Analysis of the process of laminar blood flow ward

Blood laminar flow ward, also known as sterile ward or one-way flow ward, is not a single ward or several wards, but a "clean nursing unit" composed of this special ward as the core and other necessary auxiliary rooms.

The main patients admitted are: leukemia patients who have undergone self or allogeneic bone marrow transplantation, cancer patients who have undergone strong drug chemotherapy, patients with extensive severe burns, severe respiratory organ diseases, and organ transplants. Due to the lack of their own immunity, these patients can only be treated and live in a sterile environment to prevent infection, so sterile wards must be built. The most commonly used sterile wards for clean engineering now are the hematology ward and burn ward.

Aseptic nursing is a characteristic nursing of laminar flow wards, and its key is to ensure that patients receive treatment in a sterile environment. Before entering the laminar flow sterile ward, patients must strictly follow the requirements to disinfect and sterilize their internal and external environment. On the same day, they must first go through a medicinal bath and then wear sterile clothes, pants, and slippers before entering the laminar flow sterile ward. All items entering the laminar flow room must be disinfected and sterilized before entering. The treatment, care, and daily life of patients entering the sterile blood laminar flow room are all assisted by nursing staff in this room.

1、Layout of blood laminar flow ward

Location selection: The ward should be far away from pollution sources, have a quiet environment, and a good atmospheric environment. It is advisable to set it at the end of the hospital building, arrange it separately, and form its own area. When it is centrally arranged with other departments that require cleanliness, it should be able to meet the medical communication between each other and be relatively separated, which is conducive to maintaining a clean environment.

Building scale: There is no clear specification requirement, and the number of beds can be determined by the hospital based on the size of the department and the average annual outpatient volume. The total area requirement can be calculated based on a building area of no less than 200 square meters for 1-2 beds, with an increase of approximately 50 square meters for each additional bed. It is advisable to have 4 laminar flow wards in the general hematology department.

Functional rooms: In addition to laminar flow wards, fully equipped auxiliary rooms should be provided, including observation and nursing front rooms (or nursing areas), nurse stations, clean corridors, treatment rooms, sterile storage rooms, preparation rooms (or recovery rooms), meal preparation rooms, buffer corridors (or buffer rooms), medicinal baths, patient restrooms, visitation corridors, waste treatment rooms, shoe changing rooms, dressing and shower rooms, medical staff offices, duty rooms, etc.

Clean and dirty separation: effectively control and organize the flow of various people and objects entering the clean care unit at the entrance, follow their own paths, and avoid cross infection. Set up a closed external corridor near the ward area as a visitation corridor and also serve as a waste channel to achieve clean and dirty separation.

Area size: The area of laminar flow wards should not only meet the needs of treatment and nursing work, but also ensure sufficient economic efficiency. If the area is too large, the air supply volume will increase, and the construction and operation costs will be higher. In addition, due to the long treatment period of these patients, usually around two months, they live in a closed environment for a long time. If the area is too small, it is easy to cause feelings of occlusion, and patients are prone to emotional fluctuations such as irritability, excitement, and loneliness, which are not conducive to the recovery of the disease. Therefore, it is necessary to take into account the comfort of the patient. After extensive engineering practice and follow-up visits, it has been determined that the net height should be between 2.2 and 2.5 meters, and the area should be between 6.5 and 10 square meters, with around 8 square meters being the most suitable. With the improvement of living standards, there is a trend of increasing area.

Glass window design: Nursing observation windows should be installed between the ward and the front room, or the clean corridor, and dialogue observation windows should be installed between the ward and the visitation corridor. The window sill should be lowered so that patients can see the activities of medical staff in the unit and the family members visiting the corridor while lying in bed, as well as the scenery outside the window. At the same time, the dialogue window should be equipped with aluminum alloy louvers to ensure indoor privacy when necessary. There may be a movable small window or a hole for infusion tubes under the nursing window. Medical staff can provide daily care such as food, medicine, and intravenous infusion to patients without entering the ward, which can minimize the number of times they enter the ward and ensure the cleanliness of the room.

Transfer window design: Transfer windows can be installed on the corridor leading from the ward to the outside, for the purpose of transferring waste from the ward. When conditions do not permit, it can also be packaged on-site and sent out through the waste transfer window located in the clean corridor. Both sterile storage rooms and meal preparation rooms should be equipped with transfer windows to facilitate the entry of items.

2、space design

The hematology ward can be located within the internal medicine nursing unit or can be established as a separate area. Clean rooms can be set up as needed, and they should form their own separate areas.
The clean room should be equipped with preparation rooms, patient bathrooms and toilets, nurse rooms, washing and disinfection rooms, and purification equipment rooms.
The patient bathroom and toilet can be separately set up and should be equipped with both a shower and a bathtub.
The clean room should only be used by one patient and a second shoe changing and changing area should be provided at the entrance.
The washbasin in the blood laminar flow ward should use an induction automatic faucet

During the treatment period, blood wards should use Grade I clean rooms, while during the recovery period, blood wards should use clean rooms not lower than Grade II. The airflow organization method of upward supply and downward return should be adopted. Grade I wards should have vertical unidirectional flow above the patient activity area, including the beds, with a supply air outlet area of no less than 6 square meters, and should use airflow organization with downward return air on both sides. If horizontal unidirectional flow is used, the patient activity area should be arranged upstream of the airflow, and the head of the bed should be on the air supply side.
The purification air conditioning system of each ward should adopt independent dual fans in parallel, serving as backups for each other and running 24 hours a day.
▲ The air supply should use a speed control device and at least two levels of wind speed should be set. When patients are active or undergoing treatment, the cross-sectional wind speed in the working area should not be lower than 0.20m/s, and when patients are resting, it should not be lower than 0.12m/s. The indoor temperature should not be lower than 22 ℃ in winter, and the relative humidity should not be lower than 45%. In summer, the temperature should not exceed 27 ℃, and the relative humidity should not exceed 60%. The noise should be less than 45dB (A).
▲ The adjacent and connected rooms should maintain a positive pressure of 5Pa.

The air conditioning system should meet the following requirements:
Reasonable zoning should be carried out based on indoor air conditioning design parameters, medical equipment, hygiene, usage time, air conditioning load, and other requirements;
Each functional area should be independent and form a separate system;
Each air conditioning zone should be able to enclose each other and avoid hospital infections through air routes;
Rooms with cleanliness requirements and severely polluted rooms should be separated into a separate system.

The setting of the bathroom should meet the following requirements:
The floor plan size of the bathroom compartment used by the patient should not be less than 1.10m × 1.40m, and the door should open outward. An infusion hook should be installed in the bathroom compartment.
The seat ring of the patient's seated toilet should be of a type that is not easily contaminated and easy to disinfect, and there should be no height difference when entering the squat toilet compartment. A safety grab rod should be installed next to the toilet.
The bathroom should have a front room and non manually operated hand washing facilities.
When using outdoor restrooms, it is advisable to connect them to the outpatient and ward buildings through corridors.
It is advisable to set up gender free and accessible patient specific restrooms.
The accessibility facilities and design of dedicated and public restrooms should comply with the relevant provisions of the current standard "Code for Accessibility Design" GB 50763.