Kungani izindawo zokugcina izihlalo zase-ICU nezindawo zokugcina izihlalo zase-ER ziyakhula kakhulu?

Umbono wokuziphatha kwezimpilo yokuhlala kwe-ICU: Ukuvikela umgodi, Ukuphatha izikhathi zokuhlanganiswa, nokuthi kufanele kubhekwe isibonelo sokuziphatha

Ukuthi ukuchitha umgodi ngokugcina nokuphatha ukuthi kusuka kwezinye izinhlobo zokuhlala kwezimpilo kungasiza njani ukuthi abantu abanemigodi emhlabeni noma abanemphilo yasekhaya kufanele

Ukugcina imizimba yase-ICU ekhulu kwezinkulu kunceda ukulondoloza ubuso emva kwezimpilo zokubona njengezimpilo zokubona kwezinyawo (TBI) noma amaphutha. Uma imizimba iphuma ngumhla wodwa we-Celsius, izindlela zokusebenza kwesibonelo siphula ngeminyaka engu-6 ku-10%. Lokhu kunceda ukuvikela izinkundla zokubona kusukela ukuthi zihluphe kabanzi. Kuzinhliziyo ezingaphansi kwe-37.5 degrees Celsius (ngu-99.5 Fahrenheit) kunceda ukuthi umzimba uzilalele ukuthi kufana nokuthi kuyabuka isibonelo sokuhlanza. Izifundo ezithile zokujabula izinto zokwenzeka kanye nezifundo zokuzivocavoca izindlela zokusebenza zibonisa ukuthi lokhu kunceda ukususa amandla. Emva kokuba umuntu uphumelela ukuthi akhwele umzimba, ukqala ukugcina imizimba phakathi kwe-32 ne-36 degrees Celsius (ngu-89.6 ku-96.8 Fahrenheit) kuyisisekelo esikhulu ngemizuzu eyine. Abadokotela besebenzisa izibhankethi zokugcina emanzini noma izinkampani zokugcina ngaphakathi yokusebenza lokhu. Kufanele bahlale bakhumbula ukuthi kufanele bahlale bakhumbula imizimba yomzimba ngokuphelele, ngoba uma kugcina kakhulu noma kuthi kubhiza kunceda ukuthi kubhekene nezinkinga zokusebenza kwezinkundla.

Ukuphula Ukusebenza Kwamadoda Okunye Nezinkinga Zokugcina Ngokusebenzisa Ukuchitha Kwesikhathi Sokuphela

Kodwa ukuthi umphumela wokuphansi kwesikhathi, amaphathogeni asizokwazi ukuzikopisha ngokuphelele. Amaphayile ayisho ukuthi amabaktiria ayakhula kancane kwezindawo eziqinile, nokuthi izivinini zokukhula ziyaphansi kwe-40 ku-60 percent kodwa isikhathi siphansi kwezindawo zokuphansi kwe-21 degrees Celsius (ngokugcina kwe-69.8 degrees Fahrenheit) kungezindawo ezinkulu. Izindawo eziqinile zisebenza ngokuhambisana nezifilti zokuvavanya kwe-HVAC ukuze zihambise indlela yokubaluleka kwezidilithi zokuvula emasimini. Lokhu kokuphansi kwesikhathi kufaka i-Pseudomonas nezinye izibhaktria zokuphansi kwe-gram kungafanele kakhulu, kusinda ukuthi izispore zokufutha zizohamba kahle, futhi kusinda ukuthi izivinini zokuvula zizobhekwa. Amahospitale ayo aqondisa izindawo zabo kwezindawo zokuphansi kwe-20 ku-22.8 degree Celsius (ngokugcina kwe-68 ku-73 degrees Fahrenheit) ayabona ukuthi kunezindlela zokufa kwezinhlangano zezihospitale zingaphezu kwe-19 percent ngaphansi kwezinye amahospitale angaqondisa lezi zindawo. Ngakho-ke ukuthi ukuphansi kwesikhathi akuyiyo kuphela ukuthi kubonakala kahle kubantu abasebenzayo, kodwa kubonakala kakhulu njengokuthi kuyisisekelo sokuvikela izinhlangano.

Ukukhokha Kwesikhathi Se-ICU: Izindlela Zokusebenza Kwe-HVAC Ezidingekayo Kulokhu Okudingekayo Ukuphatha Umuntu

Amaphuzu Okuhamba Kwesilawuli Ngamihour (ACH), Amaphuzu Okugcina Isifunda, Nemiphumo Yokuqondisa I-MERV-16+

Amasistimu ase-HVAC esikhundleni sa-Intensive Care Unit kufune ukuba kubhalekhe amafutha angama-12 kuze kube ama-15 ngamuhla, okuyisithathu kwezinye zezindawo zasekhaya lokugcina. Lokhu kubhalekha kwamafutha kusebenza ngokuphakanyisana nezindlela zokuphatha ubunzima. Isikhundla sa-ICU sibonakala ngokuvamile ukuba sinezinhlaka zokuphakamisa ukuze libhaleke amafutha amhlophe kusuka kuyo, kubulawa abantu abanemiphakathi yokuqonda engapheli. Amakhambani okukhupha amadoda akhuphile ayisebenza ngokuvamile ngokuphakamisa okungafanele ukuze kubulawe izinto ezingavumelekile kulezi zindawo. Ukudibanisa amafiltara a-MERV-16 kanye nangokuthi kuyabona umphela. Lezi zifiltara ezinkulu zingakwazi ukubhala amaphuzu angaphezu komkhulu wokuphakamisa kwe-95%, ngokuphakamisa kwe-0.3 microns, kufaka iziviro ezingavumelekile njenge-flu neziviro zocoronavirus. Umgcino wokuhlola kwenza ukuthi le kombinethi ibhala isiphelo sezinhlangano zokugcina esikhundleni sa-ICU ngokuphakamisa kwe-60%. Ukubhaleka kwamafutha kufuna ukuthi kubhekwe kahle kuma-pacients abahlala emhlabathini. Abengineyiri bafanele ukubhekisa ukuthi akukho mafutha amabi abhalekha ngqo kubo, kodwa futhi kubhekwe ukuthi kubulawe izimo zokuzimisa.

Ukubuyiselwa, Ukulawula Kwemithwalo Yomhlangano, nokukhangela Ngokushesha Kwezinkathi Zokuhlala Kwamaphuzu

Izinsiza zokubuyiselwa ziyimfundo ephakeme kuleli xesha, ikakhulu ngokugcina izindlela zokufa ezimbili nezinsiza zokubuyiselwa zokuphatha amaphuzu esebenza ngemizuzwana emi-10 uma kuthi kusenzeka into. Umthwalo wamaphuzu wahlala phakathi kwemilinganiselo ya-30 ku-60% RH. Le yilinye yezindilinganiso ekhomba ukuthi amahlobo amakhulu ayikwazi ukuphanda kakhulu futhi ekhomba ukuthi akhathalise umkhakha wokuphanda okungahleli ukuthi kwenziwe izinto ezihlukene zokuphatha amaphuzu okuhlela izinto ezihlukene. Izinhlobo zokukhangela zikhokha imiphumela ngemizuzwana emi-30 futhi zibhala amazwi okuhlonipha uma izinkathi zokuhlala zihamba ngaphezu kwe-0.6 degrees Celsius noma umthwalo wamaphuzu ubuye ngaphezu kwe-5%. Sibona lokhu sibonakaliswe kahle ngokuphakeme kwezinkathi zokuphakama kwamaphuzu kuleyisonto yasemva. Amakhaya abantu abaningi asebenzisa lezi zinhlobo zokukhangela ayabuyiselwa kwezinkathi zokuphakama kwamaphuzu ngaphezu kwe-92% yazo zonke izindawo ezisetyenziswa khona. Lezi zinca zikhombisa kahle ukuthi ukulawula kwezinhlobo zokuhlala kuyisidingo esiphakeme kwezindawo zokusebenza zokuphatha abantu uma bafuna ukusebenza ngokuphakeme ngaphandle kokuphakama kwamaphuzu.

Izindawo Zokugcina Emhlabeni: Ukubalansha Umkhawulo Wezinto Zokusebenza, Umsebenzi Wabantu Abasebenzisa, Nokuvikela Umuntu Osebenzisa

Isibalo sesikhathi sokuphela sisebenza ngokwesikhalazo esithile sokufika kwezinkolelo zokugcina nokukhupha okuhluke kwezinkolelo zezihospital ezingaphansi. Izinhlelo zonke zokusebenza ezifakwe kusodwa zisenza umthelela omkhulu wokugcina. Hlala uqonde izinhlelo zokubhala iziphoto zezibhanki (CT), izinhlelo zokubhala iziphoto zezibhanki zokuhambisa, nezinye izinhlelo zokujabulisa okuzenza umthelela wokugcina ozinake kusodwa okungaba ngaphezu kwezinkilowati eziyisishiyagalombili nesine ngendawo. Uma sifaka kuleli qembu izindlebe zokuvula nokuvulwa ngokuthintana nezabantu abafika nabahamba ngamazinsuku angavamile, ukulinganisa isilinganisi sezintemperatura kusodwa kuyizinkinga ezinkulu. Izinhlelo zonke zokuhlola zisondela ukuthi izintemperatura zibe phakathi kwezintemperatura eziyisibili nesine (ngokuphakeme kwezintemperatura eziyisishiyagalombili nesine kuFahrenheit), kodwa izibalo zesikhathi sokuphela zingaba phakathi kwezi zinhlelo. Abasemthethweni nabadokotela bafuna ukusebenza kusodwa kumangaliso okuncane, phakathi kwezintemperatura eziyisibili nesibili (kwezintemperatura eziyisishiyagalombili nesibili kuFahrenheit). Abantu abathile abasebenzisa amandla okuphela noma abadinga ukusebenzisa izinkolelo zokuphela kwezinye izindawo zokuphela zidinga ukulinganisa izintemperatura ngokuchanekileyo, ngokuphakeme phakathi kwezintemperatura eziyisibili nesithathu (kwezintemperatura eziyisishiyagalombili nesithathu kuFahrenheit) ukuze sibophelele ukuthi izimo zokungabi nempilo, izinfeksheni, noma ukuthuthuka kwesiqhelo kuzoba yizinkinga eziphakeme. Ingxenye yezinkinga kukuthi izihospital zidinga ukuthi ukushiswa kwesigodi kusodwa kusobala kakhulu ukuze sibophelele ukuthi izinfeksheni zingashiyelwe, lokho kunokuthi kusobala ngaphezu kwezishumi nambili ngamuhla. Kodwa leli kholwa eliphezulu kungenzela ukuthi kubhekwe kusodwa kwezinkinga zokubhekwa. Izindlela ezintsha zisetyenziswa manje zisetyenzisa izinhlelo zokugcina ezizwakale kusukela kwezinhlelo zokujabulisa ukuthi abantu bazingaphi noma izinhlelo zizingasebenza njani. Lezi zinhlelo zisobala izintemperatura ngokuphakeme kwezinkilogramu eziyisibili nesibili (ngokuphakeme kwezintemperatura eziyisishiyagalombili kuFahrenheit) futhi zisavele kusodwa kwezinkilogramu eziyisishiyagalombili nesine kuFahrenheit, zonke zisobala ngokushesha kwezinkinga zokuphela futhi zisobala abantu ngokuphakeme.

Imithombo Yezimboni Zokuphatha Ukuphakama Kwesikhathi Esikweni Sokuphatha Isibindi: ASHRAE 170, Imilayezo Yase-SCCM, Nokuthi Kuyaphakanyiswa Ngokwempilo

Imiphakathi Yezikhathi Zokuphakama Kwesikhathi Esikweni Sokuphatha Isibindi Ne-ER Yase-ASHRAE 170-2021 (20–23°C) Futhi Yisiphi Sifanana Nokuphatha Okuhle Kwezimpilo

I-ASHRAE Standard 170-2021 isetshenziswa kubukho lwezinkampani zokuphatha izindawo eziningi kanye nezindawo zokuphatha izimilo, kuyasiza ukuthi ubukho bube phakathi kwe-20 kuya kuye ku-23 degrees Celsius noma kwe-68 kuya kuye ku-73 Fahrenheit. Le yisikhundla sokubukho siyavumeka ngumkhakha wokuphatha izindawo eziningi (Society of Critical Care Medicine) ngoba sisebenza kahle ekuvikeleni amagugu kanye nokusiza kwemithombo yezinyawo zomuntu. Uma ubukho buhlala phakathi kwezilinganiso lezi, amagugu ayikwazi ukuphila kahle ngaphandle kokuthi umuntu abe nomlilo, futhi abadokotela bafuna ukuphatha izimilo zomlilo kubantu abanemililo emsebenzini yasekunene (septic patients), kanye nokuphatha imithombo yezinyawo kubantu abaqhubeka ukuziphatha emsebenzini yasekunene (traumatic brain injuries) noma emsebenzini yasekunene yezibuko zemithombo (cardiac arrest). Le standard ibiza ukuthi kufanele kubhekwe i-MERV-16 plus amafiltela wehawa kanye nezindlela zokuhlanganisa iziqu zehawa kubuso lwesikhundla, okuyizindlela eziphathelene ngezikhundla zokuphatha izindawo eziningi (ICU HVAC) zezindawo zokuphatha izindawo eziningi zezindawo zokuphatha izindawo eziningi. Ukubeka ubukho phakathi kwezilinganiso zokubukho zezingu-5 Fahrenheit kufanele kubhekwe ngokuphathelene ngezinsuku zonke ngoba izihospitali ziyabona izinto zonke zokuguqula ngeminyaka yazo, njengokuthi izixhobo zisitartekile ngokusha noma iziqu zokusebenza ziyaguqula ngokusha emsebenzini yokuqwalasela. Izihospitali ezingaphansi kwezindawo zokuphatha izindawo eziningi ziyakhuleka ukuthi zibuye ziqwalasele izixhobo zokuphatha ubukho, kodwa kukho izisombululo esizakuqala kuzoba khona le sizwe. I-modular upgrade kits nezisensha zazikhiwe kuzoba yizinto ezinconywa kakhulu njengoba izihospitali ziyabhekisa kakhulu emiphumelweni yokuphatha umuntu ngaphandle kokuthi ziyabhekisa kuphela emiphumelweni yokuqwalasela kwezimali.

Imibuzo Evame Ukubuzwa

Kungani ukuthi isikhathi esincane se-ICU sithathwa njengokuthinteka kakhulu kubantu abanemiphumela yomhlaba nasekupheleni kwemithi?

Izikhathi ezincane ze-ICU zincoma umhlaba futhi zinamathisela impilo yomhlaba, zibophelela ukuthinta kakhulu kwezinkundla zomhlaba futhi zinconywa ukuthola okuhle kubantu abanemiphumela yomhlaba nasekupheleni kwemithi.

Ukuthi isikhathi esincane sesikhathi sokuzimisa sisebenza kanjani ekulawuleni kokuphela kwemithi emazini?

Isikhathi esincane sesikhathi sokuzimisa sibophelela ukukhetha kwezinhlobo zemithi, sibuyekeza ubukhulu bekususa izinhlobo zemithi, futhi sibophelela ukusebenza kwezinhlobo zemithi ezingavumelekile, ngakho-ke sisebenza ekulawuleni kokuphela kwemithi emazini.

Izinhlobo zokusebenza kwe-HVAC eziphakanyisiweyo kumhlaba we-ICU ziyiphi?

Amahlaba we-ICU ayidinga ukuguqula kwezinye zokuzimisa kusasa-12-15, isikhathi sokuzimisa esiphakanyisiweyo kumahlaba we-ICU, futhi ukususa okuphelele nokufuna i-MERV-16+ ukuze kuvunyelwe umhlaba othuluzi nokuthembekile kubantu.

Ukuthi izihlawuli zokulawula njenge-ASHRAE 170-2021 zinconywa kanjani ekulawuleni kwezikhathi zokuzimisa kumahlaba we-ICU?

I-ASHRAE 170-2021 isiphumo sokubeka izindlela zokusebenza zokuphepha izilinganiso zokulingana kwezintemperatura nekukhokha kwamafiltara wezilwane, kufanana nezindlela zokusebenza eziphakeme kwezinsizakalo zokulungiselela abantu ukuthi baze benzele ngokuphepha kwezinsizakalo zokulungiselela abantu kanye nokuvikela abantu kuzo zokugqibela kwezinsizakalo zokulungiselela abantu.