On this page you can download for free current version normative legal act on labor protection: rules on labor protection when performing painting work.

More information about the document:

• Approved by order of the Ministry of Labor of Russia dated March 7, 2018 No. 127n (Order 127n)
• Order 127n was registered with the Ministry of Justice of the Russian Federation on 06/07/2018 under the number 51323
• Valid from 09.09.2018

Application area:

The rules on labor protection in the performance of painting work establish state regulatory requirements for labor protection in the organization and conduct of the main production processes and the performance of work on the preparation of painting materials and surfaces for painting, the application of paints and varnishes and powder polymer paints, drying and surface treatment of paint and varnish coatings (hereinafter - painting work).

The requirements of the labor protection rules when performing painting work are mandatory for employers - legal entities, regardless of their organizational and legal forms and individuals (with the exception of employers - individuals who are not individual entrepreneurs), when organizing and carrying out painting work.

MINISTRY OF LABOR AND SOCIAL PROTECTION OF THE RUSSIAN FEDERATION

ORDER
dated March 7, 2018 No. 127n

ABOUT THE APPROVAL OF THE RULES
ON LABOR SAFETY IN CARRYING OUT PAINTING WORKS

Below you can leave your comments (questions) regarding the application of this document in practice.

Order
No. 127n dated 25.02.2016

!!! Has expired in accordance with order No. 1043n of December 22, 2017 !!!

In accordance with Part 1.1 of Article 100 of the Federal Law of November 21, 2011 N 323-FZ “On the Basics of Protecting the Health of Citizens in the Russian Federation” (Sobraniye Zakonodatelstva Rossiyskoy Federatsii, 2011, N 48, Art. 6724; 2013, N 27, Art. I order:

1. Approve the attached terms and stages of accreditation of specialists, as well as categories of persons with medical, pharmaceutical or other education and specialists subject to accreditation.

2. The Department of Medical Education and Personnel Policy in Health Care of the Ministry of Health of the Russian Federation organizes the accreditation of specialists, taking into account the stages of transition.

3. To impose control over the execution of this order on the First Deputy Minister of Health of the Russian Federation I.N. Kagramanyan.

Minister
V.I. Skvortsova

Approved
order of the Ministry of Health
Russian Federation
dated February 25, 2016 N 127n

Deadlines and stages
accreditation of specialists, as well as categories of persons with medical, pharmaceutical or other education and subject to accreditation of specialists

In accordance with Part 1.1 of Article 100 of the Federal Law of November 21, 2011 N 323-FZ "On the Fundamentals of Protecting the Health of Citizens in the Russian Federation".

Judicial practice and legislation
Order of the Ministry of Health of Russia dated February 25, 2016 N 127n
"On approval of the terms and stages of accreditation of specialists, as well as categories of persons with medical, pharmaceutical or other education and subject to accreditation of specialists"

<Письмо>Ministry of Health of Russia dated 08/05/2016 N 16-5/10/2-4838<Об осуществлении медицинской деятельности специалистами, прошедшими аккредитацию по специальностям "Стоматология" или "Фармация">

order dated February 25, 2016 N 127n "On approval of the terms and stages of accreditation of specialists, as well as categories of persons with medical, pharmaceutical or other education and subject to accreditation of specialists" (registered in the Ministry of Justice of Russia on March 14, 2016, N 41401) (hereinafter - order N 127n);

<Письмо>Ministry of Health of Russia dated 07.07.2016 N 16-5/10/2-4126<Об аккредитации специалистов>

In accordance with the provisions of Order No. 127n, at present, the accreditation procedure for a specialist is carried out by persons who, after January 1, 2016, received higher education in basic educational programs in accordance with federal state educational standards in the specialties "Dentistry" and "Pharmacy".

In accordance with paragraph 6 of Article 144 of the Code of the Republic of Kazakhstan dated September 18, 2009 "On the health of the people and the healthcare system", the attached Sanitary Rules "Sanitary and epidemiological requirements for healthcare facilities" were approved.

In particular, the Sanitary Rules contain sanitary and epidemiological requirements for:

1) selection of a land plot for construction, design and placement of healthcare facilities;

6) collection, neutralization, storage of medical waste at healthcare facilities;

The choice of a land plot for construction, design of healthcare facilities is determined by the assignment for design in accordance with the requirements of state standards in the field of architecture, urban planning and construction, in accordance with subparagraph 23-16) of Article 20 of the Law of the Republic of Kazakhstan dated July 16, 2001 "On architectural, urban planning and construction activities in the Republic of Kazakhstan” (hereinafter referred to as state standards in the field of architecture, urban planning and construction).

When designing infectious diseases hospitals, the department provides for:

2) isolated departments for hospitalization of patients with airborne, intestinal, viral infections, especially dangerous and quarantine infections;

When designing, an independent isolated external entrance is provided in the examination box of the infectious diseases hospital.

When designing perinatal centers, maternity hospitals, it is necessary to provide for postpartum wards with a capacity of no more than two mother beds. The perinatal center provides departments for resuscitation and intensive care for newborns.

The composition and area of ​​the in vitro fertilization departments is determined by the technological process and capacity of the institution.

When operating rooms are located one above the other, septic operating rooms are placed above aseptic ones.

Operating blocks (departments) are provided impassable. Entrance for medical personnel is provided through sanitary checkpoints, for patients through locks.

Aseptic departments (blocks) include: rooms with a toilet, a bath or shower, a treatment room, a doctor's office, rooms for storing sterile material and other rooms, depending on the profile of the department.

Sanitary passes for personnel are designed as part of three adjacent rooms. The first room is equipped with a shower, a sanitary unit. The second room is used for putting on clean surgical suits, shoes, shoe covers. The third room is intended for changing and collecting used linen.

In the centers of outpatient, plastic and aesthetic surgery, dermato-cosmetology facilities, outpatient clinics, small operating rooms with a minimum set of rooms are provided - an operating room, a preoperative room, a sanitary checkpoint, a gateway at the entrance to the operating room for patients and a postoperative ward. The sanitary checkpoint is designed as part of one room, which is equipped with a shower with the provision of conditions for storing clean and collecting dirty linen for personnel.

In small operating rooms, the patient enters through the gateway, the staff through the preoperative room.

The design of rooms for magnetic resonance imaging, radiation diagnostics and therapy, as well as hygienic standardization of the value of the permissible effective dose rate, are carried out in accordance with the requirements of sanitary rules, hygienic standards approved by the state body in the field of sanitary and epidemiological welfare of the population in accordance with paragraph 6 of Article 144 and Article 145 of the Code of the Republic of Kazakhstan dated September 18, 2009 "On the health of the people and the healthcare system" (hereinafter referred to as standardization documents) and state standards in the field of architecture, urban planning and construction.

Psychiatric, tuberculous narcological clinics are located in the suburban area or outlying areas, if possible in green areas, in compliance with gaps from the residential area.

In residential buildings, it is allowed to place healthcare facilities providing outpatient care with a capacity of no more than 100 visits per shift, including those with day hospitals, outpatient surgery centers (with patients staying no more than 5 days), with a separate entrance.

It is not allowed to place hospitals with round-the-clock stay of patients in a residential building, with the exception of cases provided for in paragraph 15 of the Sanitary Rules.

Reception and ward departments for patients, operating rooms, dressing rooms, procedural, manipulation, childbirth, dental rooms, central sterilization departments, electro-light therapy rooms, workshops, warehouses for poisonous, potent, flammable and combustible liquids are not located in the basement and basement floors of buildings.

The order is put into effect upon the expiration of twenty-one calendar days after the day of its first official publication.

Legislation

Acting order Minister of National Economy of the Republic of Kazakhstan No. 127 dated February 24, 2015

Order Acting Minister of National Economy of the Republic of Kazakhstan No. 127 dated February 24, 2015
Registered with the Ministry of Justice of the Republic of Kazakhstan on April 14, 2015 No. 10713

I ORDER:

1. Approve the attached Sanitary Rules "Sanitary and epidemiological requirements for healthcare facilities".

2. The Committee for the Protection of Consumer Rights of the Ministry of National Economy of the Republic of Kazakhstan shall ensure in the manner prescribed by law:
2) within ten calendar days after the state registration of this order, its submission for official publication in print periodicals and in the information and legal system "Adilet";
3) placement of this order on the official Internet resource of the Ministry of National Economy of the Republic of Kazakhstan.

3. To impose control over the execution of this order on the supervising Vice Minister of the National Economy of the Republic of Kazakhstan.

4. This order shall enter into force upon the expiration of ten calendar days from the date of its first official publication.

And about. Minister
national economy
Republic of Kazakhstan M. Kusainov

Order 127 mz rk 2018

On approval of the Rules for organizing and conducting the procurement of medicines, preventive (immunobiological, diagnostic, disinfectant) drugs, medical devices and medical equipment, pharmaceutical services for the provision of a guaranteed volume of free medical care

On approval of the Sanitary Rules "Sanitary and epidemiological requirements for healthcare facilities"

Order Acting Minister of National Economy of the Republic of Kazakhstan dated February 24, 2015 No. 127

On Approval of the Rules for Mandatory Medical Examinations

Acting order Minister of National Economy of the Republic of Kazakhstan dated February 24, 2015 No. 128

On approval of the List of harmful production factors, professions in which mandatory medical examinations are carried out

On approval of the Sanitary Rules "Sanitary and epidemiological requirements for the organization and implementation of sanitary - anti-epidemic (preventive) measures to prevent infectious diseases"

On approval of the Sanitary Rules "Sanitary and Epidemiological Requirements for Laboratories Using Potentially Hazardous Chemical and Biological Substances"

Acting order Minister of National Economy of the Republic of Kazakhstan dated April 15, 2015 No. 338.

On approval of the Regulations on the activities of organizations and (or) structural divisions of healthcare organizations that carry out pathoanatomical diagnostics, and the Rules for conducting a pathoanatomical autopsy

Order of the Minister of Health and Social Development of the Republic of Kazakhstan dated February 25, 2015 No. 97.

order acting Minister of Health
Republic of Kazakhstan
dated November 23, 2010 No. 907

www.almaty-pab.kz

On approval of the Sanitary Rules "Sanitary and epidemiological requirements for healthcare facilities"

Order of the Minister of Health of the Republic of Kazakhstan dated May 31, 2017 No. 357. Registered with the Ministry of Justice of the Republic of Kazakhstan on September 27, 2017 No. 15760.

In accordance with paragraph 6 of Article 144 of the Code of the Republic of Kazakhstan dated September 18, 2009 "On the health of the people and the healthcare system", I ORDER:

1. Approve the attached Sanitary Rules "Sanitary and epidemiological requirements for healthcare facilities".

2. Recognize as invalid the Order of the Acting Minister of the National Economy of the Republic of Kazakhstan dated February 24, 2015 No. 127 “On Approval of the Sanitary Rules “Sanitary and Epidemiological Requirements for Healthcare Facilities” (registered in the Register of State Registration of Regulatory Legal Acts No. 10713, published in the Information -legal system "Adilet" dated August 5, 2015).

3. The Committee for Public Health Protection of the Ministry of Health of the Republic of Kazakhstan in the manner prescribed by law to ensure:

1) state registration of this order with the Ministry of Justice of the Republic of Kazakhstan;

2) within ten calendar days from the date of state registration of this order, sending a copy of it in paper and electronic form to the Republican State Enterprise on the right of economic management "Republican Center for Legal Information" for official publication and inclusion in the Standard Control Bank of regulatory legal acts of the Republic of Kazakhstan;

3) placement of this order on the Internet resource of the Ministry of Health of the Republic of Kazakhstan.

4. To impose control over the execution of this order on the supervising Vice Minister of Health of the Republic of Kazakhstan.

5. This order shall enter into force upon the expiration of twenty-one calendar days after the day of its first official publication.

"AGREED"
Minister for Investment and Development
Republic of Kazakhstan
____________ Zh. Kassymbek
September 8, 2017

"AGREED"
Minister of National Economy
Republic of Kazakhstan
____________ T. Suleimenov
September 20, 2017

"AGREED"
Minister of Energy
Republic of Kazakhstan
____________ K. Bozumbaev
August 22, 2017

Sanitary regulations

"Sanitary and epidemiological requirements for healthcare facilities"

Chapter 1. General Provisions

1. These Sanitary Rules "Sanitary and epidemiological requirements for healthcare facilities" (hereinafter referred to as the Sanitary Rules) establish sanitary and epidemiological requirements for healthcare facilities.

2. Sanitary rules contain sanitary and epidemiological requirements for:

2) water supply and sanitation of healthcare facilities;

3) lighting, ventilation and air conditioning and heat supply, premises of healthcare facilities;

4) repair and maintenance of premises of healthcare facilities;

5) organization and implementation of sanitary and anti-epidemic and sanitary and preventive measures at healthcare facilities;

7) nutritional conditions at healthcare facilities;

8) working conditions and welfare services for personnel.

3. The following concepts are used in these Sanitary Rules:

1) medical waste of class "A" - not differing in composition from municipal waste, not possessing hazardous properties;

2) antiseptic - a chemical antimicrobial agent intended for use on the skin or tissue in order to destroy microbes;

3) aseptic department - premises for providing medical care in the absence of a purulent infection in a patient;

4) aseptic mode - a set of sanitary-technical and sanitary-hygienic measures that prevent microbes from entering the wound;

5) medical waste class "B" - epidemiologically hazardous medical waste (infected and potentially infectious waste. Materials and tools, items contaminated with blood and other biological fluids. Pathological waste, organic operational waste (organs, tissues). Food waste from infectious departments Waste from microbiological, clinical diagnostic laboratories, pharmaceutical, immunobiological industries working with microorganisms of pathogenicity groups III-IV Biological waste from vivariums Live vaccines unsuitable for use;

6) boxing - a room with a separate entrance for the patient to enter from the outside. It consists of: a ward, a sanitary unit, a bath and a gateway;

7) medical waste class "B" - extremely epidemiologically hazardous medical waste (materials that have been in contact with patients with especially dangerous and quarantine infectious diseases that can lead to emergencies in the field of sanitary and epidemiological welfare of the population and require measures for sanitary protection of the territory. Waste from laboratories, pharmaceutical and immunobiological industries working with microorganisms of pathogenicity groups I-II Waste from patients with anaerobic infection and from patients with tuberculosis Waste from microbiological laboratories working with tuberculosis pathogens);

8) medical waste class "G" - toxicologically hazardous medical waste (drugs, including cytostatics, diagnostics, disinfectants that are not to be used. Mercury-containing objects, instruments and equipment. Waste of raw materials and products of pharmaceutical industries. Waste from the operation of equipment, transport , lighting systems);

9) medical waste of class "D" - radioactive medical waste (containing radioactive substances in an amount and concentration that exceed the values ​​regulated for radioactive substances established by the legislation of the Republic of Kazakhstan in the field of the use of atomic energy);

10) healthcare facilities - facilities where healthcare organizations and individuals engaged in medical practice in the field of healthcare operate;

11) healthcare organization - a legal entity carrying out activities in the field of healthcare;

12) an individual maternity ward or a shared ward - an equipped room with a bathroom for childbirth for one woman in labor, in which the puerperal with the newborn is until discharge from the hospital;

14) mobile medical facility - a mobile consultative and diagnostic facility located on the basis of vehicles (road, rail, sea, river, aviation) with equipment and places for medical personnel;

15) medical waste - waste generated in the process of providing medical services and performing medical manipulations;

16) neutralization of medical waste - reduction or elimination of hazardous properties of waste by mechanical, physical-chemical or biological treatment;

17) special installation for the neutralization of medical waste - specialized technological equipment designed for the neutralization of medical waste, using incineration, autoclaving, microwave treatment, plasma treatment and other methods of neutralization;

18) container for the safe collection and disposal of medical waste (hereinafter - KBSU) - waterproof and puncture-proof disposable containers for the collection and safe disposal of sharp and stabbing medical waste;

19) sanitary clothing - industrial clothing for protecting objects of labor from workers and workers from general industrial pollution;

21) residential area - a part of the territory of a settlement intended to accommodate residential, public (public and business) and recreational areas, as well as certain parts of engineering and transport infrastructure, other facilities, the location and operation of which does not have an impact that requires special sanitary protection zones;

22) gateway - a part of the room between the ward, department and common corridor, eliminating the possibility of air from one room to another through the ventilation system and located between rooms with different levels of air pollution.

Chapter 2

4. The choice of a land plot for construction, design of healthcare facilities is determined by the design task in accordance with the requirements of state standards in the field of architecture, urban planning and construction, in accordance with subparagraph 23-16) of Article 20 of the Law of the Republic of Kazakhstan dated July 16, 2001 "On architectural, urban planning and construction activities in the Republic of Kazakhstan” (hereinafter referred to as state standards in the field of architecture, urban planning and construction).

5. When designing infectious diseases hospitals, the department provides for:

1) admission department, where it is necessary to have at least two examination rooms or boxes;

3) diagnostic department (diagnostic wards);

6. When designing, an independent isolated external entrance is provided in the examination box of the infectious diseases hospital.

7. When designing perinatal centers, maternity hospitals, it is necessary to provide postpartum wards with a capacity of no more than two mother beds. The perinatal center provides departments for resuscitation and intensive care for newborns.

8. The composition and area of ​​the departments of in vitro fertilization is determined by the technological process and capacity of the institution.

9. When operating rooms are located one above the other, septic operating rooms are placed above aseptic ones.

10. Aseptic departments (blocks) include: rooms with a toilet, a bath or shower, a treatment room, a doctor's office, rooms for storing sterile material and other rooms, depending on the profile of the department.

11. Sanitary passes for personnel are designed as part of three adjacent rooms. The first room is equipped with a shower, a sanitary unit. The second room is used for putting on clean surgical suits, shoes, shoe covers. The third room is intended for changing and collecting used linen.

12. In the centers of outpatient, plastic and aesthetic surgery, dermato-cosmetology facilities, outpatient clinics, small operating rooms with a minimum set of rooms are provided - an operating room, a preoperative room, a sanitary checkpoint, a gateway at the entrance to the operating room for patients and a postoperative ward. The sanitary checkpoint is designed as part of one room, which is equipped with a shower with the provision of conditions for storing clean and collecting dirty linen for personnel.

In small operating rooms, the patient enters through the gateway, the staff through the preoperative room.

13. The design of rooms for magnetic resonance imaging, radiation diagnostics and therapy, as well as hygienic standardization of the value of the permissible effective dose rate are carried out in accordance with the requirements of sanitary rules, hygienic standards approved by the state body in the field of sanitary and epidemiological welfare of the population in accordance with paragraph 6 of Article 144 and article 145 of the Code of the Republic of Kazakhstan dated September 18, 2009 "On the health of the people and the healthcare system" (hereinafter referred to as standardization documents) and state standards in the field of architecture, urban planning and construction.

14. Psychiatric, tuberculosis narcological are located in the suburban area or outlying areas, if possible in green areas, observing gaps from the residential area.

15. In residential buildings, it is allowed to place healthcare facilities providing outpatient care with a capacity of not more than 100 visits per shift, including those with day hospitals, outpatient surgery centers (patients stay no more than 5 days), if there is a separate entrance.

16. It is not allowed to place hospitals with round-the-clock stay of patients in a residential building, except for the cases provided for in paragraph 15 of these Sanitary Rules.

17. Reception and ward departments for patients, operating rooms, dressing rooms, procedural, manipulation, childbirth, dental rooms, central sterilization departments, electro-light therapy rooms, workshops, warehouses for poisonous, potent, flammable and combustible are not located in the basement and basement floors of buildings liquids.

Chapter 3. Sanitary and epidemiological requirements for water supply and sanitation of healthcare facilities

18. Centralized domestic drinking, hot water supply and sanitation are provided at healthcare facilities.

19. In the absence of a centralized water supply system at a healthcare facility, water is used from non-centralized water supply sources (wells) or imported water that complies with standardization documents. Water supply is carried out by a special vehicle. Water is stored in special labeled containers.

20. In all doctor's offices, wards, auxiliary rooms (staff room, housewife room, dirty linen collection room, sanitary rooms, sanitary facilities), sinks with cold and hot water supply are provided.

Preoperative, dressing, procedural, manipulation, vaccination rooms, resuscitation rooms and wards, delivery rooms, locks of boxes, semi-boxes, nurses' posts at the wards of newborns, requiring a special regime, should be equipped with sinks with cold and hot water supply with installation of elbow and non-contact taps with mixers.

21. In the absence of centralized hot water supply in preoperative and delivery rooms, treatment rooms, dressing rooms, vaccination rooms, sterilization, resuscitation and departments for newborns and children under one year old, reception departments, sanitary rooms, washing, buffets, distribution rooms, catering units, laundries, continuous water heaters.

22. When placing an object in settlements that do not have or partially centralized sewerage network, the installation of a local sewerage system is provided. Wastewater is collected in an underground watertight container. The wastewater receiving tank is equipped with a lid, placed in the utility area and cleaned as it is filled.

Chapter 4. Sanitary and epidemiological requirements for lighting, ventilation and air conditioning and heat supply, premises of healthcare facilities

23. Natural and artificial lighting is provided in the premises of healthcare facilities.

Windows oriented to the southern rhumbs of the horizon are equipped with sun protection devices.

Lighting by "second light" or only artificial lighting is allowed in rooms where the operating rules do not require natural lighting.

24. Natural and artificial illumination of the premises of healthcare facilities is determined by the parameters in accordance with Appendix 1 to these Sanitary Rules.

25. Optimal microclimate and air conditions in the premises of healthcare facilities are provided by ventilation, air conditioning and heating systems. Supply and exhaust ventilation systems serve groups of premises in accordance with the cleanliness class.

26. Buildings of healthcare facilities that provide inpatient and outpatient care for 150 or more visits per shift should be equipped with mechanically driven supply and exhaust ventilation systems.

For healthcare facilities with less than 150 visits per shift, it is planned to install air conditioning devices with bactericidal filters in aseptic rooms.

In infectious hospitals (departments), including anti-tuberculosis, in each box and semi-box in the ward section, a separate exhaust ventilation system with gravitational induction is installed. In the absence of supply and exhaust ventilation with mechanical stimulation in the infectious diseases departments, natural ventilation is equipped with shielded bactericidal irradiators for each box and semi-box, which can be used in the presence of people.

In all rooms, except for operating rooms, in addition to supply and exhaust ventilation with mechanical stimulation, natural ventilation is provided.

27. The air supplied to operating rooms, anesthesia, delivery, resuscitation, postoperative wards, intensive care wards, wards for patients with skin burns and oncohematological patients with immunodeficiency is disinfected using bactericidal air filters with a high degree of purification (at least 95%) . In operating rooms, intensive care wards, resuscitation, maternity, procedural, laboratories, rooms in which the operation of medical equipment is accompanied by the release of harmful substances into the air, local exhausts or fume hoods are provided.

28. The frequency of air exchange is selected on the basis of calculations to ensure the specified purity and maintain the gas composition of the air. Relative air humidity is not more than 60%, air speed is not more than 0.15 meters per second.

29. Air ducts, grilles, ventilation chambers are kept clean, without mechanical damage, corrosion, or leaks. The inner surface of air ducts for supply and exhaust ventilation (air conditioning) excludes the removal of air duct material particles, protective coating into the premises and is made of materials that do not have sorbing properties.

30. Equipment for ventilation systems is located in special rooms, separate for supply and exhaust systems, not adjacent vertically and horizontally to doctors' offices, operating rooms, wards, rooms for permanent residence of people.

31. Exhaust ventilation with a single air exchange, supply ventilation with a double air exchange is installed in the premises.

32. In aseptic rooms, hidden laying of air ducts, pipelines, fittings is carried out.

33. At healthcare facilities providing inpatient care and outpatient care with a capacity of 150 or more visits per shift, mechanically driven exhaust ventilation without an organized inflow device is equipped in showers, toilets, sanitary rooms, rooms for dirty linen, temporary storage of waste and pantries for disinfectants.

34. In anti-tuberculosis organizations (departments):

1) the ventilation system should provide at least six air exchanges per hour in the wards and twelve in the rooms for performing aerosol-forming procedures (sputum collection room, bronchoscopy), with a balanced supply, preventing the occurrence of stagnant zones;

2) recuperators of rotary or plate type are not used;

3) exhaust units serving high-risk areas and class 1-2 biological safety cabinets are equipped with devices for air disinfection using HEPA filters or bactericidal ultraviolet irradiation of sufficient intensity;

4) it is not allowed to combine floor networks with one vertical collector;

5) equipment for supplying and removing air is located on opposite walls;

6) all doors of rooms and locks are equipped with devices for automatic closing, doors of wards and boxes (in the lower part of the canvas) with ventilation grilles for air inflow;

7) exhaust ventilation from the departments for patients with multidrug-resistant mycobacteria is arranged separately from each ward with mechanical stimulation and additionally with gravitational stimulation with the installation of a deflector. Supply ventilation in these compartments is provided with mechanical stimulation and air supply to the corridor;

8) stairwells, elevator shafts, elevator shafts, are equipped with autonomous supply and exhaust ventilation with a predominance of exhaust.

9) the supply and exhaust ventilation system must be operated around the clock.

35. Preventive inspection, repair of ventilation and air conditioning systems, cleaning and disinfection is carried out in accordance with the approved schedule of the institution.

36. At healthcare facilities, by order of the head, a person is appointed responsible for the operation of ventilation and air conditioning systems, the implementation of the schedule for scheduled preventive maintenance of ventilation systems.

37. Independent supply and exhaust ventilation systems with heating and air conditioning are provided for the premises: operating rooms, resuscitation rooms and intensive care wards (separately for septic and aseptic departments), delivery rooms (delivery wards), neonatal wards, oncohematological, dialysis, burns dressing departments, separate ward sections, sputum sampling, bacteriological laboratory, endoscopy, X-ray rooms, except for dental clinics (rooms) with dental devices and pantomographs working with a highly sensitive image receiver (without a photo lab), and dental devices with digital image processing, workload not exceeding 40 (mA*min)/week.

38. Air conditioning is allowed in operating rooms, anesthesia, delivery, postoperative wards, intensive care wards, oncohematological patients, patients with acquired immunodeficiency syndrome, with skin burns, resuscitation, in wards for newborns, infants, premature, injured children. Air conditioning is not provided in rooms fully equipped with incubators.

39. Buildings of healthcare facilities are equipped with central heating systems. In the absence of a centralized source of heat supply, an autonomous boiler house operating on liquid, solid and gaseous fuels is provided.

40. In rural settlements in one-story buildings, stove heating is allowed. The furnace is carried out in an isolated room with a separate entrance.

41. In the maternity ward, the air temperature is provided at least +25 0 C. In case of premature birth, the air temperature in the delivery room is provided at least + 28 0 C.

42. In the ward for premature babies, the air temperature is +25 0 C - + 28 0 C.

43. Temperature, air exchange rate, cleanliness category in the premises, including the day hospital of healthcare facilities, are determined by the parameters established in Annex 2 to these Sanitary Rules.

Chapter 5

44. During the period of major repairs, the functioning of the premises of healthcare facilities is terminated.

45. It is allowed to carry out current repairs while ensuring reliable isolation of functioning premises from those being repaired.

46. ​​Elimination of current defects is carried out immediately.

47. In the premises of healthcare facilities with a wet mode of operation, subjected to wet current disinfection (operating rooms, dressing rooms, childbirth, preoperative, anesthesia, procedural, manipulation, vaccination rooms, hospital premises for patients with multidrug-resistant mycobacteria tuberculosis, sputum collection rooms, as well as bathrooms, showers, sanitary facilities, enema rooms, rooms for storing and dismantling dirty linen, rooms for surgical profile) moisture-resistant material is used for interior decoration.

48. Suspended ceilings are not used in infectious diseases and anti-tuberculosis departments.

49. In organizations for the protection of motherhood and childhood, surgical and infectious diseases hospitals, at the entrance to each department, elbow dispensers with an antiseptic for hand treatment are installed.

50. Furniture, equipment, small-scale mechanization and cleaning equipment of healthcare facilities are used from materials that are resistant to detergents and disinfectants.

51. At healthcare facilities it is not allowed:

1) the use of faulty small-scale mechanization, equipment, devices;

2) the use of anesthesia and breathing apparatus with broken sealing of the gas supply system.

52. Wet cleaning (floor, furniture, equipment, window sills, doors) is carried out at least twice a day, in operating rooms between operations, using detergents and disinfectants approved for use in the Republic of Kazakhstan.

53. Cleaning equipment (buckets, basins, rags, mops) is marked with indication of the premises and types of cleaning work, used strictly for its intended purpose and disinfected after use.

Sanitary rooms are equipped with structures for drying cleaning equipment. At healthcare facilities providing outpatient care with a capacity of no more than 25 visits per shift, it is allowed to store cleaning equipment in sanitary facilities and utility rooms if there are storage shelves.

It is allowed to use new technologies for cleaning premises in compliance with epidemiological and disinfection regimes.

54. General cleaning of the premises of healthcare facilities is carried out:

1) in the premises of the operating unit, small operating rooms, CSOs, sterilization rooms, in the delivery room, maternity wards, dressing rooms, manipulation, examination, vaccination, procedural, dental rooms of a surgical profile, in the premises of the milk room at least once every seven calendar days;

2) in wards for patients with burns, in wards for patients with infectious diseases, purulent-septic infections, tuberculosis, in aseptic wards after a single discharge of patients, as well as at the death of a patient;

3) in other premises of healthcare facilities, it is carried out at least once a month.

55. When carrying out general cleaning of the premises of healthcare facilities, the following requirements must be observed:

1) employees use specially allocated sanitary clothing and use personal protective equipment (hereinafter referred to as PPE);

2) cleaning is carried out using disposable wipes or reusable disinfected rags;

3) wet cleaning of surfaces is carried out with solutions of detergents in the sequence: ceiling, windows and window sills, walls and doors - from top to bottom, equipment, floor - from the far wall to the exit, the toilet is cleaned last;

4) washing off the applied detergents is carried out with water, using disposable napkins or reusable rags;

5) disinfection of walls, window sills, floors, equipment, furniture is carried out with chemical disinfectants, in accordance with the instructions for their use;

6) the change of sanitary clothing and protective gloves to clean ones is carried out by employees before the stage of washing off the applied chemical disinfectants;

7) washing off chemical disinfectants is carried out with water using rags. Flushing can be omitted if disinfection is carried out with chemical disinfectants that do not require a flushing procedure after use;

8) after the general cleaning of the premises, disinfection, cleaning and drying of cleaning equipment is carried out;

9) after cleaning, turn on bactericidal irradiators for the estimated time in accordance with the instructions.

56. In dressing rooms, delivery rooms, resuscitation wards, wards for newborns, premature babies and children under one year old, treatment rooms, vaccination rooms, dental rooms, infection boxes, rooms with aseptic regime, bactericidal irradiators are switched on after each current cleaning, followed by ventilation of the premises, except for operating rooms . Estimated time of quartzization is determined in accordance with the instruction manual for the equipment.

57. Unshielded mobile bactericidal irradiators are installed at the rate of 2.0-2.5 watts per cubic meter of the room.

58. In anti-tuberculosis hospitals and organizations of the primary health care network, shielded bactericidal irradiators are used and are continuously used in the presence of people in places with insufficient ventilation, where sources of airborne infections are concentrated (corridors; rooms for procedures accompanied by increased aerosol emission, sectional halls of pathological laboratories, operating rooms for surgical operations and the like).

Shielded bactericidal irradiators are installed at the rate of one lamp with a power of 30 watts per 20 square meters. m on the floor and at a height of at least 2.20 m from the floor, provided that the radiation is not directed at people in the room. At the same time, the level of ultraviolet radiation in the upper part of the room at a distance of 1 m from the lamp should be in the range of 100-300 microwatts / sq. cm and not more than 0.2 microwatts / sq. see in the zone of predominant stay of people.

59. When using other installations for air disinfection, the calculation is carried out in accordance with the operating instructions.

The operation of an open bactericidal irradiator is accompanied by a sign "Do not enter, the bactericidal irradiator is on!" in Kazakh and Russian.

60. The following requirements are imposed on the linen regime at healthcare facilities:

1) objects are provided with bed linen, diapers, towels;

2) sterile or disposable underwear is used in operating rooms, delivery rooms, rooms with aseptic regime;

3) change of linen for patients is carried out once every seven calendar days and as it gets dirty;

4) change of bed linen for puerperas is carried out every three calendar days and as it gets dirty;

5) in the reception departments of hospitals, a room is allocated for temporary storage of patients' outerwear.

61. The collection of used linen is carried out in a dense special container (oilcloth, plastic bags, equipped linen carts). Dismantling of dirty linen in the departments is not allowed.

Temporary storage (no more than twelve hours) of dirty linen in departments is carried out in sanitary rooms, specially designated for this purpose premises in closed containers (metal, plastic tanks), which are easily washed and disinfected. To work with dirty linen, personnel are provided with replaceable sanitary clothing.

62. Linen of infectious diseases, purulent-surgical and pathoanatomical departments is disinfected before washing.

63. Washing of linen is carried out in laundries, regardless of the form of ownership, subject to the allocation of special technological lines that exclude the possibility of contact of linen with non-hospital linen.

Independent laundries are obligatory at maternity hospitals, children's, infectious diseases and specialized hospitals.

64. At healthcare facilities providing outpatient care with a capacity of not more than 100 visits per shift, a mini-laundry is allowed, consisting of at least two adjacent rooms (one for collection and washing, the other for drying and ironing) with a washing machine - automatic .

At healthcare facilities providing outpatient care with a capacity of less than 25 visits per shift, it is allowed to combine collection, washing, drying and ironing in the back rooms.

65. In hospitals, a disinfection department is provided (the composition and areas are determined by the capacity of the hospital). In the absence of their own disinfection department, disinfection of bedding is carried out in organizations that have disinfection chambers.

66. Bedding (mattresses, pillows, blankets) at healthcare facilities are subjected to disinfection by the method of chamber disinfection in the following cases:

1) after discharge or transfer of a patient from surgical, traumatological, oncological, hematological, burn departments, departments for pregnant women and women in childbirth, departments for children, infectious, anti-tuberculosis, dermatovenereological departments;

2) according to epidemic indications;

3) when bedding is contaminated with biomaterial;

4) after the death of the patient.

Mattresses and pillows in tightly sewn hygienic covers are disinfected by wiping or spraying the covers with chemical disinfectants.

67. Transportation of clean and dirty linen is carried out in a packaged form in closed labeled containers (“clean”, “dirty” linen).

Clean linen is stored in specially allocated rooms on racks, in cabinets on shelves.

Paragraph 1. Sanitary and epidemiological requirements for the maintenance of surgical departments

68. In the operating block (department), the following zones are provided:

1) "sterile" (operating and assisting surgeons, operating room nurse),

2) "clean" (anesthesiologists, junior and technical staff, delivery of the patient, from clean linen, medicines),

3) "dirty" (removal of medical waste, used linen, dressings).

For small operating rooms, the following areas are provided:

1) “sterile” through the sanitary inspection room (operating and assisting surgeons, anesthesiologists, operating nurse, clean sterile underwear),

2) "clean" (junior and technical staff, delivery of the patient, medicines).

After the end of the operation, the disposal of medical waste, used linen is allowed through the gateway.

69. At least 2 dressing rooms are provided in surgical departments. Dressings with purulent discharge are carried out in a septic dressing room, in its absence, in an aseptic dressing room after dressing patients who do not have purulent discharge.

Paragraph 2. Sanitary and epidemiological requirements for the maintenance of objects of dermato-cosmetology, plastic and aesthetic surgery

70. At dermato-cosmetology facilities using local anesthesia, as well as manipulations to correct functional wrinkles, local hyperhidrosis, using preparations based on botulinum toxin, are carried out in treatment or manipulation rooms.

71. At the objects of plastic aesthetic surgery, surgical procedures using preparations based on botulinum toxin are performed in operating rooms or small operating rooms, with the exception of the correction of functional wrinkles, local hyperhidrosis.

72. Interior decoration, engineering support and equipment of procedural and manipulation rooms used to provide medical services in dermato-cosmetology, operating rooms and small operating rooms used to provide plastic and aesthetic surgery services must comply with the requirements established by these Sanitary Rules.

73. Procedure and manipulation rooms used for the correction of functional wrinkles, local hyperhidrosis, using preparations based on botulinum toxin are additionally provided with refrigeration equipment for storing used preparations.

74. Storage of preparations based on botulinum toxin is carried out in conditions that exclude access by unauthorized persons, on a separate shelf of the refrigerator, in a separate labeled container (original packaging), taking into account temperature conditions and other restrictions established by their manufacturer.

Paragraph 3. Sanitary and epidemiological requirements for the maintenance of perinatal centers, obstetric hospitals

75. In the reception rooms of the gynecological, maternity wards and the admissions department of the children's hospital, sanitary checkpoints for personnel with a dressing room and showers are equipped.

76. The wards of the postpartum department are filled cyclically, no more than three calendar days of stay.

77. In the ward for the joint stay of mother and child, individual cribs and a changing table for newborns are installed.

78. Departments of pathology of newborns and nursing are provided only as part of perinatal centers and children's hospitals, with appropriate planning isolation.

79. An individual maternity ward is provided with liquid soap, an antiseptic, a disposable towel, a visual wall guide on hand washing techniques, a rug, a ball, and a wall bar. A free interior is allowed in the wards, subject to the use of items that are subjected to wet processing, the use of personal clean clothes for the mother and child.

80. The provision of medical care to newborns, infants and young children with infectious pathology is carried out in departments for children in specially allocated, separate boxed rooms.

81. Boxed premises are filled taking into account the cyclicity, the age of the child and his pathology.

82. In departments of the second stage of nursing and departments for children under 3 years of age, wards for joint round-the-clock stay of mothers, a filter for their preventive examination and changing clothes are provided.

83. The composition of the children's department provides for at least 2 rooms for preparing, bottling baby formula and a room for processing dishes. Powdered milk mixtures after opening the package are marked with the date and time of opening.

84. In the children's departments, a canteen is provided for children over three years old.

85. Children's departments use toys made of materials that allow physical or chemical disinfection. For disinfection of toys, specially allocated and marked containers are used.

86. Cleaning and disinfection of incubators, incubators for children is carried out by a medical worker, taking into account the recommendations of the manufacturer, in a specially designated room.

Paragraph 4. Sanitary and epidemiological requirements for the maintenance of blood service facilities

87. At the facilities of the blood service, the compliance of the premises with the following requirements is ensured:

1) work areas should not be walk-through;

2) authorized access is provided in production premises for the preparation and storage of blood products and in laboratory premises.

88. In the premises, wet cleaning (floor, furniture, equipment, window sills, doors) is carried out at least twice a shift, before starting work using detergents, after finishing work using detergents and disinfectants permitted for use on the territory of the Republic of Kazakhstan .

89. Work areas are provided with sinks for washing hands, dispensers with liquid soap and antiseptic solution, disposable towels or electric towels.

90. Separate storage of various categories of blood products and materials is provided:

1) prepared whole blood and its components;

2) intermediate blood products;

3) blood products in temporary quarantine (until the results of quality tests are received);

4) finished blood products intended for medical use;

5) blood products not subject to release for medical use.

In the absence of separate storage conditions, specially marked areas of premises, racks, refrigerators, containers are allocated.

91. At all stages of production, storage and transportation of blood products, the conditions of the "cold chain" are provided:

1) refrigeration equipment, thermal containers and / or refrigerated trucks that maintain the established temperature regime for storage and transportation, as well as constant monitoring of compliance with the temperature regime at all stages;

2) packaging that prevents physical damage and minimizes the risk of microbiological contamination of blood products;

3) constant monitoring of compliance with the temperature regime at all stages.

92. Refrigeration equipment equipped with locks or access restriction devices shall be used to store blood products.

93. In the premises used for visiting donor sessions, the flow of working procedures, sufficient ventilation, electrical equipment, lighting, and authorized storage of blood products are ensured. The suitability of proposed external facilities is determined prior to the start of the donor session.

Paragraph 5. Sanitary and epidemiological requirements for the maintenance of infectious diseases hospitals and departments

94. The admission department of infectious diseases hospitals is provided with:

1) a supply of clean bags (made of dense fabric) for laying the clothes and linen of patients in them and for storing them before being sent to the disinfection chamber;

2) containers for collecting vomit and feces;

3) separate cleaning equipment for cleaning premises, sanitary facilities;

4) detergents, disinfectants and disinfectants;

5) sterile laboratory glassware for sampling material for research;

6) shielded bactericidal ultraviolet irradiators, allowing disinfection in the presence of people;

7) gowns, scarves, respirators for working medical personnel;

8) anti-pedicule styling;

9) sets of protective suits of the first type.

95. Sanitary treatment of the patient is carried out in the emergency department. In cases where a patient enters a box or semi-box, sanitization is carried out directly in these rooms.

96. Departments for hospitalization of patients with airborne, especially dangerous and quarantine infections and the diagnostic department (diagnostic wards) should be completely boxed. In other departments, boxes and semi-boxes should be at least 30% of the total number of wards.

97. The work of the departments is organized according to the principle of providing medical care and servicing patients in the ward.

98. The entry of personnel into the boxes is provided from a non-infectious "conditionally clean" corridor through locks in which sanitary clothing is changed, hands are washed and disinfected.

99. In the boxes of the infectious diseases departments, glazed openings from the airlocks to the wards, transfer cabinets for the delivery of food, medicines and linen from the airlock to the ward are provided. In boxed wards, transfer cabinets are provided from the corridor to the ward. Patients eat in the ward.

100. The filling of boxes is carried out taking into account the cyclicity, nosological forms and characteristics of the clinical course of individual forms of infectious diseases.

101. Patients with intestinal infections are provided with individual labeled pots, the labeling of which should correspond to the patient's bed number. The patient's secretions are disinfected.

Paragraph 6. Sanitary and epidemiological requirements for the maintenance of anti-tuberculosis organizations

102. On the territory of anti-tuberculosis organizations, separate walking areas for patients are provided in accordance with the epidemiological status.

103. Anti-tuberculosis organizations provide for a reception department with at least two examination rooms or boxes.

In anti-tuberculosis organizations, separate hospitalization of patients is provided in accordance with the results of sputum smear microscopy, drug sensitivity testing and the prescribed treatment regimen (hereinafter referred to as the epidemiological status) in the following specialized departments:

1) a department for patients with bacterial excretion with preserved sensitivity to rifampicin;

2) department for patients without bacterial excretion with preserved sensitivity to rifampicin;

3) department for patients with multidrug resistance;

4) department for patients with extensive drug resistance;

5) a department for patients with chronic bacterial excretion of tuberculosis who do not receive specific treatment;

6) department for compulsory treatment.

104. Each department for the treatment of patients with bacterial excretion is zoned in accordance with the epidemiological status. Patients with bacterioexcretion with unknown drug-susceptibility status are kept in single rooms with separate sanitary facilities and showers until the results of the drug-susceptibility test are received.

105. Separate hospitalization of patients with tuberculosis is ensured in the compulsory treatment unit depending on drug sensitivity.

106. Patients with chronic forms of tuberculosis with constant bacillus excretion, who need symptomatic treatment, are subject to isolation in specialized organizations or departments at anti-tuberculosis organizations until the period of abacillation.

107. Separate rooms are allocated in anti-tuberculosis organizations for outpatient admission of patients who excrete multi- (poly-) resistant strains.

108. In anti-tuberculosis organizations, the cycle of filling the wards within fourteen calendar days is observed.

109. The building of anti-tuberculosis hospitals is divided into "clean" and "dirty" zones, with a lock between them, equipped with a mechanical ventilation system, air disinfection devices, and a sink for washing hands.

In the "clean" area of ​​the ward for patients and treatment rooms are not located.

110. A sputum collection room is allocated in each department, in primary health care organizations, outpatient and inpatient care facilities.

The sputum collection room is equipped with a bactericidal irradiator, a handwashing sink with a dispenser with antiseptic soap and an antiseptic solution, containers with a disinfectant solution, containers for clean containers and containers with sputum (bixes, metal boxes with galvanized or stainless steel handles), equipped with a local system ventilation with an air exchange rate of the premises of at least twelve air exchanges per hour.

111. Patients with cough, with the release of mycobacteria and patients with the release of drug-resistant forms of mycobacteria use surgical masks:

1) when communicating with medical workers and visitors;

2) when moving through the territory of other departments and administrative buildings.

112. Used patient care products, linen, bedding, furniture, equipment are subject to mandatory disinfection before being removed from the department of anti-tuberculosis organizations (for use in other departments, write-offs, disposal).

113. In tuberculosis hospitals, visiting patients by visitors in the wards, unauthorized transfer of patients from ward to ward, unauthorized movement of patients outside the departments is prohibited.

114. Food intake of patients with the release of mycobacterium tuberculosis is carried out in the wards.

115. In the bacteriological laboratory of anti-tuberculosis organizations (departments), three separate sections are provided for performing bacterioscopic examinations:

1) for the preparation and staining of smears;

2) for bacterioscopy;

3) for registration and storage of drugs.

Paragraph 7. Sanitary and epidemiological requirements for the maintenance of physiotherapy rooms

116. Isolated cabins in children's departments (offices) are not provided, all procedures are carried out in the presence of a nurse.

117. Remote control devices and devices with a power of more than 50 watts are placed in isolated rooms or cabins shielded with metallized fabric (with microwire).

118. Physiotherapy equipment is installed in isolated booths, free from grounding (isolation from walls and floors).

119. Apparatus for conducting UHF and microwave therapy with a remote and with a universal arrangement of capacitor plates of emitters require the organization of specially allocated rooms or cabins shielded with a cloth with a microwire.

120. Laser installations of hazard class 3 and 4 are located in separate rooms. The walls are made of fireproof materials with a matte surface. The doors of the premises must be closed with internal locks with blocking devices that exclude access to the premises during laser operation. A laser hazard sign and an automatically activated light panel “Danger, the laser is working!” are placed on the door. in the state and Russian languages.

121. Laser installations of hazard class 1 and 2 are allowed to be placed in common areas.

122. The electric sleep cabinet is located in an impassable area, taking into account the orientation of the windows to a quiet area, in soundproof conditions. At the office, a control room with a viewing window for observation is provided.

123. The room for group inhalation is isolated from other rooms.

The compressor for individual inhalation devices is placed with them or in an adjacent room. Compressors for inhalation units for several treatment sites can be placed in the basement or semi-basement.

124. An independent supply and exhaust ventilation is provided in the inhalation room. In an individual inhaler, it is necessary to provide four air exchanges per hour, in a group inhaler, ten air exchanges per hour.

125. Departments of physiotherapy are subdivided into a "dry" zone (rooms for electro-, light-, heat therapy) and a "wet" zone (hydrotherapy, mud therapy). For procedures for each type of treatment, separate rooms are equipped. It is allowed to place equipment for electrotherapy and phototherapy in the same room.

126. Individual, reusable or disposable underwear is used for each patient. During the procedures, medical personnel use disposable gloves.

Paragraph 8. Sanitary and epidemiological requirements for the maintenance of centralized sterilization departments

127. Premises of centralized sterilization departments are divided into three zones:

1) "dirty" (reception of dirty material, sorting, laying in a disinfection-washing machine);

2) “clean” (unloading the cleaned, disinfected and dried material from the disinfection-washing machine, packing, placing it in the sterilizer). A separate room is provided for the packaging of medical linen;

3) "sterile" (receipt of sterile material from sterilizers and its storage).

The entrance to the premises of the "clean" and "sterile" zones is carried out through a sanitary checkpoint.

128. When using reusable medical instruments in work, a washing and sterilization department is provided.

Sterilizing equipment is installed in accordance with its instructions for use.

129. Organization and conduct of disinfection, pre-sterilization cleaning, sterilization and storage of medical devices is carried out in accordance with standardization documents.

Paragraph 9. Sanitary and epidemiological requirements for the maintenance of dental clinics (rooms)

130. In dental facilities with a capacity of more than 50 visits per shift, children are received in separate rooms.

In dental facilities with a capacity of 50 or less visits per shift, it is allowed to conduct therapeutic and orthopedic appointments in one office, the intersection of flows of adults and children in therapeutic, orthopedic, orthodontic and separately in surgical profile, subject to disinfection and sterilization regimes.

131. In rural settlements, it is allowed to have separate rooms for the combined reception of adults and children in the surgical and therapeutic profile, in compliance with the isolation and disinfection-sterilization regimes.

132. In the premises of a dental clinic located in a residential and public building, it is allowed to have dental devices and pantomographs operating with a highly sensitive image receiver (without a photo lab), and dental devices with digital image processing, a working load not exceeding 40 (mA * min) / week.

133. The work of the office of surgical dentistry is organized taking into account the separation of the flows of "clean" and "purulent" interventions.

134. A table for sterile materials and instruments or a bactericidal chamber for storing instruments is installed in each dental office.

135. All dental offices are provided with medical equipment and medical products in an amount sufficient for uninterrupted operation, taking into account the time required for their processing between manipulations.

An individual dental examination kit is allocated for each visit.

136. Dentures and templates with wax rolls should be disinfected before fitting. The impression trays are disinfected and sterilized.

Handpieces of boron machines are subjected to disinfection, pre-sterilization cleaning and sterilization after each use in accordance with the manufacturer's recommendations.

137. Cabinets shall be equipped with bactericidal irradiators or other air disinfection devices.

Paragraph 10. Sanitary and epidemiological requirements for the maintenance of healthcare facilities for palliative care and nursing care

138. Departments of palliative care and nursing care are provided as part of a multidisciplinary or specialized healthcare facility, or operate as an independent facility.

139. In hospices and palliative care units (hereinafter referred to as hospices), it is necessary to provide additional rooms for sleeping and eating for persons caring for patients (from relatives, volunteers and other persons who are not employees of the healthcare facility).

140. The arrangement of wards for hospice patients is envisaged with a capacity of up to four beds.

141. As part of the hospice department, a separate ward for one or two beds is provided for patients with purulent-septic and infectious diseases.

142. In hospices, a separate room is provided for visiting patients and organizing the reception of parcels for patients.

Paragraph 11. Sanitary and epidemiological requirements for the maintenance of hemodialysis units

143. Rooms for outpatients in the department for chronic hemodialysis are allocated in an independent zone.

144. Rooms for rest, changing and storage of personal belongings are provided for outpatients.

145. Rooms for hemodialysis in infectious diseases hospitals should be located adjacent to the boxes for patients.

146. For program hemodialysis patients who are carriers or patients with chronic forms of an infectious disease, as well as for persons with positive test results for markers of parenteral viral hepatitis, a separate area or a separate room and equipment is provided.

147. Premises for water treatment, preparation and storage of dialysis concentrates, storage of ingredients for the preparation of dialysis concentrates shall be located isolated from each other. All rooms are equipped with supply and exhaust ventilation.

148. An uninterrupted supply of purified water is provided for in dialysis rooms.

149. Before dialysis, the expiration date of single-use products (dialyzer, column, blood container, lines) is checked, and the integrity of consumer packaging is also checked. Do not use single-use products with damaged consumer packaging that violates their sterility.

150. During the procedure, equipment, devices and instruments that have not been disinfected and sterilized are not used.

151. Connecting the patient's vessels to the lines of the apparatus is carried out under aseptic conditions. During each dialysis procedure, to prevent contamination of the puncture zone, it is necessary to use sterile oilcloths and diapers. The puncture site for the entire period of the procedure is closed with a sterile dry gauze swab.

152. The mattress on the bed in the dialysis room must be protected from the ingress of blood, other biological fluids into it with an oilcloth or other waterproof coating. Bed sheets (chair beds) must be changed after each dialysis session. It is allowed to use the patient's individual linen, while it is necessary to provide that the individual linen is not contaminated with blood stains and other secretions.

Paragraph 12. Sanitary and epidemiological requirements for the maintenance of pathological organizations

153. A room for storing corpses shall be equipped with refrigeration units providing a temperature of +2 0 C - +4 0 C, mechanization means for transporting corpses, racks, shelves or special safes. Corpses on the floor are not stored.

154. Cold and hot water is supplied to the sectional tables. The sectional table is equipped with a container for collecting and disinfecting wastewater before draining into the drainage system. The workplace at the sectional table is equipped with a wooden grate.

155. Sectional tables, wheelchairs, stretchers and other devices for transporting corpses shall be covered with a waterproof material resistant to detergents and disinfectants.

156. The floor is washed daily with hot water and detergents. Wall panels, doors are washed as they become dirty, but at least once a week.

157. At least once a month and after the autopsy of corpses that died from infectious diseases, general cleaning is carried out in the premises, using detergents and disinfectants.

158. Work with sectional material is carried out using PPE (gown, gloves, aprons, glasses). In cases that do not exclude tuberculosis, high-protection masks and respirators are used.

Chapter 6

159. For the effective organization and implementation of measures to prevent nosocomial infectious diseases (hereinafter referred to as nosocomial infections), an infection control program is being developed at a healthcare facility, which provides for:

1) accounting and registration of nosocomial infections;

2) analysis of morbidity, identification of risk factors, investigation of outbreaks of nosocomial infections and taking measures to eliminate them;

3) organization and implementation of microbiological monitoring;

4) development of tactics of antibiotic prophylaxis and antibiotic therapy;

5) organization of measures to prevent occupational diseases;

6) staff training on infection control;

7) organization and control of the sanitary and anti-epidemic regime;

8) organization of collection, neutralization, storage and transportation of medical waste.

160. At healthcare facilities of a non-infectious profile, if an infectious disease is detected in a patient that poses an epidemiological danger to others, he is transferred to an isolation ward. In the absence of an isolation ward, patients with infectious diseases are subject to transfer to the appropriate infectious disease hospitals.

161. The flow of movement of patients admitted for inpatient treatment is provided for in a planned and emergency manner from the admission department to the department according to the profile of hospitalization. It is allowed on an emergency basis (according to clinical indications) for the movement of patients to the operating room, the department of anesthesiology and resuscitation, the delivery room, bypassing the emergency department.

To prevent the intersection of "dirty" and "clean" flows, transportation of patients, visitors, delivery of food to patients, elevators should be defined as "conditionally dirty" and "conditionally clean".

162. In the admissions department, a throat examination, temperature measurement, examination for pediculosis, scabies, dermatomycosis of incoming patients are carried out, with a note in the medical history. Biological material is being selected according to epidemiological indications for laboratory research.

163. If an infectious disease is suspected, the patient is isolated in the diagnostic ward at the admission department (box) before being transferred to the infectious diseases department (hospital).

164. Patients with purulent-septic infectious diseases are isolated in the department of purulent surgery, and in its absence, in a separate ward.

165. Sanitary treatment of patients is carried out upon admission to the hospital and a set of clean underwear, pajamas, slippers is issued. Patients in home clothes are allowed to stay in the hospital, with the exception of patients who are being treated in anti-tuberculosis organizations.

166. In the wards, beds are installed in strict accordance with the area established in accordance with the current state standards in the field of architecture, urban planning and construction.

167. Compliance with the cyclic filling of wards during hospitalization of patients (within three calendar days) is ensured.

168. The reprofiling of beds in healthcare facilities for epidemiological indications is coordinated with the territorial subdivision of the state body in the field of sanitary and epidemiological welfare of the population.

169. In hirudotherapy rooms, leeches are used once, reuse is not allowed. Leeches after use are disposed of in accordance with the accepted scheme for handling Class B medical waste.

170. All medical manipulations related to the violation of the integrity of the skin and mucous membranes are carried out with disposable gloves.

171. Medical personnel clean their hands before and after each medical manipulation in compliance with all stages of hand processing.

172. Permissible levels of bacterial contamination of the air environment of premises, depending on their functional purpose and the class of cleanliness of healthcare facilities, are determined by the parameters established in Annex 3 to these Sanitary Rules.

173. Laboratory and instrumental studies carried out during special checks at healthcare facilities are carried out in accordance with Appendix 4 to these Sanitary Rules.

174. The organization of measures for the implementation of production control is carried out in accordance with standardization documents.

175. Disinfection, disinfestation and deratization activities at healthcare facilities are organized and carried out on a systematic basis in accordance with standardization documents.

Chapter 7

176. Collection, disposal, storage and removal of medical waste from healthcare facilities is carried out in accordance with the Waste Management Program approved by the head of the healthcare facility, which provides for:

1) the composition of generated waste by class;

2) the procedure for collecting medical waste;

3) applied methods of disinfection (neutralization) and waste disposal;

4) waste management scheme;

5) hygienic training of personnel in the rules of epidemic safety in waste management.

In order to organize a system for handling medical waste, by order of the head of the healthcare facility, a responsible person is appointed to monitor compliance with the requirements of these Sanitary Rules.

177. Disposable, waterproof bags, bags, metal and plastic containers, containers for collection and safe disposal are used to collect waste. Metal and plastic containers, containers for collecting hazardous waste are tightly closed.

178. The classification of medical waste is determined in accordance with the Basel Convention on the Control of Transboundary Movements of Hazardous Wastes and Their Disposal. To collect each class of waste, bags, container packages are used, having colors:

1) waste class "A" - black;

2) waste class "B" - yellow;

3) waste class "B" - red;

4) class "G" waste - white.

179. The following requirements apply to the collection of Class A medical waste:

1) collection is carried out in reusable containers and disposable bags;

2) disposable bags are placed on special trolleys or inside reusable containers. Waste collection containers and trolleys are marked with the appropriate inscriptions “Medical waste. Class "A".

180. The following requirements are imposed on the collection of medical waste of classes "B" and "C":

1) are collected in disposable soft (bags) or hard non-puncture (containers) yellow packaging or with yellow marking. The choice of packaging depends on the morphological composition of the waste;

2) piercing and sharp objects are collected in impenetrable and waterproof KBSU without preliminary analysis and disinfection;

3) in the presence of special devices for separating needles (needle removers, needle destructors, needle cutters), used syringes without needles are collected in disposable soft (bags) with other Class B medical waste, which are disinfected at special facilities;

4) for the collection of organic, liquid medical waste of class "B", moisture-resistant containers with a lid ensuring their sealing are used;

5) KBSU are filled with no more than three fourths of the volume. Upon filling, the KBSU is tightly closed with a lid and sent to the medical waste storage room, where it is stored for no more than three days;

6) at the final packaging of medical waste of classes "B" and "C" for their removal from the unit, disposable containers (bags, KBSU) are marked with the appropriate inscriptions "Medical waste. Class "B" or "C", indicating the name of the unit, date, surname, first name and patronymic (if any) (hereinafter - full name) of the person responsible for waste collection.

181. Class G medical waste is collected in containers marked with the appropriate inscriptions “Medical waste. Class "G", indicating the name of the unit, date, full name of the person responsible for the collection of waste.

182. When organizing the neutralization of waste using special installations, the collection and storage of medical waste of class "B" is carried out without preliminary neutralization at the places of generation, provided that epidemiological safety is ensured.

183. Pathological and organic operational medical waste of class "B" (organs, tissues, and so on) are subject to cremation (burning) or burial in cemeteries in a specially designated area. Preliminary disposal of this medical waste is not required, with the exception of waste from infectious patients.

184. Class B medical waste is subject to mandatory disposal by physical or chemical methods at a healthcare facility. It is not allowed to export non-decontaminated medical waste of class "B" outside the territory of the organization.

185. Liquid biological medical waste after neutralization by chemical methods (disinfection) is discharged into the drainage system.

186. Incineration of medical waste of classes B and C on the territories of healthcare organizations outside of specialized installations is prohibited.

187. For the storage of medical waste of classes "B", "C", "D" at healthcare facilities providing inpatient care and outpatient care with a capacity of more than 50 visits per shift, a separate room is allocated, equipped with mechanically driven exhaust ventilation, refrigeration equipment for storing biological waste (if any), racks, scales, containers for collecting bags of medical waste, a sink with hot and cold water supply, air disinfection units, and hand sanitizer.

188. At healthcare facilities providing outpatient care with a capacity of 50 visits or less per shift, it is allowed to store medical waste in utility rooms equipped with refrigeration equipment for storing biological waste (if any) and hand sanitizer.

189. Storage of more than twenty-four hours of food waste, non-neutralized medical waste of class "B" is carried out in refrigerators and freezers, but not more than three days.

190 Biological medical waste class "B" is stored at a temperature not exceeding +5 0 C.

191. The collected medical waste is hermetically packed into bags without damage to the integrity with the help of a tie on the opening of the bag. As they accumulate, they are taken out and disposed of by specialized organizations.

192. Transportation, neutralization and disposal of hazardous medical waste of classes "B" and "C" are carried out in accordance with standardization documents.

193. After the removal of medical waste, the storage room for medical waste, used inventory and equipment are disinfected.

194. Class D radioactive medical waste is handled in accordance with standardization documents.

195. The responsible person of the medical organization keeps a daily record of the generated medical waste in a log in the form, in accordance with Appendix 5 to these Sanitary Rules.

196. Personnel are provided with sets of sanitary clothing and PPE (gowns, overalls, gloves, masks, respirators, special footwear, aprons, sleeves).

Chapter 8. Sanitary and epidemiological requirements for nutritional conditions at healthcare facilities

197. The catering unit of healthcare facilities is located in a separate building or in a separate block of premises connected to the main building and other buildings, convenient ground and underground passages, with the exception of infectious diseases departments.

198. The device, maintenance of the catering unit and equipment, the requirements for raw materials and finished products are provided in accordance with standardization documents.

199. Every day a daily sample of prepared dishes is left at the catering unit.

For a daily sample, half a serving of first courses is left, portioned second courses are taken as a whole in an amount of at least 100 grams (hereinafter - gr.), third courses are taken in an amount of at least 200 grams.

Daily samples are stored in labeled (1, 2, 3 dishes) jars with lids at a temperature of +2 0 C - +6 0 C in a specially designated place in the refrigerator for storing prepared food. After 24 hours, the daily sample is thrown into food waste. Vessels for storing a daily sample (containers, lids) are boiled for five minutes.

200. For the delivery of prepared food to the pantry departments of the hospital, labeled (for food) thermoses or dishes with closing lids are used. Transportation is carried out using special carts.

201. The distribution of prepared food is carried out by the barmaids and nurses on duty of the department in dressing gowns marked “for distributing food”.

Technical personnel involved in cleaning the wards and other premises of the department are not allowed to distribute food.

202. Control over the distribution of food in accordance with the prescribed diets is carried out by the head nurse.

203. When serving, first courses and hot drinks have a temperature not lower than + 75 0 С, second ones - not lower than +65 0 С, cold dishes and drinks - from +7 0 С to +14 0 С. Until the moment of distribution, first and second courses are on a hot plate up to two hours from the moment of preparation.

204. In canteens, the following are provided:

1) two rooms - for distributing food and washing dishes;

2) reserve water heaters with water supply to washing baths.

205. Processing of dishes is carried out in the following sequence: mechanical removal of food and washing in the first wash with degreasing agents, rinsing with hot water in the second wash and drying dishes on special shelves, grates.

206. In canteen infectious diseases, dermatovenerological, anti-tuberculosis organizations (departments), according to epidemiological indications in departments of a different profile:

1) after eating, the dishes are collected in the pantry on a separate table, freed from food debris, disinfected, washed and dried. Disinfection is carried out chemically (solutions of disinfectants, including in a washing machine) or thermally (by boiling, processing in an air sterilizer);

2) food remains are dumped into a special marked tank with a lid and disinfected according to the modes for the corresponding infections by falling asleep with a dry disinfectant in the ratio of one to five (one hour exposure). The table for used dishes, brushes, ruffs are disinfected after each use. Rags for tables and dishes are disinfected by immersion in a disinfectant solution, rinsed and dried.

207. Transfers for patients are transferred in plastic bags indicating the last name and first name of the patient, date and time of transfer. Lists of permitted (with indication of their quantity) dishes and ready-to-eat food products are posted at the places of reception of transfers and in departments.

208. Powdered infant formula after opening the package is marked with the date and time of opening and stored in the conditions and terms indicated on the package "storage after opening the package." Dilution of mixtures is carried out using sterile dishes. Ready milk mixtures are transported, applied, stored and distributed according to the manufacturer's documents.

209. In hospitals with a capacity of up to 50 beds, outpatient surgery centers, organizations providing inpatient care, it is allowed to provide hot meals to patients on a contractual basis with the relevant organizations, subject to the established norms and rules.

Chapter 9

210. At healthcare facilities, in the absence of canteens for staff, a room equipped with a refrigerator, devices for heating water and food, and sinks for washing hands is allocated.

211. It is not allowed to eat and smoke in the toilet rooms, directly in functional rooms, and in rooms not designated for these purposes.

212. At healthcare facilities providing inpatient care, amenity premises for personnel are equipped according to the type of sanitary checkpoint and include dressing rooms, washrooms, a toilet, a room for storing sanitary clothing and PPE. Dressing rooms are equipped with separate wardrobes for storing special and personal clothing.

At healthcare facilities providing outpatient care with a capacity of no more than 25 visits per shift, it is allowed to have separate lockers for storing sanitary clothing and personal clothing in the amenity premises.

213. Sanitary facilities shall be equipped with sinks for washing hands with hot and cold water supply, equipped with detergents, disposable towels or electric towels.

214. Medical personnel are provided with sets of replaceable work clothes (gowns, caps (scarves), removable shoes, PPE).

215. Medical personnel of anti-tuberculosis organizations, when working in the presence of coughing patients with the release of mycobacteria, patients with the release of drug-resistant forms of mycobacteria, when working with infected material, use surgical masks, protective gloves, sanitary clothing.

216. Medical personnel of anti-tuberculosis organizations use respirators with a filtration efficiency of at least 94% of particles up to 0.3-0.4 microns in size, and corresponding in size and configuration to a medical worker, providing a snug fit to the face.

217. The change of sanitary clothing for medical personnel conducting invasive diagnostic and therapeutic procedures, as well as having contact with biological material, is carried out daily and / or as it gets dirty.

The change of sanitary clothing for medical personnel whose work is not related to invasive procedures is carried out at least twice a week and / or as it gets dirty.

218. Washing of sanitary clothes is carried out centrally, separately from the linen of patients.

219. Medical personnel providing advisory assistance, technical and administrative personnel performing temporary work in departments of hospitals are provided with a change of clothes and shoes.

220. It is not allowed for medical personnel in sanitary clothing to be outside the healthcare facility.

221. Upon admission to work and subsequently, medical personnel undergo mandatory medical and periodic examinations, in accordance with standardization documents.

Personal medical books with permission to work are stored at the workplace.

"On approval of the Instructions for the destruction of narcotic drugs and psychotropic substances included in lists II and III of the list of narcotic drugs, psychotropic substances and their precursors, subject to control in the Russian Federation, the further use of which in medical practice is recognized as inappropriate"

Edition dated 05/07/2015 - Valid from 08/11/2015

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MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION

ORDER
dated March 28, 2003 N 127

On the approval of the instructions for the destruction of narcotic drugs and psychotropic substances included in the lists of the II and III list of narcotic drugs, psychotropic substances and their precursors subject to control in the Russian Federation, the further use of which in medical practice is recognized as inappropriate

(As amended by the Order of the Ministry of Health of the Russian Federation of 05/07/2015 N 228n)

In accordance with Decree of the Government of the Russian Federation of June 18, 1999 N 647 "On the procedure for the further use or destruction of narcotic drugs, psychotropic substances and their precursors, as well as tools and equipment that were confiscated or withdrawn from illicit circulation or whose further use was deemed inappropriate "(Collected Legislation of the Russian Federation, 1999, N 27, Art. 3360) I order:

1. Approve the "Instruction for the destruction of narcotic drugs and psychotropic substances included in lists II and III of the List of narcotic drugs, psychotropic substances and their precursors, subject to control in the Russian Federation, the further use of which in medical practice is recognized as inappropriate" (Appendix).

2. To impose control over the implementation of this Order on the Deputy Minister A.V. Katlinsky.

Minister
Yu.L.SHEVCHENKO

INSTRUCTIONS
FOR THE DESTRUCTION OF NARCOTIC DRUGS AND PSYCHOTROPIC SUBSTANCES INCLUDED IN LISTS II AND III OF THE LIST OF NARCOTIC DRUGS, PSYCHOTROPIC SUBSTANCES AND THEIR PRECURSORS, SUBJECT TO CONTROL IN THE RUSSIAN FEDERATION, THE FURTHER USE OF WHICH IN NON-INDUSTRIAL USE

(As amended by the Order of the Ministry of Health of the Russian Federation of 05/07/2015 N 228n)

1. GENERAL PROVISIONS

1.1. This Instruction determines the procedure for the destruction of narcotic drugs and psychotropic substances included in lists II and III of the List of narcotic drugs, psychotropic substances and their precursors subject to control in the Russian Federation<1>(hereinafter respectively - narcotic drugs and psychotropic substances, the List), the further use of which in medical practice is recognized as inappropriate. (As amended by the Order of the Ministry of Health of the Russian Federation of 05/07/2015 N 228n)

<1>dated June 30, 1998 N 681 "On approval of the list of narcotic drugs, psychotropic substances and their precursors subject to control in the Russian Federation" (Sobraniye zakonodatelstva Rossiyskoy Federatsii, 1998, N 27, art. 3198; 2004, N 8, art. 663 ; N 47, item 4666; 2006, N 29, item 3253; 2007, N 28, item 3439; 2009, N 26, item 3183; N 52, item 6752; 2010, N 3, item 314 ; N 17, item 2100; N 24, item 3035; N 28, item 3703; N 31, item 4271; N 45, item 5864; N 50, item 6696, 6720; 2011, N 10, 1390; N 12, item 1635; N 29, item 4466, 4473; N 42, item 5921; N 51, item 7534; 2012, N 10, item 1232; N 11, item 1295; N 19, item 2400; N 22, item 2864; N 37, item 5002; N 41, item 5625; N 48, item 6686; N 49, item 6861; 2013, N 6, item 558 ; N 9, item 953; N 25, item 3159; N 29, item 3962; N 37, item 4706; N 46, item 5943; N 51, item 6869; 2014, N 14, item 1626; N 23, item 2987; N 27, item 3763; N 44, item 6068; N 51, item 7430; 2015, N 1 item 1593). (As amended by the Order of the Ministry of Health of the Russian Federation of 05/07/2015 N 228n)

1.2. The destruction of narcotic drugs and psychotropic substances is carried out in cases where:

The expiration date has expired;

A narcotic drug or psychotropic substance has been subjected to chemical or physical impact, which has resulted in its unsuitability, excluding the possibility of recovery or processing (including the remains of incompletely used narcotic drugs and psychotropic substances in opened ampoules (vials), the presence of turbidity or discoloration of the solution due to for non-compliance with the storage regime, the presence of damage to the primary packaging); (As amended by the Order of the Ministry of Health of the Russian Federation of 05/07/2015 N 228n)

Unused drugs are accepted from relatives of deceased patients;

It is difficult to determine whether a drug is a narcotic drug or a psychotropic substance;

A narcotic drug or psychotropic substance confiscated or withdrawn from illegal circulation may not be used for medical, scientific or other purposes. (As amended by the Order of the Ministry of Health of the Russian Federation of 05/07/2015 N 228n)

1.3. Narcotic drugs and psychotropic substances, the further use of which is recognized as inappropriate by the authorities exercising their seizure or confiscation, are subject to destruction in full, except in cases when these authorities, on the basis of the conclusions of the Ministry of Health of Russia and the Ministry of Industry and Trade of Russia or commissions consisting of representatives of these ministries in the field and the body that carried out the seizure or confiscation, a decision will be made to turn them into state revenue and transfer them for use for the purposes provided for by the legislation of the Russian Federation. (As amended by the Order of the Ministry of Health of the Russian Federation of 05/07/2015 N 228n)

1.4. The basis for the destruction of narcotic drugs and psychotropic substances confiscated or seized from illicit circulation is a court decision, a decision of an investigator or an employee of an inquiry agency to terminate a criminal case or to refuse to initiate a criminal case, as well as a decision of a body or official to impose an administrative penalty or to terminate proceeding on the case of an administrative offense<*>.

<*>Decree of the Government of the Russian Federation of July 24, 2002 N 557 "On making additions to the Decree of the Government of the Russian Federation of June 18, 1999 N 647" (Collected Legislation of the Russian Federation, 07/29/2002, N 30, art. 3057).

1.5. The destruction of narcotic drugs and psychotropic substances, the further use of which in medical practice is recognized as inappropriate, including those confiscated or withdrawn from illegal circulation, is carried out by state unitary enterprises and state institutions in the manner established by Federal Law of January 8, 1998 N 3-FZ " About narcotic drugs and psychotropic substances<2>and normative legal acts of the Russian Federation adopted in accordance with it. (As amended by the Order of the Ministry of Health of the Russian Federation of 05/07/2015 N 228n)

<2>Collection of Legislation of the Russian Federation, 1998, N 2, Art. 219; 2002, No. 30, art. 3033; 2003, N 2, art. 167; No. 27, Art. 2700; 2004, N 49, art. 4845; 2005, N 19, art. 1752; 2006, N 43, art. 4412; No. 44, Art. 4535; 2007, N 30, Art. 3748; N 31, art. 4011; 2008, N 30, Art. 3592; No. 48, Art. 5515; No. 52, art. 6233; 2009, N 29, art. 3588, 3614; 2010, No. 21, Art. 2525; N 31, art. 4192; 2011, N 1, art. 16, 29; No. 15, Art. 2039; No. 25, Art. 3532; No. 49, Art. 7019, 7061; 2012, N Yu, art. 1166; No. 53, Art. 7630; 2013, N 23, Art. 2878; No. 30, art. 4057; No. 48, Art. 6161.6165; 2014, N 23, art. 2930; 2015, N 6, Art. 885. (As amended by the Order of the Ministry of Health of the Russian Federation of 05/07/2015 N 228n)

The destruction of narcotic drugs and psychotropic substances (with the exception of the destruction of narcotic drugs and psychotropic substances confiscated or seized from illegal circulation) included in List II of the List may be carried out by municipal unitary enterprises and municipal institutions that are part of the municipal health care system in the manner established by Federal Law dated 8 January 1998 N 3-FZ "On Narcotic Drugs and Psychotropic Substances" and the regulatory legal acts of the Russian Federation adopted in accordance with it, when providing medical care to citizens in the Russian Federation by medical organizations of the municipal health care system<3>. (As amended by the Order of the Ministry of Health of the Russian Federation of 05/07/2015 N 228n)

The destruction of narcotic drugs and psychotropic substances is carried out by the enterprises and institutions specified in paragraphs one and two of this paragraph, if they have a license for the activity in the circulation of narcotic drugs, psychotropic substances and their precursors, the cultivation of narcotic plants, indicating the work (service) for the destruction of narcotic drugs and psychotropic substances<4>. (As amended by the Order of the Ministry of Health of the Russian Federation of 05/07/2015 N 228n)

<4>Decree of the Government of the Russian Federation of December 22, 2011 N 1085 "On licensing activities for the circulation of narcotic drugs, psychotropic substances and their precursors, the cultivation of narcotic plants" (Sobraniye zakonodatelstva Rossiyskoy Federatsii, 2012, N 1, art. 130; N 22, art. 2879; N 37, item 5002). (As amended by the Order of the Ministry of Health of the Russian Federation of 05/07/2015 N 228n)

The transfer of narcotic drugs and psychotropic substances to be destroyed to these enterprises and institutions is carried out on the basis of an agreement and an act of acceptance and transfer. (As amended by the Order of the Ministry of Health of the Russian Federation of 05/07/2015 N 228n)

1.6. For the destruction of narcotic drugs and psychotropic substances at the enterprises and institutions specified in clause 1.5 of this Instruction, commissions are created. (As amended by the Order of the Ministry of Health of the Russian Federation of 05/07/2015 N 228n)

In the event of the destruction of narcotic drugs and psychotropic substances confiscated or seized from illegal circulation, the composition of the commission is formed taking into account the requirements of paragraph 9 of the Decree of the Government of the Russian Federation of June 18, 1999 N 647 "On the procedure for the further use or destruction of narcotic drugs, psychotropic substances and their precursors, plants containing narcotic drugs or psychotropic substances or their precursors, or parts thereof, containing narcotic drugs or psychotropic substances or their precursors, as well as tools and equipment that have been confiscated or withdrawn from illicit circulation or whose further use is deemed inappropriate"<5>. (As amended by the Order of the Ministry of Health of the Russian Federation of 05/07/2015 N 228n)

<5>Collection of Legislation of the Russian Federation, 1999, N 27, Art. 3360; 2002, No. 30, art. 3057; 2004, N 8, art. 663; No. 47, Art. 4666; 2009, No. 12, art. 1429; 2011, N 46, Art. 6519; No. 51, art. 7526; 2012, N 37, Art. 5002. (As amended by the Order of the Ministry of Health of the Russian Federation of 05/07/2015 N 228n)

Write-off of narcotic drugs and psychotropic substances subject to destruction shall be made no later than the last working day of the calendar month. The destruction of narcotic drugs and psychotropic substances is carried out as they accumulate, but at least once a quarter. (As amended by the Order of the Ministry of Health of the Russian Federation of 05/07/2015 N 228n)

1.7. The need for the destruction of narcotic drugs and psychotropic substances, with the exception of those confiscated or withdrawn from illegal circulation, is justified by the responsible person appointed by order of the head of the medical organization, pharmacy organization. (As amended by the Order of the Ministry of Health of the Russian Federation of 05/07/2015 N 228n)

At the same time, an order is issued on the write-off of narcotic drugs and psychotropic substances and their subsequent destruction, which indicates:

The name of narcotic drugs and psychotropic substances, indicating their dosage forms, dosages, packaging and batch numbers;

Net and gross weight of narcotic drugs and psychotropic substances to be written off and destroyed (for narcotic drugs and psychotropic substances registered as medicinal products - gross weight); (As amended by the Order of the Ministry of Health of the Russian Federation of 05/07/2015 N 228n)

Reasons for decommissioning and destruction;

The person responsible for write-off and destruction;

Place and method of destruction.

Date and number of the contract (in case of transfer of narcotic drugs and psychotropic substances for destruction to the enterprises and institutions specified in paragraph 1.5 of this Instruction). (As amended by the Order of the Ministry of Health of the Russian Federation of 05/07/2015 N 228n)

1.8. If it is not possible to timely destroy the remains of incompletely used narcotic drugs and psychotropic substances, the ampoules (vials) are sealed using improvised material (for example, sealing wax, plasticine, wax, paraffin and other material), ampoules (vials) are placed in any packaging container and stored in safe on a separate shelf until destruction (transfer for destruction). (As amended by the Order of the Ministry of Health of the Russian Federation of 05/07/2015 N 228n)

For subject-quantitative accounting, write-offs and destruction, the actual volume of residues of narcotic drugs and psychotropic substances in opened ampoules (vials) is calculated arithmetically without taking into account possible losses, including when typing into a syringe and preparing for an injection. (As amended by the Order of the Ministry of Health of the Russian Federation of 05/07/2015 N 228n)

2. PROCEDURE FOR THE DESTRUCTION OF NARCOTIC DRUGS AND PSYCHOTROPIC SUBSTANCES

2.1. The destruction of narcotic drugs and psychotropic substances is carried out at specially equipped sites (polygons) and (or) in specially prepared premises.

2.2. Personnel performing work on the destruction of narcotic drugs and psychotropic substances must have a permit to work with narcotic drugs and psychotropic substances, know the physicochemical and toxic properties of the substances being destroyed and the chemical reactions that occur during the neutralization and destruction of their chemical reactions.

2.3. Features of the destruction of narcotic drugs and psychotropic substances: (As amended by the Order of the Ministry of Health of the Russian Federation of 05/07/2015 N 228n)

Liquid dosage forms in glass ampoules, vials are destroyed by crushing the primary packaging, liquid dosage forms in plastic ampoules, syringe tubes are destroyed by crushing the primary packaging, followed by dilution of the resulting content with water in a ratio of 1:100 and draining the resulting solution into the sewer; (As amended by the Order of the Ministry of Health of the Russian Federation of 05/07/2015 N 228n)

Solid dosage forms containing water-soluble pharmaceutical substances of narcotic drugs and psychotropic substances, after crushing to a powdery state, are diluted with water in a ratio of 1:100 and the resulting suspension (solution) is drained into the sewer; (As amended by the Order of the Ministry of Health of the Russian Federation of 05/07/2015 N 228n)

Water-soluble pharmaceutical substances are destroyed by diluting with water in a ratio of 1:100 and draining the resulting solution into the sewer; (As amended by the Order of the Ministry of Health of the Russian Federation of 05/07/2015 N 228n)

Solid dosage forms containing water-insoluble pharmaceutical substances of narcotic drugs and psychotropic substances, soft dosage forms, transdermal dosage forms are destroyed by incineration; (As amended by the Order of the Ministry of Health of the Russian Federation of 05/07/2015 N 228n)

Water-insoluble pharmaceutical substances are destroyed by incineration. (As amended by the Order of the Ministry of Health of the Russian Federation of 05/07/2015 N 228n)

The remains of crushed (crushed) primary packages of narcotic drugs and psychotropic substances are destroyed in accordance with the legislation of the Russian Federation on production and consumption waste<6>or in case of reference to medical waste - in the manner established by the legislation of the Russian Federation in the field of ensuring the sanitary and epidemiological welfare of the population<7>. (As amended by the Order of the Ministry of Health of the Russian Federation of 05/07/2015 N 228n)

2.4. When destroying narcotic drugs and psychotropic substances, the commission draws up an act, which indicates:

Date and place of drawing up the act;

Place of work, position, surname, name, patronymic of persons participating in the destruction;

Reason for destruction;

Information about the name (indicating the type of dosage form, dosage, unit of measurement, series) and the amount of the destroyed narcotic drug, psychotropic substance, as well as the container or packaging in which they were stored;

The number of copies of the act is determined by the number of parties involved in the destruction of narcotic drugs and psychotropic substances.

2.5. The transfer for further use of narcotic drugs and psychotropic substances in respect of which a decision has been made to destroy them is prohibited.

On the approval of the Instructions for the destruction of narcotic drugs and psychotropic substances included in lists II and , further...

MINISTRY OF HEALTH OF THE RUSSIAN FEDERATION

On Approval of the Instruction for the Destruction of Narcotic Drugs and Psychotropic Substances Included in Lists II and III of the List of Narcotic Drugs, Psychotropic Substances and Their Precursors Subject to Control in the Russian Federation

Document as amended by:
(Official Internet portal of legal information www.pravo.gov.ru, 07/31/2015, N 0001201507310005).
____________________________________________________________________

In accordance with the Decree of the Government of the Russian Federation of June 18, 1999 N 647 "On the procedure for the further use or destruction of narcotic drugs, psychotropic substances and their precursors, as well as tools and equipment that were confiscated or withdrawn from illicit circulation or whose further use was deemed inappropriate "(Collected Legislation of the Russian Federation, 1999, N 27, Art. 3360)

I order:

1. Approve the Instructions for the destruction of narcotic drugs and psychotropic substances included in lists II and III of the List of narcotic drugs, psychotropic substances and their precursors, subject to control in the Russian Federation, the further use of which in medical practice is recognized as inappropriate (Appendix).

2. To impose control over the implementation of this order on the Deputy Minister A.V. Katlinsky.

Minister
Y. Shevchenko

Registered
at the Ministry of Justice
Russian Federation
May 5, 2003
registration N 4484

Application. Instructions for the destruction of narcotic drugs and psychotropic substances included in lists II and III of the List of narcotic drugs, psychotropic substances and their precursors subject to control in the Russian Federation, further use ...

Application

APPROVED
by order of the Ministry
health care
Russian Federation
dated March 28, 2003 N 127

INSTRUCTIONS
for the destruction of narcotic drugs and psychotropic substances included in lists II and III of the List of narcotic drugs, psychotropic substances and their precursors subject to control in the Russian Federation, the further use of which in medical practice is recognized as inappropriate

1. General Provisions

1.1. This Instruction determines the procedure for the destruction of narcotic drugs and psychotropic substances included in lists II and III of the List of narcotic drugs, psychotropic substances and their precursors subject to control in the Russian Federation (hereinafter respectively - narcotic drugs and psychotropic substances, the List), the further use of which in medical practice is deemed inappropriate.
by order of the Ministry of Health of Russia dated May 7, 2015 N 228n.

________________
Decree of the Government of the Russian Federation of June 30, 1998 N 681 "On approval of the list of narcotic drugs, psychotropic substances and their precursors subject to control in the Russian Federation" (Sobraniye zakonodatelstva Rossiyskoy Federatsii, 1998, N 27, art. 3198; 2004, N 8, 663; N 47, item 4666; 2006, N 29, item 3253; 2007, N 28, item 3439; 2009, N 26, item 3183; N 52, item 6752; 2010, N 3, 314; N 17, item 2100; N 24, item 3035; N 28, item 3703; N 31, item 4271; N 45, item 5864; N 50, item 6696, 6720; 2011, No. 10, item 1390; N 12, item 1635; N 29, item 4466, 4473; N 42, item 5921; N 51, item 7534; 2012, N 10, item 1232; N 11, item .1295; N 19, item 2400; N 22, item 2864; N 37, item 5002; N 41, item 5625; N 48, item 6686; N 49, item 6861; 2013, N 6, 558; N 9, art. 953; N 25, art. 3159; N 29, art. 3962; N 37, art. 4706; N 46, art. 5943; N 51, art. 6869; 2014, N 14 , item 1626; N 23, item 2987; N 27, item 3763; N 44, item 6068; N 51, item 7430; 2015, N 11, item 1593).
(The footnote was additionally included from August 11, 2015 by order of the Russian Ministry of Health of May 7, 2015 N 228n)

1.2. The destruction of narcotic drugs and psychotropic substances is carried out in cases where:

- the expiration date has expired;

- a narcotic drug or psychotropic substance has been subjected to chemical or physical impact, resulting in its unsuitability, excluding the possibility of recovery or processing (including the remains of incompletely used narcotic drugs and psychotropic substances in opened ampoules (vials), the presence of turbidity or discoloration of the solution from - for non-compliance with the storage regime, the presence of damage to the primary packaging);
by order of the Ministry of Health of Russia dated May 7, 2015 N 228n.

- unused drugs are accepted from relatives of deceased patients;

- it is difficult to determine whether the drug is a narcotic drug or a psychotropic substance;

- a narcotic drug or psychotropic substance confiscated or withdrawn from illegal circulation cannot be used for medical, scientific or other purposes.
(Paragraph as amended, put into effect on August 11, 2015 by order of the Ministry of Health of Russia dated May 7, 2015 N 228n.

1.3. Narcotic drugs and psychotropic substances, the further use of which is recognized as inappropriate by the authorities exercising their seizure or confiscation, are subject to destruction in full, except in cases when these authorities, on the basis of the conclusions of the Ministry of Health of Russia and the Ministry of Industry and Trade of Russia or commissions consisting of representatives of these ministries in the field and the body that carried out the seizure or confiscation, a decision will be made to turn them into state revenue and transfer them for use for the purposes provided for by the legislation of the Russian Federation.
(Paragraph as amended, put into effect on August 11, 2015 by order of the Ministry of Health of Russia dated May 7, 2015 N 228n.

1.4. The basis for the destruction of narcotic drugs and psychotropic substances confiscated or seized from illicit circulation is a court decision, a decision of an investigator or an employee of an inquiry agency to terminate a criminal case or to refuse to initiate a criminal case, as well as a decision of a body or official to impose an administrative penalty or to terminate proceedings in the case of an administrative offense *.

________________

* Decree of the Government of the Russian Federation of July 24, 2002 N 557 "On amendments to the Decree of the Government of the Russian Federation of June 18, 1999 N 647" (Collected Legislation of the Russian Federation, 2002, N 30, Art. 3057).

1.5. The destruction of narcotic drugs and psychotropic substances, the further use of which in medical practice is recognized as inappropriate, including those confiscated or withdrawn from illegal circulation, is carried out by state unitary enterprises and state institutions in the manner established and adopted in accordance with it by the regulatory legal acts of the Russian Federation.
________________
Collection of Legislation of the Russian Federation, 1998, N 2, Art. 219; 2002, N 30, art. 3033; 2003, N 2, article 167; N 27, art. 2700; 2004, N 49, art. 4845; 2005, N 19, article 1752; 2006, N 43, art. 4412; N 44, art. 4535; 2007, N 30, art. 3748; N 31, art. 4011; 2008, N 30, art. 3592; N 48, art. 5515; N 52, art. 6233; 2009, N 29, art. 3588, 3614; 2010, N 21, article 2525; N 31, art. 4192; 2011, N 1, art.16, 29; N 15, art. 2039; N 25, art. 3532; N 49, art. 7019, 7061; 2012, N 10, article 1166; N 53, art. 7630; 2013, N 23, article 2878; N 30, art. 4057; N 48, art. 6161, 6165; 2014, N 23, article 2930; 2015, N 6, article 885.


The destruction of narcotic drugs and psychotropic substances (with the exception of the destruction of narcotic drugs and psychotropic substances confiscated or seized from illegal circulation) included in List II of the List may be carried out by municipal unitary enterprises and municipal institutions that are part of the municipal healthcare system in the manner established by Federal Law of 8 January 1998 N 3-FZ "On Narcotic Drugs and Psychotropic Substances" and the regulatory legal acts of the Russian Federation adopted in accordance with it, when providing medical care to citizens in the Russian Federation by medical organizations of the municipal health care system.
________________
Clause 4 of Article 5 of the Federal Law of January 8, 1998 N 3-FZ "On Narcotic Drugs and Psychotropic Substances".


The destruction of narcotic drugs and psychotropic substances is carried out by the enterprises and institutions specified in paragraphs one and two of this paragraph, if they have a license for the activity in the circulation of narcotic drugs, psychotropic substances and their precursors, the cultivation of narcotic plants, indicating the work (service) for the destruction of narcotic drugs and psychotropic substances.
________________
Decree of the Government of the Russian Federation of December 22, 2011 N 1085 "On licensing activities for the circulation of narcotic drugs, psychotropic substances and their precursors, the cultivation of narcotic plants" (Sobranie zakonodatelstva Rossiyskoy Federatsii, 2012, N 1, art. 130; N 22, art. 2879; N 37, article 5002).

The transfer of narcotic drugs and psychotropic substances to be destroyed to these enterprises and institutions is carried out on the basis of an agreement and an act of acceptance and transfer.
(Paragraph as amended, put into effect on August 11, 2015 by order of the Ministry of Health of Russia dated May 7, 2015 N 228n.

1.6. For the destruction of narcotic drugs and psychotropic substances at the enterprises and institutions specified in clause 1.5 of this Instruction, commissions are created.

In the event of the destruction of narcotic drugs and psychotropic substances confiscated or seized from illegal circulation, the composition of the commission is formed taking into account the requirements of paragraph 9 of Decree of the Government of the Russian Federation of June 18, 1999 N 647 "On the procedure for the further use or destruction of narcotic drugs, psychotropic substances and their precursors, plants containing narcotic drugs or psychotropic substances or their precursors, or parts thereof, containing narcotic drugs or psychotropic substances or their precursors, as well as tools and equipment that have been confiscated or withdrawn from illicit circulation or whose further use is deemed inappropriate" .
________________
Collection of Legislation of the Russian Federation, 1999, N 27, Art. 3360; 2002, N 30, art. 3057; 2004, N 8, article 663; N 47, art. 4666; 2009, N 12, article 1429; 2011, N 46, article 6519; N 51, art. 7526; 2012, N 37, article 5002.


Write-off of narcotic drugs and psychotropic substances subject to destruction shall be made no later than the last working day of the calendar month. The destruction of narcotic drugs and psychotropic substances is carried out as they accumulate, but at least once a quarter.
(Paragraph as amended, put into effect on August 11, 2015 by order of the Ministry of Health of Russia dated May 7, 2015 N 228n.

1.7. The need for the destruction of narcotic drugs and psychotropic substances, with the exception of those confiscated or withdrawn from illegal circulation, is justified by the responsible person appointed by order of the head of the medical organization, pharmacy organization.
(Paragraph as amended, put into effect on August 11, 2015 by order of the Ministry of Health of Russia dated May 7, 2015 N 228n.

At the same time, an order is issued on the write-off of narcotic drugs and psychotropic substances and their subsequent destruction, which indicates:

- the name of narcotic drugs and psychotropic substances, indicating their dosage forms, dosages, packaging and batch numbers;

- net and gross weight of narcotic drugs and psychotropic substances to be written off and destroyed (for narcotic drugs and psychotropic substances registered as medicinal products - gross weight);
(Paragraph as amended, put into effect on August 11, 2015 by order of the Ministry of Health of Russia dated May 7, 2015 N 228n.

- reasons for decommissioning and destruction;

The person responsible for write-off and destruction;

- place and method of destruction;

- the date and number of the contract (in the case of the transfer of narcotic drugs and psychotropic substances for destruction to the enterprises and institutions specified in paragraph 1.5 of this Instruction).
(Paragraph as amended, put into effect on August 11, 2015 by order of the Ministry of Health of Russia dated May 7, 2015 N 228n.

.;

the paragraph became invalid on August 11, 2015 - order of the Ministry of Health of Russia dated May 7, 2015 N 228n;

the paragraph became invalid on August 11, 2015 - order of the Ministry of Health of Russia dated May 7, 2015 N 228n;

the paragraph became invalid on August 11, 2015 - order of the Ministry of Health of Russia dated May 7, 2015 N 228n.

1.8. If it is not possible to timely destroy the remains of incompletely used narcotic drugs and psychotropic substances, the ampoules (vials) are sealed using improvised material (for example, sealing wax, plasticine, wax, paraffin and other material), ampoules (vials) are placed in any packaging container and stored in safe on a separate shelf until destruction (transfer for destruction).

For subject-quantitative accounting, write-offs and destruction, the actual volume of residues of narcotic drugs and psychotropic substances in opened ampoules (vials) is calculated arithmetically without taking into account possible losses, including when typing into a syringe and preparing for an injection.
(The paragraph is additionally included from August 11, 2015 by order of the Ministry of Health of Russia dated May 7, 2015 N 228n)

2. Procedure for the destruction of narcotic drugs and psychotropic substances

2.1. The destruction of narcotic drugs and psychotropic substances is carried out at specially equipped sites (polygons) and (or) in specially prepared premises.

2.2. Personnel performing work on the destruction of narcotic drugs and psychotropic substances must have a permit to work with narcotic drugs and psychotropic substances, know the physicochemical and toxic properties of the substances being destroyed and the chemical reactions that occur during the neutralization and destruction of their chemical reactions.

2.3. Features of the destruction of narcotic drugs and psychotropic substances:

- liquid dosage forms in glass ampoules, vials are destroyed by crushing the primary packaging, liquid dosage forms in plastic ampoules, syringe tubes are destroyed by crushing the primary packaging, followed by dilution of the resulting content with water in a ratio of 1:100 and draining the resulting solution into the sewer;

- solid dosage forms containing water-soluble pharmaceutical substances of narcotic drugs and psychotropic substances, after crushing to a powdery state, are diluted with water in a ratio of 1:100 and the resulting suspension (solution) is drained into the sewer;

- water-soluble pharmaceutical substances are destroyed by diluting with water in a ratio of 1:100 and draining the resulting solution into the sewer;

- solid dosage forms containing water-insoluble pharmaceutical substances of narcotic drugs and psychotropic substances, soft dosage forms, transdermal dosage forms are destroyed by incineration;

- water-insoluble pharmaceutical substances are destroyed by incineration.

The remains of crushed (crushed) primary packages of narcotic drugs and psychotropic substances are destroyed in accordance with the legislation of the Russian Federation on production and consumption waste or, if classified as medical waste, in the manner established by the legislation of the Russian Federation in the field of ensuring the sanitary and epidemiological welfare of the population.
________________
Federal Law No. 89-FZ of June 24, 1998 "On Production and Consumption Waste" (Sobraniye Zakonodatelstva Rossiyskoy Federatsii, 1998, No. 26, Art. 3009; 2001, No. 1, Art. 21; 2003, No. 2, Art. 167 ; 2004, N 35, item 3607; 2005, N 19, item 1752; 2006, N 1, item 10; N 52, item 5498; 2007, N 46, item 5554; 2008, N 30, item .3616; N 45, article 5142; 2009, N 1, article 17; 2011, N 30, article 4590, 4596; N 45, article 6333; N 48, article 6732; 2012, N 26, article .3446; N 27, article 3587; N 31, article 4317; 2013, N 30, article 4059; N 43, article 5448; N 48, article 6165; 2014, N 30, article 4220, 4262 ; 2015, N 1, art. 11, 38).

(Collected Legislation of the Russian Federation, 2011, N 48, art. 6724; 2012, N 26, art. 3442, 3446; 2013, N 27, art. 3459, 3477; N 30, art. 4038; N 39, art. 4883 ; N 48, item 6165; N 52, item 6951; 2014, N 23, item 2930; N 30, item 4106, 4244, 4247, 4257; N 43, item 5798; N 49, item 6927 , 6928; 2015, N 1, art. 72, 85; N 10, art. 1425).

It is allowed to burn the dosage forms specified in the second and third paragraphs of this clause, and the pharmaceutical substances specified in the fourth paragraph of this clause.

The burning of pharmaceutical substances and dosage forms after dousing with a flammable liquid is carried out under draft (if destruction is carried out indoors), on a fire (if destruction is carried out at a landfill) or in special furnaces. Ash is removed or buried in the manner prescribed by the Federal Law of June 24, 1998 N 89-FZ "On Production and Consumption Waste".
(Paragraph as amended, put into effect on August 11, 2015 by order of the Ministry of Health of Russia dated May 7, 2015 N 228n.

2.4. When destroying narcotic drugs and psychotropic substances, the commission draws up an act, which indicates:

- date and place of drawing up the act;

Place of work, positions, last names, first names, patronymics of persons participating in the destruction;

- grounds for destruction;

- information about the name (indicating the type of dosage form, dosage, unit of measure, series) and the amount of the destroyed narcotic drug, psychotropic substance, as well as the container or packaging in which they were stored;

- method of destruction.

The number of copies of the act is determined by the number of parties involved in the destruction of narcotic drugs and psychotropic substances.

2.5. The transfer for further use of narcotic drugs and psychotropic substances in respect of which a decision has been made to destroy them is prohibited.

2.6. The head of the legal entity* bears personal responsibility for exercising control over activities related to the circulation of narcotic drugs and psychotropic substances.

________________

* (Sobraniye zakonodatelstva Rossiyskoy Federatsii, 1998, N 2, art. 219).

Revision of the document, taking into account
changes and additions prepared
JSC "Kodeks"