè÷åñòâî ìèêîáàêòåðèé (êâàðòèðû, ïàëàòû, êàáèíåòû, ñòîëîâàÿ è ò.ä.), èëè ãäå ïðîâîäÿò ðàáîòó ñ ìàòåðèàëîì, îáñåìåíåííûì ìèêîáàêòåðèÿìè (áåëüåâàÿ, áàêòåðèîëîãè÷åñêàÿ ëàáîðàòîðèÿ è ò.ä.).

 

Òàáëèöà 2

 


 

ÁÀÊÒÅÐÈÎËÎÃÈ×ÅÑÊÈÉ ÊÎÍÒÐÎËÜ ÒÅÊÓÙÅÉ ÄÅÇÈÍÔÅÊÖÈÈ

 ÊÂÀÐÒÈÐÍÛÕ Î×ÀÃÀÕ È Â ÏÐÎÒÈÂÎÒÓÁÅÐÊÓËÅÇÍÛÕ Ó×ÐÅÆÄÅÍÈßÕ

 

┌───────────┬───────────────┬────────────┬─────────────┬───────────┬──────────────┬──────────────┐

│Ãäå áåðóò  │Êòî ïðîâîäèò   │Âèä êîíò-   │Êðàòíîñòü    │ Êîëè÷åñòâî│Ïåðå÷åíü      │ Ìåðîïðèÿòèÿ 

│ñìûâû äëÿ  │áàêòåðèîëîãè-  │ðîëüíûõ     │ïðîâåäåíèÿ   │êîíòðîëüíûõ│îáúåêòîâ,          ïðè     

│áàêòåðèîëî-│÷åñêèé êîíòðîëü│ìèêðî-      │áàêòåðèîëîãè-│   ñìûâîâ  │ïîäëåæàùèõ    │ïîëîæèòåëüíîì │

│ãè÷åñêîãî  │è êóäà äîñòàâ- │îðãàíèçìîâ  │÷åñêîãî                 │áàêòåðèîëîãè- │  ðåçóëüòàòå 

│êîíòðîëÿ   │ëÿåò ñìûâû                 │êîíòðîëÿ                │÷åñêîìó                    

                                                              │êîíòðîëþ                   

├───────────┼───────────────┼────────────┼─────────────┼───────────┼──────────────┼──────────────┤

│ êâàðòèðàõ│Âðà÷ (ïîìîùíèê │Ìèêîáàêòåðèè│Âûáîðî÷íî â  │Íå ìåíåå   │×èñòûå ïîñóäà,│1. Ñîñòàâëåíèå│

│ó áîëüíûõ ñ│ýïèäåìèîëîãà)  │òóáåðêóëåçà │10% î÷àãîâ   │10 ñìûâîâ â│áåëüå,        │àêòà (îòìåòêà │

îáèëüíûì   │äåçèíôåêöèîííîé│            │ýòîé ãðóïïû â│îäíîì î÷àãå│ïëåâàòåëüíèöû,│â êàðòå ýïèä- │

│áàöèëëî-   │ñòàíöèè (ÄÑ)               │òå÷åíèå ãîäà │           │óáîðî÷íûé     │îáñëåäîâàíèÿ).│

│âûäåëåíèåì │èëè îòäåëà                                         │ìàòåðèàë,     │2. Èíñòðóêòàæ.│

           äåçèíôåêöèè                                        │ïîâåðõíîñòü   │3. Ïîâòîðíàÿ 

           │ÑÝÑ; â áàêòåðè-                                    │ñòîëîâ        │äåçèíôåêöèÿ  

           │îëîãè÷åñêóþ                                        │(îáåäåííûõ,   │îáúåêòîâ â   

           │ëàáîðàòîðèþ ïðè                                    äëÿ ñáîðà     │ïðèñóòñòâèè  

           │ÄÑ èëè ÑÝÑ                                         ãðÿçíîé       │ñîòðóäíèêîâ ÄÑ│

                                                              │ïîñóäû)       │èëè ïðîòèâî- 

                                                                            │òóáåðêóëåçíîãî│

                                                                            │äèñïàíñåðà   

                                                                                         

│ ïðîòèâî- │Òî æå          │Ìèêîáàêòåðèè│Åæåêâàðòàëüíî│Íå ìåíåå   │Òî æå         │Òî æå        

│òóáåðêóëåç-               │òóáåðêóëåçà.│             │30 ñìûâîâ                             

│íîì                       │Ñòàôèëîêîêê │                                                   

ó÷ðåæäåíèè                                                                              

└───────────┴───────────────┴────────────┴─────────────┴───────────┴──────────────┴──────────────┘

 

Òàáëèöà 3

 

ÁÀÊÒÅÐÈÎËÎÃÈ×ÅÑÊÈÉ ÊÎÍÒÐÎËÜ ÇÀÊËÞ×ÈÒÅËÜÍÎÉ ÄÅÇÈÍÔÅÊÖÈÈ

 ÊÂÀÐÒÈÐÍÛÕ Î×ÀÃÀÕ È Â ÏÐÎÒÈÂÎÒÓÁÅÐÊÓËÅÇÍÛÕ Ó×ÐÅÆÄÅÍÈßÕ

 

┌────────────┬────────────┬────────────┬─────────────┬───────────┬──────────────┬──────────────┐

│Ãäå áåðóò   │Êòî ïðîâîäèò│Âèä êîíò-   │Êðàòíîñòü    │Êîëè÷åñòâî │Ïåðå÷åíü      │ Ìåðîïðèÿòèÿ 

│ñìûâû äëÿ   │áàêòåðèî-   │ðîëüíûõ     │ïðîâåäåíèÿ   │êîíòðîëüíûõ│îáúåêòîâ,          ïðè     

│áàêòåðèîëî- │ëîãè÷åñêèé  │ìèêðî-      │áàêòåðèîëîãè-│  ñìûâîâ   │ïîäëåæàùèõ    │ïîëîæèòåëüíîì │

│ãè÷åñêîãî   │êîíòðîëü è  │îðãàíèçìîâ  │÷åñêîãî                 │áàêòåðèîëîãè-  ðåçóëüòàòå 

│êîíòðîëÿ    │êóäà íàïðàâ-            │êîíòðîëÿ                │÷åñêîìó                    

            │ëÿþò                                            │êîíòðîëþ                   

├────────────┼────────────┼────────────┼─────────────┼───────────┼──────────────┼──────────────┤

│ î÷àãàõ ó  │Ëàáîðàíò    │Ìèêîáàêòåðèè│Îáùèé îáúåì  │Íå ìåíåå   │Ïîñóäà, áåëüå,│1. Ñîîáùåíèå â

│áàëüíûõ,    │áàêòåðèî-   │òóáåðêóëåçà.│êîíòðîëÿ -   │10 ñìûâîâ â│ïëåâàòåëüíèöû,│îòäåë î÷àãîâîé│

│âûäåëÿþùèõ  │ëîãè÷åñêîé  │Ñòàôèëîêîêê │10% îò       │îäíîì î÷àãå│ïîë, ïðåäìåòû │äåçèíôåêöèè ÄÑ│

│ìèêîáàêòåðèè│ëàáîðàòîðèè │            ñäåëàííûõ               │îáñòàíîâêè,   │èëè â îòäåë  

│òóáåðêóëåçà │ïðè ÄÑ èëè              │äåçèíôåêöèé             │ñàíèòàðíî-òåõ-│ÑÝÑ.         

            │ÑÝÑ; â                  │äëÿ ãîðîäà è │           │íè÷åñêîå      │2. Èíñòðóêòàæ │

            │ëàáîðàòîðèþ │            │2% äëÿ                  │îáîðóäîâàíèå  │äåçèíôåêöèîí- │

            │ïðè ÄÑ èëè              │ñåëüñêîé                              │íîé áðèãàäû. 

            │ÑÝÑ                     │ìåñòíîñòè                             │3. Ïîâòîðíàÿ 

                                                                          │äåçèíôåêöèÿ ïî

                                                                          │íàçíà÷åíèþ   

                                                                          │çàâåäóþùåãî  

                                                                          │îòäåëîì      

                                                                          │çàêëþ÷èòåëüíîé│

                                                                          │äåçèíôåêöèè  

                                                                                       

│ ïðîòèâî-  │Òî æå       │Òî æå       │Ïî óñìîòðåíèþ│Íå ìåíåå   │Òî æå         │Òî æå        

│òóáåðêóëåç-                        │çàâåäóþùåãî  │30 ñìûâîâ                            

│íîì                                 │áàêòåðèîëîãè-│                                      

ó÷ðåæäåíèè                          │÷åñêîé                                             

                                    │ëàáîðàòîðèè                                        

                                    │ÄÑ èëè ÑÝÑ                                         

└────────────┴────────────┴────────────┴─────────────┴───────────┴──────────────┴──────────────┘

 


 

Ïðèìå÷àíèÿ. 1. Ñîòðóäíèêè ëàáîðàòîðèé ïðîòèâîòóáåðêóëåçíûõ ó÷ðåæäåíèé îêàçûâàþò ïðàêòè÷åñêóþ è êîíñóëüòàòèâíóþ ïîìîùü ðàáîòíèêàì ëàáîðàòîðèé ÄÑ èëè ÑÝÑ â îáó÷åíèè ìåòîäèêàì èäåíòèôèêàöèè ìèêîáàêòåðèé òóáåðêóëåçà.

2. Ñìûâû ñ îáúåêòîâ áåðóò íå ïîçæå ÷åì ÷åðåç 30 - 45 ìèíóò ñî âðåìåíè çàâåðøåíèÿ äåçèíôåêöèè.

 

9. ÌÅÒÎÄÈÊÀ ÎÒÁÎÐÀ ÏÐÎÁ (ÑÌÛÂÎÂ) ÄËß ÁÀÊÒÅÐÈÎËÎÃÈ×ÅÑÊÎÃÎ

ÊÎÍÒÐÎËß ÒÅÊÓÙÅÉ È ÇÀÊËÞ×ÈÒÅËÜÍÎÉ ÄÅÇÈÍÔÅÊÖÈÈ

 

9.1. Âçÿòèå ñìûâîâ ñ îáúåêòîâ îñóùåñòâëÿþò ñòåðèëüíûìè âàòíûìè òàìïîíàìè íà ïàëî÷êàõ, êîòîðûå ìîíòèðóþò â ïðîáèðêàõ è ñòåðèëèçóþò ïåðåä âûõîäîì â î÷àã.

Íåïîñðåäñòâåííî ïåðåä âçÿòèåì ñìûâîâ äëÿ êîíòðîëÿ êà÷åñòâà äåçèíôåêöèè îáúåêòîâ õëîðñîäåðæàùèìè ïðåïàðàòàìè òàìïîíû â ëàáîðàòîðèè ñìà÷èâàþò ñòåðèëüíûì 1,0% ðàñòâîðîì ãèïîñóëüôèòà íàòðèÿ. Ïåðåä âçÿòèåì ñìûâîâ äëÿ êîíòðîëÿ êà÷åñòâà âëàæíîé óáîðêè ïîìåùåíèÿ èëè òåðìè÷åñêîé îáðàáîòêè îáúåêòîâ òàìïîíû ñìà÷èâàþò ñòåðèëüíîé âîäîïðîâîäíîé âîäîé.

9.2. Ñìûâû ñ êàæäîãî îáúåêòà áåðóò òîëüêî îäíèì òàìïîíîì, êîòîðûé ïîìåùàþò â ïðîíóìåðîâàííóþ ïðîáèðêó, îòìå÷àÿ â æóðíàëå òîò æå íîìåð îáúåêòà. Êîíòðîëüíûå ñìûâû ñ ìåëêèõ îáúåêòîâ ïðîèçâîäÿò ñî âñåé ïîâåðõíîñòè, ïðè áîëüøîé ïîâåðõíîñòè - ñ íåñêîëüêèõ ó÷àñòêîâ (êàæäûé ïëîùàäüþ ïî 10 x 10 ñì). Ñìûâû äîñòàâëÿþò â ëàáîðàòîðèþ íå ïîçæå 2 ÷àñîâ ñ ìîìåíòà îòáîðà ïðîá.

9.3. Äëÿ âûÿâëåíèÿ ìèêîáàêòåðèé òóáåðêóëåçà è ñòàôèëîêîêêà òàìïîí îòìûâàþò â 20 ìë ñòåðèëüíîé âîäîïðîâîäíîé âîäû â øèðîêîãîðëîé ïðîáèðêå ñ áóñàìè â òå÷åíèå 10 ìèíóò.

9.4. Äëÿ âûäåëåíèÿ ñòàôèëîêîêêà ïåðåíîñÿò 0,1 ìë îòìûòîé æèäêîñòè íà äíî ñòåðèëüíîé ÷àøêè Ïåòðè è çàëèâàþò 8 - 10 ìë îñòóæåííîãî 2,0% ìÿñîïåïòîííîãî (èëè êàçåèíîâîãî) àãàðà. Îñòîðîæíûì ïîêà÷èâàíèåì ðàñïðåäåëÿþò ïðîáó â àãàðå. Ïîñåâû èíêóáèðóþò ïðè +37 °C â òå÷åíèå 24 ÷àñîâ, âûäåðæèâàþò â òå÷åíèå ñóòîê ïðè êîìíàòíîé òåìïåðàòóðå è ó÷èòûâàþò ðîñò êîëîíèé ñòàôèëîêîêêà íà àãàðå.

9.5. Äëÿ âûäåëåíèÿ ìèêîáàêòåðèé òóáåðêóëåçà îòìûòóþ æèäêîñòü îáðàáàòûâàþò ìåòîäîì öåíòðèôóãèðîâàíèÿ èëè ìåòîäîì ôëîòàöèè. Ïðè öåíòðèôóãèðîâàíèè íàëèâàþò 10 ìë æèäêîñòè â öåíòðèôóæíóþ ïðîáèðêó è öåíòðèôóãèðóþò 10 ìèíóò ïðè 1500 - 2000 îá./ìèí. Çàòåì ñëèâàþò íàäîñàäî÷íóþ æèäêîñòü, âçìó÷èâàþò îñàäîê êîíöîì ñòåðèëüíîé ïàñòåðîâñêîé ïèïåòêè â 1,0 - 1,5 ìë ñòåðèëüíîãî ôèçèîëîãè÷åñêîãî ðàñòâîðà. Ñ ïîìîùüþ ãðàäóèðîâàííîé (èëè ïàñòåðîâñêîé) ïèïåòêè çàñåâàþò ïî 0,2 ìë âçâåñè íà ïîâåðõíîñòü äâóõ-òðåõ ÿè÷íûõ ñðåä (Ëåâåíøòåéíà-Éåíñåíà, "Íîâàÿ", Ôèíí-2, Ãåëüáåðãà).

9.6. Ïðè ôëîòàöèè ñëèâàþò âñþ æèäêîñòü èç øèðîêîãîðëîé ïðîáèðêè â óçêîãîðëûé ôëàêîí, ïðè÷åì òàìïîí äîïîëíèòåëüíî îòæèìàþò î êðàé ïðîáèðêè. Ê ñìûâó äîáàâëÿþò 10 ìë 0,5% ðàñòâîðà NaOH, âñòðÿõèâàþò 5 ìèíóò, çàòåì äîáàâëÿþò 0,5 ìë êñèëîëà èëè áåíçèíà â 100 ìë ñâåæåïåðåãíàííîé äèñòèëëèðîâàííîé âîäû. Íå ñëåäóåò ïîëüçîâàòüñÿ âîäîïðîâîäíîé, äàæå êèïÿ÷åíîé âîäîé. Ñìåñü âñòðÿõèâàþò 5 - 10 ìèíóò, çàòåì äîáàâëÿþò äèñòèëëèðîâàííóþ âîäó äî ãîðëûøêà ôëàêîíà (250 ìë). ×åðåç 15 - 30 ìèíóò ïîñëå äîáàâëåíèÿ âîäû ó ãîðëûøêà ôëàêîíà îáðàçóåòñÿ ñëèâêîîáðàçíîå ôëîòàöèîííîå êîëüöî. Ôëîòàöèîííîå êîëüöî ñíèìàþò ïàñòåðîâñêîé ïèïåòêîé è ïîìåùàþò â ñòåðèëüíóþ ïðîáèðêó. Ê âçÿòîìó êîëüöó äîáàâëÿþò ðàâíîå êîëè÷åñòâî ñòåðèëüíîãî ôèçèîëîãè÷åñêîãî ðàñòâîðà, òùàòåëüíî âñòðÿõèâàþò, ïîñëå ÷åãî íà ïîâåðõíîñòè ÷åðåç 10 ìèíóò îáðàçóåòñÿ íîâîå ôëîòàöèîííîå êîëüöî, êîòîðîå ïîëíîñòüþ èñïîëüçóþò äëÿ ïîñåâà íà 2 - 3 ïðîáèðêè ÿè÷íîé ñðåäû (ïîñåâ ïðîèçâîäÿò ïåòëåé-ðàêåòêîé èëè ïàñòåðîâñêîé ïèïåòêîé).

9.7. Ïðè êîíòðîëå êà÷åñòâà òåêóùåé äåçèíôåêöèè â êâàðòèðíûõ î÷àãàõ öåíòðèôóæíûé îñàäîê èëè ôëîòàöèîííîå êîëüöî äëÿ óíè÷òîæåíèÿ âòîðè÷íîé ôëîðû îáðàáàòûâàþò 3 - 10% ðàñòâîðîì ñåðíîé êèñëîòû (â çàâèñèìîñòè îò çàãðÿçíåíèÿ îáúåêòà). Âî âñåõ ñëó÷àÿõ îñàäîê (ôëîòàöèîííîå êîëüöî) çàëèâàþò ðàâíûì êîëè÷åñòâîì ñåðíîé êèñëîòû â ñòåðèëüíîé ïðîáèðêå íà 10 ìèíóò. Çàòåì îñàäîê äâàæäû ïî 5 ìèíóò ïðîìûâàþò â 6 - 8 ìë ôèçèîëîãè÷åñêîãî ðàñòâîðà (öåíòðèôóãèðîâàíèåì). Ïîñëå âñòðÿõèâàíèÿ ñìåñè ñåðíîé êèñëîòû è ôëîòàöèîííîãî êîëüöà â òå÷åíèå 10 ìèíóò ïîñåâ ïðîèçâîäÿò èç âòîðè÷íî îáðàçîâàâøåãîñÿ êîëüöà.

9.8. Äëÿ ïðåäîõðàíåíèÿ ñðåäû îò âûñûõàíèÿ íèæíèé êîíåö âàòíîé ïðîáèðêè îïóñêàþò â êèïÿùèé ïàðàôèí èëè çàêðûâàþò ïðîáèðêó ñòåðèëüíîé ðåçèíîâîé ïðîáêîé. Ïîñåâû ðàçìåùàþò íà 2 - 3 äíÿ â ïîëóãîðèçîíòàëüíîì, à çàòåì â âåðòèêàëüíîì ïîëîæåíèè â òåðìîñòàòå ïðè òåìïåðàòóðå +37 °C. Ïðîñìàòðèâàþò ïîñåâû åæåäíåâíî äî 1 - 2 ìåñÿöåâ.

9.9. Èç êîëîíèé ãîòîâÿò ìàçêè, äëÿ ÷åãî ñòåðèëüíîé ïàñòåðîâñêîé ïèïåòêîé (íå îòëàìûâàÿ ó íåå çàïàÿííîãî êîí÷èêà) èëè ïåòëåé íàä ïëàìåíåì ãîðåëêè ñíèìàþò êîëîíèþ è ýìóëüãèðóþò â êàïëå âîäû íà ïðåäìåòíîì ñòåêëå. Âûñîõøèå ìàçêè ôèêñèðóþò íàä îãíåì, êðàñÿò ïî Öèëþ-Íåëüñåíó è ìèêðîñêîïèðóþò. Ïðè ìèêðîñêîïèðîâàíèè îáíàðóæèâàþò íà ñèíåì ôîíå ìàçêà áîëüøîå ñêîïëåíèå êèñëîòîóïîðíûõ ïàëî÷åê, îêðàøåííûõ â êðàñíûé öâåò. Ïðè îêðàñêå ìàçêà ôëþîõðîìàìè íà òåìíîì íåôëþîðåñöèðóþùåì ôîíå âèäíû ìèêîáàêòåðèè òóáåðêóëåçà çîëîòèñòî-æåëòîãî öâåòà.

9.10. Ïðè âûÿâëåíèè ìèêîáàêòåðèé òóáåðêóëåçà ìåòîäîì ìèêðîêóëüòèâèðîâàíèÿ íà ñòåêëàõ äëÿ ìàçêîâ óïîòðåáëÿþò îáû÷íûå ïðåäìåòíûå ñòåêëà, ðàçðåçàííûå ïî äëèííèêó íà òðè ðàâíûå ÷àñòè, õîðîøî ïðîìûòûå, îáåçæèðåííûå è ïðîñòåðèëèçîâàííûå. Âî âðåìÿ ïðèãîòîâëåíèÿ ìàçêîâ ñòåêëà ðàñêëàäûâàþò íà ñòåðèëüíûå ëèñòû áóìàãè, òàêîé æå áóìàãîé ïðèêðûâàþò èõ ñâåðõó.

9.11. Öåíòðèôóæíûé îñàäîê èëè ÷àñòü ôëîòàöèîííîãî êîëüöà íàñëàèâàþò ïî êàïëÿì èç ïàñòåðîâñêîé èëè ãëàçíîé ïèïåòêè íà äâà óçêèõ ïðåäìåòíûõ ñòåêëà, ñìàçàííûõ äëÿ ôèêñàöèè ìàçêà ÿè÷íûì áåëêîì, çàòåì âûñóøèâàþò. Ñòåêëà ïîìåùàþò â äâå ïðîáèðêè ñ êðîâÿíîé ñðåäîé èëè ïîëóòâåðäîé ñèíòåòè÷åñêîé äðîææåâîé (ï. ï. 9.13, 9.14). Ïîñåâû âûäåðæèâàþò â òåðìîñòàòå ïðè +37 °C. Èç êðîâÿíîé ñðåäû ñòåêëà èçâëåêàþò ÷åðåç 7 è 14 äíåé, à ñ ïîâåðõíîñòè ïîëóòâåðäîé ñèíòåòè÷åñêîé ñðåäû, ñîîòâåòñòâåííî, ÷åðåç 2 - 3 äíÿ.

9.12. Îñòàòêè êðîâÿíîé ñðåäû îñòîðîæíî ñìûâàþò âîäîé. Ñòåêëà âûñóøèâàþò, ôèêñèðóþò ñìåñüþ Íèêèôîðîâà, îêðàøèâàþò ïî Öèëþ-Íåëüñåíó èëè ôëþîõðîìàìè, ìèêðîñêîïèðóþò.

9.13. Ïðîïèñü ïîëóòâåðäîé ñèíòåòè÷åñêîé ñðåäû: ê 500 ìë äèñòèëëèðîâàííîé âîäû äîáàâëÿþò 3,0 ã ôîñôîðíîêèñëîãî íàòðèÿ; 0,25 ã ñåðíîêèñëîãî êàëèÿ; 10,0 ìë ãëèöåðèíà; 0,8 ã öèòðàòà íàòðèÿ; 0,8 ã ñåðíîêèñëîé ìàãíåçèè; 20,0 ìë êàçåèíîâîãî ãèäðîëèçàòà; 1 - 2 êàïëè 40% ùåëî÷è. Ïîñëå òùàòåëüíîãî ïåðåìåøèâàíèÿ ñðåäó àâòîêëàâèðóþò ïðè 1 êãñ/êâ. ñì (+120 °C) â òå÷åíèå 20 ìèíóò. Ïåðåä óïîòðåáëåíèåì ñðåäû â íåå äîáàâëÿþò: 12,5 ìë 40,0% ãëþêîçû, 25,0 ìë íîðìàëüíîé ëîøàäèíîé ñûâîðîòêè áåç êîíñåðâàíòà íà 100,0 ìë ñðåäû, 0,2 - 0,25% àãàðà (âñå èíãðåäèåíòû ñòåðèëüíûå) è 0,1 ìë ñóòî÷íîé êóëüòóðû äðîææåé; pH ñðåäû äîëæíà áûòü 7,2 - 7,4.

9.14. Ïðîïèñü êðîâÿíîé ñðåäû: ÷åëîâå÷åñêàÿ êðîâü ñ öèòðàòîì íàòðèÿ, ðàçâåäåííàÿ íåïîñðåäñòâåííî ïåðåä ïîñåâîì äèñòèëëèðîâàííîé âîäîé 1:3.

 

10. ÁÀÊÒÅÐÈÎËÎÃÈ×ÅÑÊÈÉ ÊÎÍÒÐÎËÜ ÊÀÌÅÐÍÎÉ ÄÅÇÈÍÔÅÊÖÈÈ

 

10.1. Äëÿ áàêòåðèîëîãè÷åñêîãî êîíòðîëÿ êàìåðíîé äåçèíôåêöèè ïðè òóáåðêóëåçå èñïîëüçóþò áàòèñòîâûå òåñòû (0,5 x 1 ñì), îáñåìåíåííûå 2 ìëðä. âçâåñüþ 4-ñóòî÷íîé êóëüòóðû êèñëîòîóïîðíîãî ñàïðîôèòà Â-5. Áàòèñòîâûå òåñòû ïîìåùàþò â ìåøî÷êè è çàêëàäûâàþò â âåùè ñ ìàêñèìàëüíûìè òåðìîìåòðàìè íà óðîâíå âîðîòíèêîâ, êàðìàíîâ, ïîëû âåðõíåé îäåæäû. Ìåøî÷êè ðàçìåùàþò ââåðõó, ñåðåäèíå è âíèçó, ïî óãëàì è â öåíòðå (âñåãî 15 øòóê).

10.2. Ïî îêîí÷àíèè äåçèíôåêöèè áàòèñòîâûå êóñî÷êè èçâëåêàþò è ïðîèçâîäÿò âûñåâ íà òâåðäûå èëè æèäêèå ñðåäû: ñèíòåòè÷åñêèå, ÿè÷íûå, 2% ãëèöåðèíîâûé ìÿñîïåïòîííûé áóëüîí. Ðåçóëüòàòû ó÷èòûâàþò â òå÷åíèå 4 - 7 äíåé èíêóáàöèè ïîñåâîâ â òåðìîñòàòå ïðè òåìïåðàòóðå +37 °C.

Ñ óòâåðæäåíèåì íàñòîÿùèõ "Ìåòîäè÷åñêèõ óêàçàíèé" ïðåêðàùàåòñÿ äåéñòâèå "Èíñòðóêöèè ïî òåêóùåé è çàêëþ÷èòåëüíîé äåçèíôåêöèè ïðè òóáåðêóëåçå" îò 6 ìàÿ 1968 ã. çà N 744-68, óòâåðæäåííîé Ãëàâíûì ñàíèòàðíî-ýïèäåìèîëîãè÷åñêèì óïðàâëåíèåì ÌÇ ÑÑÑÐ, è ïÿòîãî ðàçäåëà "Ìåòîäè÷åñêèõ óêàçàíèé ïî áîðüáå ñ òóáåðêóëåçîì äëÿ ñàíèòàðíî-ýïèäåìèîëîãè÷åñêèõ ñòàíöèé" îò 6 îêòÿáðÿ 1970 ã. çà N 870-70, óòâåðæäåííûõ Ãëàâíûì ñàíèòàðíî-ýïèäåìèîëîãè÷åñêèì óïðàâëåíèåì ÌÇ ÑÑÑÐ.

 

 

 

 

 

Ïðèëîæåíèå 1

 

ÄÅÇÈÍÔÈÖÈÐÓÞÙÈÅ ÑÐÅÄÑÒÂÀ È ÏÐÈÃÎÒÎÂËÅÍÈÅ ÐÀÑÒÂÎÐÎÂ

 

Òàáëèöà 1

 

ÊÐÀÒÊÀß ÕÀÐÀÊÒÅÐÈÑÒÈÊÀ ÄÅÇÈÍÔÈÖÈÐÓÞÙÈÕ ÑÐÅÄÑÒÂ

 

┌───┬────────────────┬───────────────────────────────────────────────┐

│ N │    Íàçâàíèå               Õàðàêòåðèñòèêà ïðåïàðàòà           

ï/ï│   ïðåïàðàòà                                                   

├───┼────────────────┼───────────────────────────────────────────────┤

│1  │Õëîðíàÿ èçâåñòü │Áåëûé ïîðîøîê, ñîäåðæàùèé 28,0 - 35,0%        

                   │àêòèâíîãî õëîðà                               

                                                                  

│2  │ÄÒÑÃÊ           │Áåëûé ïîðîøîê, ñîäåðæàùèé 47,0 - 56,0%        

                   │àêòèâíîãî õëîðà                               

                                                                 

│3  │Ãèïîõëîðèò ëèòèÿ│Áåëûé ïîðîøîê, ñîäåðæàùèé 40,0 - 50,0%        

                   │àêòèâíîãî õëîðà                               

                                                                 

│4  │Õëîðàìèí Á èëè  │Ïîðîøîê êðåìîâîãî öâåòà, ñîäåðæàùèé 27,0 -    

   │ÕÁ              │28,0% àêòèâíîãî õëîðà                         

                                                                 

│5  │Äèõëîð-1        │Ïîðîøîê áåëîãî èëè æåëòîâàòîãî öâåòà,         

                   ñîäåðæàùèé 7,0% àêòèâíîãî õëîðà               

                                                                 

│6  │Ñóëüôîõëîðàíòèí │Áåëûé ïîðîøîê, ñîäåðæàùèé 15,6% àêòèâíîãî õëîðà│

                                                                  

│7  │Õëîðäåçèí       │Áåëûé ïîðîøîê, ñîäåðæàùèé 10,0 - 12,0%        

                   │àêòèâíîãî õëîðà                               

                                                                 

│8  │Õëîðáåòàíàôòîë  │Ïàñòà, ñîäåðæàùàÿ 33% êîíöåíòðàòà ïðåïàðàòà   

└───┴────────────────┴───────────────────────────────────────────────┘

 

Ïðèìå÷àíèå. Ïðåïàðàòû õðàíÿò â çàêðûòîé òàðå, â ñóõîì è õîðîøî âåíòèëèðóåìîì ïîìåùåíèè.

 

ÏÐÀÂÈËÀ ÏÐÈÃÎÒÎÂËÅÍÈß ÐÀÑÒÂÎÐÎÂ ÏÐÅÏÀÐÀÒÎÂ

 

Äëÿ ïðèãîòîâëåíèÿ 10,0 ë 10,0 - 20,0% èñõîäíûõ (ìàòî÷íûõ) ðàñòâîðîâ õëîðíîé èçâåñòè â ýìàëèðîâàííîå âåäðî ïîìåùàþò ñîîòâåòñòâåííî 1 - 2 êã ïðåïàðàòà. Çàòåì ïðåïàðàò ðàçìåëü÷àþò äåðåâÿííîé ëîïàòêîé è ïåðåìåøèâàþò ñ ïîñòåïåííî íàëèâàåìîé äî 10,0 ë âîäîé. Âåäðî ñ õëîðíî-èçâåñòêîâîé âçâåñüþ îñòàâëÿþò íà 24 ÷àñà ñ çàêðûòîé êðûøêîé â òåìíîì, ïðîõëàäíîì ìåñòå. ×åðåç ñóòêè îáðàçîâàâøèéñÿ îòñòîé - îñâåòëåííûé (ìàòî÷íûé) ðàñòâîð - ñëèâàþò â òåìíóþ áóòûëü ñ ïëîòíî çàêðûâàþùåéñÿ êðûøêîé è õðàíÿò íå áîëåå 10 äíåé. Ðàáî÷èå ðàñòâîðû ãîòîâÿò èç îñíîâíîãî (ìàòî÷íîãî) ðàñòâîðà.

 

Òàáëèöà 2

 

ÏÐÈÃÎÒÎÂËÅÍÈÅ ÐÀÁÎ×ÈÕ ÎÑÂÅÒËÅÍÍÛÕ ÐÀÑÒÂÎÐΠÕËÎÐÍÎÉ ÈÇÂÅÑÒÈ

 

┌───────────────────────┬───────────────────────────────────────────────┐

│ Êîíöåíòðàöèÿ ðàáî÷èõ  │Êîëè÷åñòâî îñíîâíîãî ðàñòâîðà â ìèëëèëèòðàõ äëÿ

     ðàñòâîðîâ, %          ïðèãîòîâëåíèÿ 10,0 ë ðàáî÷åãî ðàñòâîðà    

                       ├────────────────────────┬──────────────────────┤

                               èç 10,0%               èç 20,0%      

├───────────────────────┼────────────────────────┼──────────────────────┤

│0,25                   │250,0                   │125,0                

│0,5                    │500,0                   │250,0                

│2,0                    │2000,0                  │1000,0               

└───────────────────────┴────────────────────────┴──────────────────────┘

 

Òàáëèöà 3

 

ÏÐÈÃÎÒÎÂËÅÍÈÅ ÍÅÀÊÒÈÂÈÐÎÂÀÍÍÛÕ ÐÀÑÒÂÎÐÎÂ

ÄÅÇÈÍÔÈÖÈÐÓÞÙÈÕ ÑÐÅÄÑÒÂ

 

┌──────────────────┬────────────┬───────────┬───────────────────────────┐

│Íàçâàíèå ïðåïàðàòà│Êîíöåíòðàöèÿ│  Êîë-âî           Ïðèìå÷àíèå        

                       ïî     │ ïðåïàðàòà │                          

                  │ïðåïàðàòó, %│â ã íà 10,0│                          

                              ë ðàñòâîðà │                          

├──────────────────┼────────────┼───────────┼───────────────────────────┤

│ÄÒÑÃÊ             │1,0         │100,0      │Ðàñòâîðû ãîòîâÿò,         

                                         │òùàòåëüíî ïåðåìåøèâàÿ â   

                                         │ýìàëèðîâàííîé èëè         

                                         │ñòåêëÿííîé òàðå           

                                                                    

│Ãèïîõëîðèò ëèòèÿ  │0,5         │50,0       │Ãîòîâÿò â ýìàëèðîâàííîé èëè│

                                         │ñòåêëÿííîé òàðå           

                                                                   

│Ñóëüôîõëîðàíòèí   │1,0         │100,0      │Ãîòîâÿò â îáû÷íîé ïîñóäå  

                  │2,5         │250,0                                

                                                                   

│Õëîðàìèí Á èëè ÕÁ │5,0         │500,0      │Ãîòîâÿò â îáû÷íîé ïîñóäå  

                                                                   

│Äèõëîð-1          │3,0         │300,0      │Ãîòîâÿò â îáû÷íîé ïîñóäå  

                                                                   

│Õëîðäåçèí         │2,0         │200,0      │Ãîòîâÿò â îáû÷íîé ïîñóäå  

                                                                   

│Õëîðáåòàíàôòîë    │0,5         │150,0      │Ðàçìåøèâàþò óêàçàííîå     

                                         │êîëè÷åñòâî ïàñòû          

                                         │33% êîíöåíòðàòà â îáû÷íîé 

                                         │ïîñóäå                    

└──────────────────┴────────────┴───────────┴───────────────────────────┘

 

Òàáëèöà 4

 

ÏÐÈÃÎÒÎÂËÅÍÈÅ ÀÊÒÈÂÈÐÎÂÀÍÍÛÕ ÐÀÑÒÂÎÐÎÂ

ÕËÎÐÑÎÄÅÐÆÀÙÈÕ ÑÎÅÄÈÍÅÍÈÉ

 

┌──────────────────┬─────────────────────┬──────────────────────────────┐

│Íàçâàíèå ïðåïàðàòà│ Êîíöåíòðàöèÿ (%) ïî │   Êîëè÷åñòâî ïðåïàðàòà â ã  

                                             íà 10,0 ë ðàñòâîðà     

                  ├──────────┬──────────┼────────┬─────────────────────┤

                  │ïðåïàðàòó │àêòèâíîìó │ïðåïàðàò│      àêòèâàòîð     

                              õëîðó           ├──────────┬──────────┤

                                             àììîíèéíûå  àììèàê 

                                                 ñîëè            

├──────────────────┼──────────┼──────────┼────────┼──────────┼──────────┤

│Õëîðàìèí Á èëè ÕÁ │0,50      │0,13      │50,0    │13,0      │1,60     

                  │1,00      │0,26      │100,0   │26,0      │3,24     

                  │2,50      │0,65      │250,0   │65,0      │8,12     

                                                                  

│ÄÒÑÃÊ             │1,00      │0,500     │100,0   │50,0      │6,25     

                                                                 

│Õëîðíàÿ èçâåñòü   │0,25      │0,060     │-       │6,0       │0,78     

                  │0,50      │0,125     │-       │12,5      │1,56     

└──────────────────┴──────────┴──────────┴────────┴──────────┴──────────┘

 

Ïðèìå÷àíèå. Ðàçìåøàâ ïðåïàðàò äî ïîëíîãî ðàñòâîðåíèÿ, äîáàâëÿþò àêòèâàòîð - àììîíèéíûå ñîëè (ñåðíîêèñëûé èëè õëîðèñòûé àììîíèé) èëè àììèàê (25% ðàñòâîð).

 

 

 

 

 

Ïðèëîæåíèå 2

 

ÌÅÒÎÄÛ, ÑÐÅÄÑÒÂÀ È ÐÅÆÈÌÛ ÎÁÅÇÇÀÐÀÆÈÂÀÍÈß

ÎÒÄÅËÜÍÛÕ ÎÁÚÅÊÒΠ Î×ÀÃÀÕ ÒÓÁÅÐÊÓËÅÇÀ

 

┌─────────────────────┬─────────────────────────────────────────────────┬───────────────┐

│Íàèìåíîâàíèå îáúåêòîâ              Ïðè òåêóùåé äåçèíôåêöèè                 Ïðè      

   îáåççàðàæèâàíèÿ   ├────────────────────────┬────────────────────────┤çàêëþ÷èòåëüíîé

                        Ìåòîäû è ñðåäñòâà    │ ðåæèì îáåççàðàæèâàíèÿ    äåçèíôåêöèè 

                           äåçèíôåêöèè       ├────────────┬───────────┤              

                                             │êîíöåíòðàöèÿ│ýêñïîçèöèÿ,│              

                                             │ðàñòâîðîâ, %│   ìèí.                   

├─────────────────────┼────────────────────────┼────────────┼───────────┼───────────────┤

          1                     2                 3           4            5      

├─────────────────────┼────────────────────────┼────────────┼───────────┼───────────────┤

│1. Ìîêðîòà â         │1. Êèïÿòÿò â ðàñòâîðå   │2,0         │15 ñ                     

ïëåâàòåëüíèöàõ       │ñîäû                                │ìîìåíòà                  

│(ïëåâàòåëüíèöû                                           │çàêèïàíèÿ                

îòêðûòûå ñ ñîäåðæèìûì│2. Ïîãðóæàþò â ñîñóä ñ                                       

│â íèõ)               │êðûøêîé, ñîäåðæàùèé îäèí│                                     

                     │èç ðàñòâîðîâ:                                                

                     │ñóëüôîõëîðàíòèíà        │2,5         │180                      

                     │õëîðàìèíà               │5,0         │360        │Êàê ïðè òåêóùåé│

                     │àêòèâèðîâàííûå ðàñòâîðû:│                       │äåçèíôåêöèè   

                     │õëîðàìèíà               │2,5         │120                      

                     │ÄÒÑÃÊ                   │1,0         │120                      

                                                                                  

                     │3. Àâòîêëàâèðóþò        │0,5 êãñ/êâ. │30                       

                     │ïëåâàòåëüíèöû áåç ñíÿ-  │ñì                                    

                     │òèÿ êðûøåê                                                   

                                                                                  

│2. Ìîêðîòà           │1. Êèïÿòÿò â ðàñòâîðå   │2,0         │15                       

                     │ñîäû                                                         

                                                                                  

                     │2. Çàëèâàþò â åìêîñòè                                        

                     │(èç ðàñ÷åòà 2 îáúåìà                                         

                     │äåçðàñòâîðà íà 1 îáúåì                                       

                     │ìîêðîòû) îäíèì èç                                            

                     │ðàñòâîðîâ:                                                   

                     │ñóëüôîõëîðàíòèíà        │2,5         │360                      

                     │õëîðàìèíà               │5,0         │720                      

                     │àêòèâèðîâàííûì ðàñòâîðîì│2,5         │240        │Êàê ïðè òåêóùåé│

                     │õëîðàìèíà                                      │äåçèíôåêöèè   

                                                                                  

                     │3. Çàñûïàþò îäíèì èç                                         

                     │ïðåïàðàòîâ:                                                  

                     │õëîðíîé èçâåñòüþ        │200 ã/ë     │60                       

                     │ÄÒÑÃÊ                   │100 ã/ë     │60                       

                     │õëîðàìèíîì ñ àêòèâàòîðîì│50 ã/ë      │60                        

                     │(ñîîòíîøåíèå 1:1)                                            

                                                                                  

│3. Ïëåâàòåëüíèöû     │1. Êèïÿòÿò â ñîäîâîì    │2,0         │15         │Êàê ïðè òåêóùåé│

│(îñâîáîæäåííûå îò    │ðàñòâîðå                                       │äåçèíôåêöèè   

│ìîêðîòû è êðûøêè)                                                                 

                     │2. Ïîãðóæàþò â îäèí èç                                       

                     │ðàñòâîðîâ:                                                   

                     │ñóëüôîõëîðàíòèíà        │2,5         │120                      

                     │ÄÒÑÃÊ                   │1,0         │120                      

                     │àêòèâèðîâàííûé ðàñòâîð  │1,0         │60                       

                     │õëîðàìèíà                                                    

                                                                                  

│4. Ïîñóäà (ñòîëîâàÿ, │1. Êèïÿòÿò â ðàñòâîðå   │2,0         │15         │Êàê ïðè òåêóùåé│

îñâîáîæäåííàÿ îò     │ñîäû                                           │äåçèíôåêöèè   

│îñòàòêîâ ïèùè:                                                                    

│÷àéíàÿ, âèëêè, íîæè  │2. Îáðàáàòûâàþò â       │-           │30                       

│èç íåðæàâåþùåé ñòàëè,│ñóøèëüíî-ñòåðèëèçàöèîí- │                                      

│àëþìèíèÿ, ñêëÿíêè    │íîì øêàôó (+160 °C)                                          

│èç-ïîä ëåêàðñòâ)                                                                  

                     │3. Ïîãðóæàþò â                                               

                     │âåðòèêàëüíîì ïîëîæåíèè â                                     

                     │îäèí èç ðàñòâîðîâ:                                           

                     │õëîðàìèíà               │5,0         │240                      

                     │ñóëüôîõëîðàíòèíà        │1,0         │60                       

                     │ãèïîõëîðèòà ëèòèÿ       │0,5         │60                       

                     │äèõëîð-1                │3,0         │45                       

                     │õëîðáåòàíàôòîëà         │0,5         │60                       

                     │õëîðäåçèíà              │2,0         │60                       

                     │â àêòèâèðîâàííûå                                             

                     │ðàñòâîðû                                                     

                     │õëîðàìèíà               │0,5         │60                       

                     │èëè õëîðíîé èçâåñòè     │0,5         │60                       

                                                                                  

│5. Ïîñóäà (ñòîëîâàÿ) │1. Êèïÿòÿò â ðàñòâîðå   │2,0         │15         │Êàê ïðè òåêóùåé│

│ñ îñòàòêàìè ïèùè     │ñîäû                                           │äåçèíôåêöèè   

                                                                                  

                     │2. Ïîãðóæàþò â îäèí èç                                       

                     │ðàñòâîðîâ:                                                   

                     │õëîðäåçèíà              │2,0         │90                       

                     │õëîðáåòàíàôòîëà         │1,0         │120                      

                     │ñóëüôîõëîðàíòèíà        │1,0         │120                      

                     │ãèïîõëîðèòà ëèòèÿ       │0,5         │120                      

                     │äèõëîð-1                │3,0         │90                       

                     │õëîðàìèíà               │5,0         │360                      

                     │â àêòèâèðîâàííûå                                             

                     │ðàñòâîðû                                                     

                     │õëîðíîé èçâåñòè         │0,5         │120                      

                     │èëè õëîðàìèíà           │0,5         │120                      

                                                                                  

│6. Îñòàòêè ïèùè      │1. Êèïÿòÿò â ðàñòâîðå   │2,0         │15                       

                     │ñîäû èëè â ïàðîâàðî÷íûõ            │30                        

                     êîòëàõ                                                       

                                                                                  

                     │2. Àâòîêëàâèðóþò        │0,5 êãñ/êâ. │20         │Êàê ïðè òåêóùåé│

                                             ñì                     │äåçèíôåêöèè   

                                                                                  

                     │3. Îáðàáàòûâàþò ñóõîé   │1/5 ê îáúåìó│120                      

                     │èçâåñòüþ                │ïèùè                                 

                                                                                  

                     │4. Çàëèâàþò             │20,0        │120                      

                     │õëîðíî-èçâåñòêîâûì                                           

                     │ìîëîêîì (äâà îáúåìà                                          

                     │ðàñòâîðà íà îäèí îáúåì                                       

                     │îñòàòêîâ ïèùè)                                               

                                                                                   

                     │5. Îáåççàðàæèâàþò ïî                                         

                     │ðåæèìàì, óêàçàííûì â                                         

                     │ï. 2                                                         

                                                                                  

│7. Ðåçèíîâûå èçäåëèÿ │1. Êèïÿòÿò â ðàñòâîðå   │0,5 êãñ/êâ. │30                       

                     │ñîäû                    ñì                                   

                                                                                  

                     │2. Àâòîêëàâèðóþò                                             

                                                                                  

│8. Áåëüå (ïîñòåëüíîå,│1. Êèïÿòÿò â ðàñòâîðå                          │Êàê ïðè òåêóùåé│

ñòîëîâîå, íàòåëüíîå, │ñîäû                                           │äåçèíôåêöèè   

│÷åõëû îò ìåáåëè,                                                                  

│ìàðëåâûå ðåñïèðàòîðû)│2. Çàìà÷èâàþò â îäíîì èç                                     

                     │ðàñòâîðîâ:                                                   

                     │õëîðäåçèíà              │2,0         │60         │Êàê ïðè òåêóùåé│

                     │ñóëüôîõëîðàíòèíà        │1,0         │60         │äåçèíôåêöèè   

                     │äèõëîð-1                │3,0         │45                       

                     │õëîðáåòàíàôòîëà         │0,5         │60                       

                     │õëîðàìèíà               │5,0         │240                      

                     │â àêòèâèðîâàííîì        │1,0         │60                        

                     ðàñòâîðå õëîðàìèíà                                           

                                                                                  

│9. Íîñîâûå ïëàòêè,   │1. Êèïÿòÿò â ðàñòâîðå   │2,0         │15                       

│âêëàäíûå êàðìàíû äëÿ │ñîäû                                                         

│ïëåâàòåëüíèö,                                                                     

│ôëàíåëåâûå ôóòëÿðû   │2. Çàìà÷èâàþò â îäíîì èç                                     

│äëÿ ïëåâàòåëüíèö     │ðàñòâîðîâ:                                                   

                     │õëîðäåçèíà              │2,0         │90         │Êàê ïðè òåêóùåé│

                     │ñóëüôîõëîðàíòèíà        │1,0         │120        │äåçèíôåêöèè   

                     │õëîðáåòàíàôòîëà         │0,5         │120                      

                     │äèõëîð-1                │3,0         │90                       

                     │õëîðàìèíà               │5,0         │360                      

                     │â àêòèâèðîâàííîì        │1,0         │120                      

                     ðàñòâîðå õëîðàìèíà                                           

                                                                                  

│10. Íîñèëüíûå âåùè è │Ïðîâåòðèâàþò è          │-           │-          │Íàïðàâëÿþò äëÿ

│ïîñòåëüíûå           │ïðîãëàæèâàþò ãîðÿ÷èì                           │îáåççàðàæèâàíèÿ│

│ïðèíàäëåæíîñòè       │óòþãîì. Ïðè íàëè÷èè                            │â äåçèíôåêöèîí-│

                     │ïÿòåí ìîêðîòû åå                               │íóþ êàìåðó    

                     │íåìåäëåííî óäàëÿþò                             │(ï. 25)       

                     │òàìïîíîì, ñìî÷åííûì â                                        

                     │îäíîì èç ðàñòâîðîâ                                           

                     │(ï. 8)                                                       

                                                                                  

│11. Ïîìåùåíèÿ (ñòåíû,│1. Ïðîòèðàþò âåòîøüþ,                                        

│ïîë, äâåðè, ìåáåëü)  │ñìî÷åííîé â ðàñòâîðàõ:                                       

│â êîìíàòàõ êâàðòèð   │õëîðäåçèíà              │2,0         │-          │Îðîøàþò ïðè   

│áîëüíûõ, â ïàëàòàõ, âãèïîõëîðèòà ëèòèÿ       │0,5         │-          │ðàñõîäå       

│ëå÷åáíûõ êàáèíåòàõ, â│ñóëüôîõëîðàíòèíà        │1,0         │-          │ðàñòâîðîâ 500 

ìåñòàõ îáùåãî        │äèõëîð-1                │3,0         │-          │ìë/êâ. ì      

│ïîëüçîâàíèÿ          │õëîðáåòàíàôòîëà         │0,5         │-          │Îøòóêàòóðåííûå │

                     │â àêòèâèðîâàííîì        │0,25        │-          │ïîâåðõíîñòè   

                     ðàñòâîðå õëîðíîé èçâåñòè│                       │îáðàáàòûâàþò  

                     │â àêòèâèðîâàííîì        │0,5         │-          │äâóêðàòíî     

                     ðàñòâîðå õëîðàìèíà                                           

                                                                                  

                     │2. Ìîþò ïîëû ãîðÿ÷èì    │2,0         │-                        

                     │ìûëüíî-ñîäîâûì ðàñòâîðîì│                                     

                     │(êðîìå ïàðêåòíûõ)                                            

                                                                                  

│12. Óìûâàëüíèêè,     │1. Îáðàáàòûâàþò         │-           │-          Êàê ïðè òåêóùåé│

│ïèññóàðû, óíèòàçû,   │ðàñòâîðàìè ïðåïàðàòîâ,                         │äåçèíôåêöèè   

│êðàíû è ðàêîâèíû     │êàê â ï. 11                                                  

                                                                                  

                     │2. Ìîþò ñîëÿíîé êèñëîòîé│10,0        │-                        

                                                                                  

│13. Ìÿãêàÿ ìåáåëü,   │Ïðîòèðàþò âåòîøüþ,      │-           │-          │Êàê ïðè òåêóùåé│

│ìåëêèå ïðåäìåòû      │óâëàæíåííîé â îäíîì èç                         │äåçèíôåêöèè   

│îáèõîäà              │ðàñòâîðîâ, óêàçàííûõ â                                       

                     │ï. 11. Ïðè ýòîì îáúåêòû │                                     

                     │ñ öâåòíîé îáèâêîé                                            

                     │ïðîòèðàþò âåòîøüþ,                                           

                     ñìî÷åííîé ðàñòâîðîì                                          

                     │õëîðáåòàíàôòîëà                                               

                                                                                  

│14. Ïîìåùåíèå,                               │-           │-          Ïðè           

│ïðåäìåòû îáñòàíîâêè                                                 │ïåðåïðîôèëèðî- │

                                                                    │âàíèè ìíîãî-  

                                                                    │ýòàæíûõ       

                                                                    │ïðîòèâîòóáåðêó-│

                                                                    │ëåçíûõ ó÷ðåæäå-│

                                                                    │íèé èñïîëüçóþò │

                                                                    │àýðîçîëüíûå   

                                                                    │ïåðåíîñíûå ãå- │

                                                                    │íåðàòîðû (ÀÃÏ),│

                                                                    │èç êîòîðûõ    

                                                                    │ïðîèçâîäÿò    

                                                                    │ðàñïûëåíèå 40% │

                                                                    │ðàñòâîðîâ     

                                                                    │ôîðìàëüäåãèäà 

                                                                    │èç ðàñ÷åòà    

                                                                    │20 ìë/êóá. ì. 

                                                                    │Ïîñëå 24 ÷àñîâ │

                                                                    │ïàðû ôîðìàëüäå-│

                                                                    │ãèäà íåéòðàëè- │

                                                                    │çóþò 25% ðàñò- │

                                                                    │âîðîì àììèàêà 

                                                                    │èç ðàñ÷åòà    

                                                                    │10 ìë/êóá. ì  

                                                                                  

│15. Ïðåäìåòû óáîðêè  │Îáåççàðàæèâàþò ïî       │2,0         │120        │Êàê ïðè òåêóùåé│

                     │ðåæèìàì, óêàçàííûì â                           │äåçèíôåêöèè   

                     │ï. 9, èëè çàìà÷èâàþò â                                       

                     │îñâåòëåííîì ðàñòâîðå                                         

                     │õëîðíîé èçâåñòè                                              

                     ðàñòâîðå ÄÒÑÃÊ          │1,0         │120                      

                     ðàñòâîðå ãèïîõëîðèòà    │1,0         │60                       

                     │ëèòèÿ                                                         

                                                                                  

│16. Ïðåäìåòû óõîäà çà│1. Êèïÿòÿò â ðàñòâîðå   │2,0         │15         │Êàê ïðè òåêóùåé│

│áîëüíûìè: ïîäêëàäíûå │ñîäû                                           │äåçèíôåêöèè   

│ñóäíà, ìî÷åïðèåìíèêè,│                                                             

│íàêîíå÷íèêè äëÿ      │2. Ïðîòèðàþò (ïîäêëàäíûå│-           │-                        

│êëèçì, ïîäêëàäíûå    │ñóäíà, ðåçèíîâûå                                             

│êðóãè                │ïðåäìåòû) âåòîøüþ,                                           

                     ñìî÷åííîé â ðàñòâîðàõ,                                       

                     │óêàçàííûõ â ï. ï. 9 è 15│                                     

                                                                                  

│17. Èãðóøêè:         │1. Êèïÿòÿò â ñîäîâîì    │2,0         │15         │Êàê ïðè òåêóùåé│

│ìåòàëëè÷åñêèå,       │ðàñòâîðå (êðîìå                                │äåçèíôåêöèè   

│ðåçèíîâûå,           │ïëàñòìàññîâûõ)                                               

│äåðåâÿííûå,                                                                       

│ïëàñòìàññîâûå        │2. Ïîãðóæàþò â ðàñòâîðû │-           │-                        

                     │è îáåççàðàæèâàþò ïî                                          

                     │ðåæèìàì, óêàçàííûì â                                          

                     │ï. 4                                                         

                                                                                  

│18. Ìÿãêèå èãðóøêè   │1. Ìàëîöåííûå ìÿãêèå    │-           │-          Êàê ïðè òåêóùåé│

                     │èãðóøêè ñæèãàþò, à                             │äåçèíôåêöèè   

                     │öåííûå ñäàþò äëÿ                                             

                     │êàìåðíîé îáðàáîòêè                                           

                     │(ï. 25)                                                      

                                                                                  

                     │2. ×èñòÿò ùåòêîé,       │-           │-                        

                     ñìî÷åííîé â îäíîì èç                                         

                     │ðàñòâîðîâ, óêàçàííûõ â                                       

                     │ï. 11                                                        

                                                                                  

│19. Êíèãè, íîòû,     │Îáåççàðàæèâàþò ïî       │-           │-          │Êàê ïðè òåêóùåé│

│áóìàãè               │ðåæèìàì, óêàçàííûì â                           │äåçèíôåêöèè   

                     │ï. ï. 18, 26                                                 

                                                                                   

│20. Âûäåëåíèÿ (êàë,  │Îáåççàðàæèâàþò ïî       │-           │-          │Êàê ïðè òåêóùåé│

│ìî÷à)                │ðåæèìàì, óêàçàííûì â                           │äåçèíôåêöèè   

                     │ï. 2                                                         

                                                                                  

│21. Ïîñóäà èç-ïîä    │1. Îáåççàðàæèâàþò â     │-           │-          Êàê ïðè òåêóùåé│

│âûäåëåíèé (ãîðøêè,   │îñâåòëåííîì ðàñòâîðå                          │äåçèíôåêöèè   

│ïîäêëàäíûå ñóäíà)    │õëîðíîé èçâåñòè                                              

                                                                                  

                     │2. Îáåççàðàæèâàþò ïî    │2,0         │120                      

                     │ðåæèìàì, óêàçàííûì â                                         

                     │ï. 5                                                         

                                                                                  

│22. Íàäâîðíûå óáîðíûå│Ñîäåðæàò ïëîòíî         │-           │-          │Êàê ïðè òåêóùåé

│è ïîìîéíûå ÿìû       çàêðûòûìè, íå äîïóñêàÿ                         │äåçèíôåêöèè   

                     │ïåðåïîëíåíèÿ. Åæåäíåâíî │                                     

                     │äåçèíôèöèðóþò ïîìåùåíèå │                                     

                     │óáîðíîé îäíèì èç                                              

                     │ðàñòâîðîâ èëè çàñûïàþò                                       

                     │ïðåïàðàòîì ïî ðåæèìàì,                                       

                     │óêàçàííûì â ï. 11. Ìóñîð│                                     

                     │ñæèãàþò èëè                                                  

                     │îáåççàðàæèâàþò ïî                                            

                     │ðåæèìàì, êàê â ï. 2                                          

                                                                                  

│23. Òðàíñïîðò        │Îáðàáàòûâàþò 2,0%       │-           │-          │Êàê ïðè òåêóùåé│

                     │îñâåòëåííûì ðàñòâîðîì                          │äåçèíôåêöèè   

                     │õëîðíîé èçâåñòè (÷èñòÿò │                                     

                     │ùåòêàìè, ïðîòèðàþò                                           

                     │âåòîøüþ) èëè ðàñòâîðàìè,│                                     

                     │óêàçàííûìè â ï. 11                                           

                                                                                  

│24. Ìåðîïðèÿòèÿ ïî   │Íå äîïóñêàþò çàëåòà ìóõ │-           │-          │Ïåðåä íà÷àëîì 

│áîðüáå ñ ìóõàìè      │â ïîìåùåíèå ïóòåì                              │äåçèíôåêöèè   

                     │çàñåò÷èâàíèÿ ôîðòî÷åê,                         │èñïîëüçóþò     

                     │îêîí è äâåðåé.                                 àýðîçîëüíûå   

                     │Äëÿ óíè÷òîæåíèÿ ìóõ                            │áàëëîíû ñ ÄÄÂÔ,│

                     │èñïîëüçóþò àýðîçîëüíûå                         │âîäíûå 3%     

                     │áàëëîíû, èíñåêòèöèäíóþ                         │ðàñòâîðû      

                     │áóìàãó ñ õëîðîôîñîì è                          │õëîðîôîñà èëè 

                     │óãëåêèñëûì àììîíèåì, 3% │                       │ñìåñü 1%      

                     │ðàñòâîðû õëîðîôîñà                             õëîðîôîñà ñ   

                                                                    │0,1% ðàñòâîðà 

                                                                    │ÄÄÂÔ          

└─────────────────────┴────────────────────────┴────────────┴───────────┴───────────────┘

 

Ïðèìå÷àíèå. Ïîñëå îáåççàðàæèâàíèÿ ìîêðîòó ñëèâàþò â êàíàëèçàöèþ, à ïëåâàòåëüíèöû èëè ïîñóäó, â êîòîðîé äåçèíôèöèðîâàëè ìîêðîòó, ìîþò îáû÷íûì ñïîñîáîì.

 

25. Ðåæèìû êàìåðíîé äåçèíôåêöèè

 

┌─────────────────────────┬──────────────┬────────────────┬─────────────┐

│Íîðìû çàãðóçêè íà 1 êâ. ì│  Òåìïåðàòóðà │Ðàñõîä ôîðìàëèíà│ Ýêñïîçèöèÿ, │

│ ïîëåçíîé ïëîùàäè êàìåðû │ ïî íàðóæíîìó │   íà 1 êóá. ì       ìèí.   

├────────────┬────────────┤  òåðìîìåòðó     êàìåðû, ìë               

  â êîìïë.      â êã                                              

├────────────┴────────────┴──────────────┴────────────────┴─────────────┤

                        Ïàðîôîðìàëèíîâûé ìåòîä                        

                                                                      

                               I âàðèàíò                              

                                                                       

│5           │30          │57 - 59 °C    │100             │120         

                                                                      

                              II âàðèàíò                               

                                                                      

│5           │30          │57 - 59 °C    │150             │60          

                                                                      

                              III âàðèàíò                             

                                                                      

│3           │18          │49 - 51 °C    │250             │240         

                                                                       

                          Ïàðîâîçäóøíûé ìåòîä                         

                                                                      

│10          │60          │80 - 90 °C    │-               │30          

└────────────┴────────────┴──────────────┴────────────────┴─────────────┘

 

Ïðèìå÷àíèÿ.

1. Ïî ïàðîôîðìàëèíîâîìó ìåòîäó îáåççàðàæèâàþò âåùè, êîòîðûå ïîðòÿòñÿ ïðè +60 °C: êîæàíûå, ìåõîâûå, ðåçèíîâûå, îáóâü è ñëåäóþùèå âèäû ñèíòåòè÷åñêèõ òêàíåé (ïî I âàðèàíòó): òðèàöåòàòíûå, àöåòàòíûå, âèñêîçíûå, ïîëèïðîïèëåíîâûå, ëàâñàíîâûå, íèòðîíîâûå, êàïðîíîâûå, õëîðèíîâûå, àöåòîõëîðèíîâûå, ïîëèâèíèëõëîðèíîâûå.

2. Ïî ïàðîâîçäóøíîìó ìåòîäó îáåççàðàæèâàþò âåùè, êîòîðûå íå ïîðòÿòñÿ ïðè +60 °C: øåðñòÿíûå, õëîï÷àòîáóìàæíûå, êëååí÷àòûå, âåùè èç áàðõàòà, øåëêà íàòóðàëüíîãî, ñèíòåòè÷åñêîãî, à òàêæå ïîäóøêè, îäåÿëà, ìàòðàöû. Ïî ýòîìó ìåòîäó îáðàáàòûâàþò ñèíòåòè÷åñêèå òêàíè: òðèàöåòàòíûå, àöåòàòíûå, âèñêîçíûå, ïîëèïðîïèëåíîâûå, ëàâñàíîâûå, íèòðîíîâûå, êàïðîíîâûå, à òàêæå ðàçëè÷íûå èõ ñî÷åòàíèÿ ñ íàòóðàëüíûìè âîëîêíàìè (õëîïîê, ëåí, øåðñòü).

 

26. Êíèãè äåçèíôèöèðóþò â êàìåðàõ óâëàæíåííûì íàãðåòûì âîçäóõîì ïðè +70 - 75 °C, îòíîñèòåëüíîé âëàæíîñòè îò 60 - 70% äî 100 ïðè òðåõ÷àñîâîé ýêñïîçèöèè è çàãðóçêå èç ðàñ÷åòà 650 - 700 êíèã íà 1 êóá. ì ïîëåçíîé ïëîùàäè êàìåðû.

 

 







ßíäåêñ öèòèðîâàíèÿ



Èíòåðíåò àðõèâ çàêîíîäàòåëüñòâà ÑÑÑÐ. Áîëåå 20000 íîðìàòèâíî-ïðàâîâûõ àêòîâ.
ÑÑÑÐ, Ñîþç Ñîâåòñêèõ Ñîöèàëèñòè÷åñêèõ ðåñïóáëèê, Ñîâåòñêàÿ âëàñòü, çàêîíîäàòåëüñòâî ÑÑÑÐ, Ëåíèí, Ñòàëèí, Ìàëåíêîâ, Õðóùåâ, Áðåæíåâ, Àíäðîïîâ, ×åðíåíêî, Ãîðáà÷åâ, èñòîðèÿ ÑÑÑÐ.

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