Dressing Room

DRESSING ROOM, dressing room, a room specially designated for changing dressings in hospitalized patients, as well as that room in outpatient clinics and polyclinics where dressings are applied to outpatients. Similar special rooms are also typically allocated in well-arranged emergency rooms. It can be assumed that the first dressing rooms in Russia were allocated as special-purpose premises under Peter I, when the Moscow Hospital and the St. Petersburg Marine Hospital were built. With the development of hospital construction, with the allocation of surgical wards, departments, and entire buildings for dressing rooms, as well as operating rooms, they have already become necessary service premises. If with respect to operating rooms, surgical experience puts forward a number of rather strict requirements that builders must take into account (see Operating Room), then with respect to dressing rooms these requirements may not be so strict. These requirements are as follows: it is better to avoid locating dressing rooms on the sunny side, as bright light interferes with work, but this can still be tolerated, since the work of a surgeon in a dressing room is not as intense and prolonged as in the operating room. When building a dressing room, the most important thing is to obtain sufficient floor area, and when calculating this area, it is necessary to take into account a number of conditions. These conditions for dressing rooms in surgical departments vary depending on whether they are intended for clean patients or for purulent patients, other conditions will be for dressing rooms in an outpatient clinic or in an emergency room. Engineer Poltavtsev gives the dimensions of dressing rooms from 18 to 30 m². When calculating the size of a dressing room, first of all, it is necessary to take into account the number of patients that the dressing room must serve, and it is necessary to remember that in stationary departments of medical institutions, the most intense work of the dressing room continues for 4-5 hours. During this period, in a clean department for 50 people, the dressing room is used for various purposes on average by 20 people (for changing dressings, for removing sutures, for hand and foot baths, for examining patients, etc.). In purulent departments, for the same number of patients, this number should be approximately doubled. In large departments, several doctors usually work in the dressing room at the same time, as well as auxiliary staff (nurses and nannies), so that the workload in the dressing room at the same time can often be significant: 2-3 people of care staff, 2-3 doctors, 3-4 patients, of whom two, or even three, may be lying patients, delivered either on beds placed on special carts or on specially adapted rolling tables, chairs, or stretchers. All these people must be accommodated in the dressing room completely freely, without interfering with each other, otherwise it is easy to violate the requirements of asepsis when performing various manipulations on patients. In addition, in recent years, the teaching of clinical medicine has been significantly restructured, production practice has been introduced for students of medical institutes, which is conducted in all urban medical institutions; the same institutions also serve as clinics for medical technical schools and for the training of sisters of the ROCC. All this must be taken into account when calculating the area of the room allocated for the dressing room of a stationary department. For surgical departments with 50-60 beds, the figures given by Poltavtsev should be increased to 40-50 m². In such large departments, there should be separate dressing rooms for men and women; in small surgical departments with 20-30 beds, one can get by with one dressing room when using it for men and women at different times. Dressing rooms in special departments (otorhinolaryngological, gynecological, eye) have their special equipment; and the above calculations of floor area of dressing rooms can be applied almost entirely only to gynecological patients; eye and otorhinolaryngological patients have so many peculiarities in their treatment that general surgical norms cannot be considered suitable for them, and therefore both architectural assignments and equipment must be developed by specialists. In this case, it is necessary to take into account the number of working doctors, placing tables and lighting and examination instruments accordingly, arranging window dimming, arranging research instruments, etc. The size of dressing rooms in outpatient clinics, emergency rooms, polyclinics first of all depends on the expected number of patients served simultaneously, and then on whether the dressing room will serve only for dressing purposes or if outpatient operations will also be performed in it if there is no specially allocated operating room for this purpose. The requirements for the lighting of dressing rooms are of course not as strict as for the operating room, but still the ratio of light openings to floor area should be 1:5 or even better 1:4. There is no need for overhead lighting. As for artificial lighting, in this respect one must be rather demanding, which is justified by the versatility of purposes for which a dressing room can serve: in addition to dressings, it is necessary to examine newly admitted patients, sometimes to perform primary wound treatment, to carry out all sorts of examinations, catheterization, bloodletting, blood transfusions, etc. Therefore, it is clear that there should be a lot of light in the dressing room and this light should be easily directed in different directions and make it possible to illuminate the depth of cavity wounds. A ceiling lamp with a reflector of 300 candlepower, according to the experience of the Botkin Hospital in Moscow, is quite suitable for most cases. Additionally, it is necessary to have a portable lamp of one type or another with a reflector, then any wound can be examined well. In addition to shadowless lamps for operating rooms, there are also lamps of small diameter, both ceiling and wall (type 'bra') and portable, which can be highly recommended. - Permissible fluctuations in temperature in dressing rooms are 20-25°. Everything said about heating the operating room (see Operating Room) can be fully applied to the heating of dressing rooms. - Ventilation for dressing rooms is essentially important. Constant dressings, sometimes foul-smelling pus, various foul-smelling secretions often make the air in the dressing room so heavy that the increased requirements for good ventilation are quite understandable. Builders consider hourly ventilation of dressing rooms to be two volumes per hour. Regardless of artificial ventilation, it is necessary to insist that there is always a full possibility to resort to natural ventilation - through the window frame, transom window or vent. For large dressing rooms where many various manipulations have to be performed, it can be strongly recommended that fireplaces with pear-shaped closable fireboxes be installed in the dressing rooms themselves. These fireboxes can be used for burning removed dressings, and at the same time these fireplaces quickly draw out the spoiled air. Strict requirements for dressing rooms in terms of maintaining cleanliness, the need to wash the floor sometimes several times a day, the accumulation of water vapor from the instrument sterilizer determine the requirements for the material from which the floor is made and for the coloring of the walls and ceiling. The most reasonable can be considered a floor made of metlakh tiles or of those compositions that modern technology introduces instead of stone tiles. Parquet, and even more so a painted wooden floor, should be considered completely unacceptable for dressing rooms. Linoleum is also not a solution to the problem, since the joint between the floor and the wall when the floor is covered with linoleum is a weak point in terms of the possibility of liquid leakage when washing the floor, and with it any dirt. Walls and ceiling should be painted with oil paint. The color of the paint is usually white; giving any colored coloring is hardly necessary. To the height of a person's growth, the walls should be lined with glazed white tiles. It is very durable and lasts for years without requiring any repair; oil paint, despite its durability, still requires repainting after a few years, as it gets dirty, cracks in places, gives cracks. A drain for water drainage in a dressing room is needed only in large dressing rooms, since in small dressing rooms it is not difficult to clean the floor without a drain. Furnishings of dressing rooms. In each dressing room there should be a table on which a patient can be placed for dressing and examination. The table should be placed so that it can be approached from all sides. No complex tables for dressing rooms are required; the table can be metal, wooden, painted, best covered with ripolin. One or two tables for ointments, solutions, for trays with instruments, Schimmelbusch boxes for dressing materials. An essential accessory for each dressing room should be a small cabinet for storing instruments, silk, syringes, needles, a small supply of solutions of novocaine, caffeine, chloroethyl, ether for anesthesia. The key to this cabinet should be with the dressing room sister, since the responsibility for the dressing room and all inventory and its issuance lies with her. If there is a fireplace in the dressing room for burning dressings, then still in each dressing room it is necessary to have a large bucket with a well-closing lid for removed dressings and for all sorts of random waste. This bucket is emptied several times a day, depending on the work, and in terms of cleanliness it should be under special supervision of the staff.

It is highly desirable that the Dressing Room have a chair for gynecological and urogenital examinations. If there is no special room for applying plaster casts and corsets, it is desirable to have in the Dressing Room a device (even of the Sair type) for applying corsets. An essential accessory for the Dressing Room is a sterilizer for boiling instruments. The washbasin should have water, preferably not poured but piped in. It is highly desirable to have both cold and warm water. It is best to have piped sterile water in the washbasin. No special apparatus is required to prepare this sterile water, as the same apparatus that supplies the operating room can also supply this water. The possibility of having sterile water in the Dressing Room should be taken into account when equipping the surgical department, both from the point of view of installing the sterilization apparatus and the rational branching of the pipeline.