"Budget healthcare institutions: accounting and taxation", 2011, N 11

The specificity of the activities of health care institutions implies a supply of soft inventory sufficient for the normal functioning of institutions. This can explain a significant number of questions that arise for accountants of health care institutions in the process of reflecting in accounting transactions for the acquisition, posting and write-off of soft inventory. This article reveals the main aspects of accounting for soft inventory in healthcare institutions and answers private questions from our readers.

Soft inventory objects

According to paragraph 99 of Instruction N 157n<1>soft inventory is reflected in accounting as part of inventories. By general rule of the said Instruction, material reserves include items used in the activities of the institution for a period not exceeding 12 months, regardless of their value. In addition, the composition of inventories, regardless of cost and service life, includes (clause 99 of Instruction N 157n):

• special clothing, special footwear, uniform, clothing and footwear, as well as sportswear and footwear in health care, education, social security and other institutions;
• bed linen and accessories;
• other soft goods.

<1>Instructions for the use of the Unified Chart of Accounts, approved. Order of the Ministry of Finance of Russia dated 01.12.2010 N 157n.

Thus, for accounting purposes, soft inventory items in health care facilities are accounted for as inventory, regardless of their cost and service life.

A detailed list of objects that are accounted for on account 0 105 05 000 "Soft inventory" is contained in clause 118 of Instruction N 157n. It includes:

1. underwear (shirts, shirts, bathrobes);
2. bed linen and accessories (mattresses, pillows, blankets, sheets, duvet covers, pillowcases, bedspreads, sleeping bags);
3. clothes and uniforms, including overalls (suits, coats, raincoats, short fur coats, dresses, sweaters, skirts, jackets, trousers);
4. shoes, including special shoes (boots, boots, sandals, felt boots);
5. sportswear and footwear (suits, boots);
6. other soft goods.

At the same time, special clothing includes such types of clothing, footwear and safety devices as overalls, suits, jackets, trousers, dressing gowns, sheepskin coats, sheepskin coats, various shoes, mittens, glasses, helmets, gas masks, respirators.

For your information. The financially responsible person marks the items of soft inventory in the presence of the head (deputy head) of the institution and the accounting officer with a special stamp with indelible paint without damaging the appearance of the item, indicating the name of the institution, and when issuing items for operation, makes additional marking indicating the year and month of their issue from the warehouse . Marking stamps must be kept by the head of the institution or his deputy (clause 118 of Instruction N 157n).

In tax accounting, all property of an institution is divided into depreciable and non-depreciable. So, according to par. 3 p. 1 art. 254 of the Tax Code of the Russian Federation, property that is not depreciable is classified as inventory. Depreciable property is recognized as property that is used by the institution to generate income and the value of which is repaid by depreciation. At the same time, in order to recognize property as depreciable, two conditions must be simultaneously met (clause 1 of article 256 of the Tax Code of the Russian Federation):

• useful life of the object - more than 12 months;
• the initial cost of the object is more than 40,000 rubles.

Thus, if an institution acquires soft inventory, the cost of one item of which is more than 40,000 rubles, with a useful life of not more than a year, or soft inventory, the cost of one item of which is less than 40,000 rubles, with a useful life of more than a year, in For the purposes of tax accounting, it must reflect such property as depreciable and accrue monthly depreciation on such property during the period of its operation.

Soft inventory accounts

In budgetary and autonomous healthcare institutions, soft inventory refers to movable property and is divided into two types:

• especially valuable movable property of institutions;
• other movable property of institutions.

Consequently, soft inventory in these institutions is accounted for in the accounts (clause 31 of Instructions N N 174n<2>and 183n<3>):

• 0 105 25 000 "Soft inventory - especially valuable movable property of the institution";
• 0 105 35 000 "Soft inventory - other movable property of the institution".

<2>Instructions for the use of the Chart of Accounts for accounting of budgetary institutions, approved. Order of the Ministry of Finance of Russia dated December 16, 2010 N 174n.
<3>Instructions for the use of the Chart of Accounts for accounting of autonomous institutions, approved. Order of the Ministry of Finance of Russia dated December 23, 2010 N 183n.

Inventories of state institutions, including soft inventory, are accounted for as other movable property, that is, the legislators suggested that state institutions cannot have soft inventory that could be attributed to the especially valuable property of institutions. Accordingly, state healthcare institutions use only account 0 105 35 000 (clause 21 of Instruction N 162n<4>).

<4>Instructions for the use of the Chart of Accounts for budget accounting, approved. Order of the Ministry of Finance of Russia dated 06.12.2010 N 162n.

The receipt of soft inventory can be reflected directly in the soft inventory accounts (on accounts 0 105 25 000, 0 105 35 000) or using accounts 0 106 24 000 "Investments in inventories - especially valuable movable property of the institution", 0 106 34 000 " Investments in inventories - other movable property of the institution. The latter option is used in case of receipt of soft inventory under several contracts.

Receipt of soft goods

Soft inventory may come to an institution as a result of its acquisition for a fee, in the form of centralized supply, free of charge, and may also be manufactured by the institution itself. Next, consider some of the options for the receipt of soft inventory in the institution.

Acquisition of soft inventory for a fee. The posting of soft inventory purchased for a fee is carried out at the actual cost, which includes the amount in accordance with the contract concluded with the supplier of soft inventory, the cost of information, consulting, intermediary services directly related to the purchase of soft inventory, delivery costs in proportion to the cost of each item of soft inventory inventory, expenses for working out and improving the technical characteristics of soft inventory, customs duties, other payments directly related to the acquisition of soft inventory (clause 102 of Instruction N 157n).

Note! The actual cost of soft inventory, at which it is accepted for accounting, is not subject to change (clause 107 of Instruction N 157n).

The posting of soft inventory received under a state (municipal) contract for the needs of a budgetary or autonomous institution is reflected on the basis of primary (summary) accounting documents confirming the fulfillment by the supplier (contractor, performer) of the terms of the contract for the transfer of material assets. In the event of a discrepancy between the actual volume of received material assets, their quality and nomenclature with the data specified in the supplier's accompanying documents, an Act on the acceptance of materials is drawn up (f. 0315004) (clause 33 of Instructions N N 174n and 183n).

State institutions reflect the posting of soft inventory on the basis of primary accounting documents - supplier's invoices. Discrepancies with the data of the supplier's documents are also drawn up using the above act (clause 22 of Instruction N 162n).

What is the unit of accounting for soft inventory items? for instance, the institution purchased a bedding set, which includes two pillowcases, a sheet and a duvet cover. How to take into account such a set: as one object or several objects? The unit of accounting for soft inventory is chosen by the institution independently and is indicated in its accounting policy. for instance, it can consider a bedding set as one object or as three independent objects (sheet, duvet cover, pillowcases). However, in this case, it becomes difficult to determine the price of a unit of account if the cost of the entire kit is indicated on the supplier's invoice without a breakdown into its components. According to the author, in this situation it is advisable to fix in the accounting policy of the institution a method for determining the value of the accounting unit included in the set. for instance, the cost of the duvet cover will be 50% of the cost of the set, the cost of the pillowcase will be 12.5%, the cost of the sheet will be 25%.

The accounting unit of soft inventory is chosen in such a way as to ensure the formation of complete and reliable information about the stock of soft inventory in the institution. In addition, when choosing a unit of account, one should take into account the possibility of proper control over the presence and movement of soft inventory in the institution.

Example 1. The budgetary health care institution purchased 100 sets of overalls for doctors: cotton jackets and trousers. According to the contract, the cost of one set is 180 rubles. The cost of delivery of overalls was 900 rubles. The accounting policy of the institution established that the unit of accounting for overalls for a doctor is the type of overalls: jacket, trousers. The cost of a unit of accounting for the type of workwear in case of its receipt in a set is determined as follows:

• jacket for a doctor - 60% of the cost of the set;
• pants for a doctor - 40% of the cost of the set.

In the accounting of a healthcare institution, these transactions are reflected as follows:

Thus, the cost of one jacket is 113.4 rubles. (11,340 rubles / 100 com.), and the cost of one trousers is 75.6 rubles. (7560 rubles / 100 rooms).

In accordance with paragraph 119 of Instruction N 157n, analytical accounting of material reserves is carried out by their groups (types), names, varieties and quantity in the context of materially responsible persons and (or) storage locations. In the above example, the storekeeper Sirina I.S. must keep records of soft inventory in the book (card) of accounting for material assets by type of overalls (jackets, trousers) and its quantity.

Free receipt of soft inventory. In accordance with the rules established by the Accounting Instructions for State (Municipal) Institutions, there are several options for receiving inventories free of charge, including soft inventory. These options include securing the right of operational management, receiving under a donation agreement, through centralized supply, from supranational organizations, governments of foreign states and international financial organizations, as well as other options. For each individual case, there is its own version of determining the actual cost of soft inventory.

The actual value of soft inventory received under a donation agreement is its current market value as of the date of acceptance for accounting. If there are services associated with its delivery and bringing the soft inventory into a condition in which it is suitable for use, their cost is included in the actual cost of the soft inventory. At the same time, the current market value is the amount of cash that can be received as a result of the sale of soft inventory, as of the date of acceptance for accounting. The determination of the current market value is made on the basis of the price in force on the date of posting of the property received free of charge for this or a similar type of property. Information about the current price must be documented or confirmed by an expert. In addition, in order to accept soft inventory received under a donation agreement for accounting, data on prices for similar tangible assets received in writing from manufacturing organizations, information on the price level available from state statistics bodies, trade inspections, and also in the media and specialized literature, expert opinions on the cost of individual (similar) objects. Responsibilities for determining the market price of soft inventory received under a donation agreement are assigned to the commission for the receipt and disposal of assets created in the institution on a permanent basis (clause 25 of Instruction N 157n).

For your information. In a similar way, the actual cost of soft inventory identified during the inventory of assets is determined (clause 31 of Instruction N 157n).

Free receipt (transfer) of soft inventory within the framework of the movement between state bodies, local governments (municipal bodies), state (municipal) institutions, management bodies of state non-budgetary funds, state academies of sciences, as well as between accounting entities and other state (municipal) organizations created on the basis of state (municipal) property, in connection with the termination (fixing) of property rights (including the right of operational management) is carried out at the balance sheet (actual) value of accounting objects (clause 29 of Instruction N 157n).

For your information. About the actual cost of material assets received from supranational organizations, governments of foreign states and international financial organizations, Instruction N 157n is silent. According to the author, in this case, if the cost of soft inventory is not indicated in the accompanying documents, its market price is applied.

Correspondence of invoices for gratuitous receipt of soft inventory

Instruction N 162n	Instruction N 174n	Instruction N 183n
Debit	Credit	Debit	Credit	Debit	Credit
Free receipt of inventory within the framework of centralized supply
1 105 35 340	1 304 04 340	<*>	<*>
Free receipt of soft inventory as part of the movement between institutions subordinated to different chief administrators (managers) of budgetary funds of budgets of one level, institutions, subordinate to one chief manager (manager), within the framework of income-generating activities, as well as when receiving from government and municipal organizations, other organizations (with the exception of state and municipal) and individuals
0 105 35 000	0 401 10 180	<*>	<*>
Free receipt of soft inventory as part of the movement of objects between budgetary institutions of budgets of different levels
0 105 35 000	0 401 10 151	<*>	<*>
Accounting for soft inventory (investments) received free of charge from the parent institution (separate subdivision)<**>
<*>	0 105 25 340 0 105 35 340 0 106 34 340	0 304 04 340	0 105 25 000 0 105 35 000 0 106 34 000	0 304 04 310
Acceptance for accounting of gratuitously received soft inventory upon fixing operational management rights<***>
<*>	4 105 25 340 4 105 35 340	4 210 06 660 4 401 10 180	4 105 25 000 4 105 35 000	4 210 06 000 4 401 10 180
Free receipt of soft inventory in other cases from residents of the Russian Federation and individuals who are not residents of the Russian Federation
<*>	2 105 25 340 2 105 35 340	2 401 10 180	2 105 25 000 2 105 35 000	2 401 10 180

<*>This operation is not provided for by the corresponding Instruction.
<**>Grounds - waybill, act of acceptance and transfer, Notice (f. 0504805).
<***>Grounds - an act of acceptance and transfer, Notice (f. 0504805).

Example 2. An autonomous institution received soft inventory related to other movable property of the institution in the amount of:

• RUB 125,000 - from the founder;
• 90 000 rub. - from an individual (as a gift in accordance with a donation agreement).

In the accounting of an autonomous institution, these operations are reflected as follows:

Internal movement and disposal of soft inventory due to wear and tear

A feature of accounting for soft inventory in state (municipal) institutions, including healthcare institutions, is that its release into operation is reflected in accounting as an internal movement of material assets. Operations for the transfer of soft inventory into operation are reflected in the registers of analytical accounting of inventories by changing the materially responsible person on the basis of primary accounting documents: Invoice requirements (f. 0315006), Sheets for the issuance of material assets for the needs of the institution (f. 0504210) (clause 24 Instructions N 162n, paragraph 32 of Instructions NN 174n and 183n). At the same time, debit and credit entries are made in accounting for the same soft inventory account.

Note! In tax accounting, the cost of soft inventory put into operation is taken into account when determining taxable profit at the time of its transfer into operation (clause 3, clause 1, article 254 of the Tax Code of the Russian Federation).

Disposal of soft inventory is carried out on the basis of the Act on the write-off of soft and household equipment (f. 0504143)<5>, which is the commission of the institution for the receipt and disposal of assets when making a decision to write off soft inventory. The act indicates the basis for the write-off of soft inventory, the quantity and cost of materials (rags) formed as a result of its liquidation. It must be remembered that it is possible to write off soft inventory only if two conditions are met simultaneously (clause 25 of Instruction N 162n, clause 36 of Instruction N N 174n and 183n):

• expiration of wear (term of application);
• the impossibility of using soft inventory due to its physical wear and tear.

<5>Order of the Ministry of Finance of Russia dated December 15, 2010 N 173n "On approval of the forms of primary accounting documents and accounting registers used by state authorities (state bodies), local governments, management bodies of state non-budgetary funds, state academies of sciences, state (municipal) institutions, and guidelines for their application.

The cost of soft inventory, depending on the scope of its application, is written off to the accounts:

• 0 401 20 272 "Expenditure of inventories";
• 0 109 00 000 "Costs for the manufacture of finished products, performance of works, services."

The disposal of inventories, including soft inventory, is reflected in accounting in two ways (clause 108 of Instruction N 157n):

• at the actual cost of each unit;
• at the average actual cost.

The determination of the average actual cost of soft inventory items is carried out for each of its groups (types) by dividing the total actual cost of the group (type) of stocks by their number, which are formed, respectively, from the average actual cost (quantity) of the balance at the beginning of the month and the received material stocks during current month on the date of their withdrawal.

Thus, health care institutions can choose different ways to write off soft inventory for its various groups (types). for instance, bathrobes can be written off at the actual cost of each unit, and sheets - at the average actual cost. At the same time, it should be borne in mind that the use of one of the indicated methods of write-off by group (type) of soft inventory is carried out continuously during the financial year.

Note! In accordance with paragraph 8 of Art. 254 of the Tax Code of the Russian Federation, when determining the amount of material expenses from the write-off of soft inventory in accordance with the accounting policy adopted by the institution for tax purposes, one of the following assessment methods is used: by the cost of a unit of inventory, average cost, cost of the first inventory in time of acquisition (FIFO), cost of the last acquisition time inventory (LIFO).

Example 3. The accounting department of the state healthcare institution received an act on the write-off of soft inventory with the following data.

The amount of rags from the write-off of soft inventory amounted to 2 kg at a price of 1 ruble. for 1 kg. According to the accounting policy of the institution, bathrobes and towels are subject to write-off at the cost of each unit. Soft inventory was used in budget activities.

In the accounting of a state institution, these transactions are reflected as follows:

Is it possible to increase the cost of overalls, if in the process of its internal movement (issuance for operation) costs were incurred to fit the overalls to the figure of the employee? for instance, gowns for doctors, laboratory assistants, sets of overalls for nurses, when issued to employees, were fitted according to the figures of employees. The services were provided by a tailor - a private entrepreneur. As mentioned above, in accordance with clause 107 of Instruction N 157n, the actual cost of soft inventory does not change after it is accepted for accounting. If during the process of internal movement any expenses were incurred to bring the soft inventory to a condition in which it is suitable for use (for example, to fit a gown according to the figure of a doctor), these expenses are included in subsection 225 "Works, services for the maintenance of property " KOSGU, depending on the content of the business transaction, either to account 0 401 20 225 "Expenses for work, property maintenance services" or the corresponding analytical accounts of account 0 109 00 000 "Costs for the manufacture of finished products, performance of work, services."

For reference. Personal protective equipment issued to employees must correspond to their gender, height, size (clause 12 of the Intersectoral Rules for Providing Workers with Special Clothing, Special Footwear and Other Personal Protective Equipment<6>).

<6>Approved by the Order of the Ministry of Health and Social Development of Russia dated 01.06.2009 N 290n.

Example 4. From the warehouse of the budgetary health care institution (m.o.l. Pronin A.V.) to the hostess (Okuneva I.K.) for further supply of doctors, 20 jackets worth 108 rubles were issued. each and 20 trousers worth 72 rubles. a piece. Jackets and trousers were intended for the doctors of the institution. For services in fitting jackets and trousers according to the figures of doctors, funds were transferred to a private entrepreneur - a tailor in the amount of 2250 rubles. Soft inventory was purchased as part of the compulsory health insurance activities.

In the accounting of a budgetary institution, these transactions are reflected as follows:

Contents of operation	Debit	Credit	Sum, rub.
Reflected internal displacement soft inventory:
- jackets	7 105 35 340 Pronin A.V.	7 105 35 340 Okuneva I.K.	2160
- trousers	7 105 35 340 Pronin A.V.	7 105 35 340 Okuneva I.K.	1440
Written off the cost of fitting jackets and trousers according to the figures of workers	7 401 20 272	7 302 25 730	2250

Journal Expert

"Budget healthcare institutions:

accounting and taxation"

In institutions and in production are used different kinds inventory, each of which has its own characteristics of operation and accounting. In some types of institutions, the most common is soft inventory.

In the article, we will consider what assets belong to soft inventory, what are the nuances of its use and write-off, as well as the norms of use.

Soft inventory according to the instructions

Accountants need to know exactly which items of inventory belong to the “soft” group, because special accounting rules are typical for this category of assets. Not all items that feel soft are considered soft inventory in the accounting sense.

The procedure for classifying assets as soft inventory is regulated by the Instruction on the Application of the Unified Chart of Accounts for State Authorities, Local Self-Government, Management of State Extra-Budget Funds, State Academies of Sciences, State (Municipal) Institutions, approved by Order of the Ministry of Finance of the Russian Federation dated December 01, 2010 No. 157n in paragraph .118.

soft inventory- inventories of ready-to-use items that are used for a relatively long time in direct contact with the human body. The guidance specifies exactly which assets should be considered soft inventory:

• everything related to underwear (shirts, pajamas, bathrobes, etc.);
• bedding items (pillowcases, duvet covers, sheets, mattress covers, bedspreads);
• bedding (mattresses, blankets, pillows, sleeping bags, etc.);
• clothing, overalls, uniforms, uniforms (all types and items of clothing);
• footwear, including specialized footwear (all types of footwear);
• sportswear and shoes;
• real property.

NOTE! The “overalls” include, in addition to the actual items of clothing and footwear, also protective devices: respirators, helmets, goggles, etc.

Soft inventory items are mainly ordered from suppliers or, if the base allows, they can be made by the institution itself.

Not everything is soft inventory that is soft to the touch

The key feature of classifying an asset as soft inventory is its accounting affiliation, determined by regulations, and not the actual feeling of softness. Accountants should not classify items in this category without relying on the Instruction, which clearly names all types of inventories.

Often, by mistake, soft inventory lists stocks that are not:

1. Sewing products: tablecloths, curtains, curtains, napkins, towels, rugs, etc. These items are not mentioned in the said normative act, they cannot be attributed to any of the categories presented there.
2. Raw materials for soft stock: fabric, accessories, foam rubber, lining materials. Soft inventory is not raw material, but always finished products.
3. Small personal items: handkerchiefs, toothbrushes, hair ties, etc. They cannot serve as soft inventory, since their service life is relatively short - less than a year.
4. rags- soft inventory turns into it after the loss of serviceability, but it itself is not such and cannot be written off as soft inventory.
5. Separate "soft" items. So, for example, a backpack worn during high-altitude work cannot be classified as soft equipment, because it does not provide individual protection, unlike a safety belt.

Another type of error is the non-inclusion of relatively “hard” items in this asset type, which in fact should be considered soft inventory, for example, helmets, hard hats, gas masks, etc.

Norms of soft inventory

Decree of the Government of the Russian Federation of November 7, 2005 No. 659 substantiates the norms for the use of soft equipment for children on full state support (boarding schools). Letter of the Ministry of Education of the Russian Federation of September 22, 1993 No. 164-M contains similar norms for kindergartens, schools, vocational schools, etc. educational institutions. According to these standards, the period of use of the issued item does not exceed 1-2 years, then it is written off from the balance sheet, but if the item is not worn out, it may remain in personal use along with a new, freshly issued item.

Subtleties of "soft" accounting

There are some fundamental points related to the balance and write-off of soft inventory items:

1. Dismantling before registration. Many items from the list of soft inventory are purchased not one at a time, but in sets, for example, bed linen most often includes a sheet, a duvet cover and one or two pillowcases. It would be a mistake to capitalize this inventory as a single accounting object, because the items included in it are not interconnected. The accountant must evaluate each item separately, fixing the cost in the receipt order: the total amount of all items will be the cost of the set.
2. Marking. It is applied only to soft equipment, as stated in paragraph 118 of the Instruction. Each item credited must be marked with a stamp and the name of the institution, made in indelible paint. Marking is carried out by financially responsible persons, it must be attended by the head (or his deputy) and an accountant. You gotta try not to spoil too much appearance products.
3. The accounting register is the inventory item itself. Also a unique feature of soft inventory. When an item is issued from the warehouse for use, it is additionally marked with the date of issue (month and year).

IMPORTANT! The stamp used for marking is kept by the management.

Depreciation accounting

The long service life of soft inventory causes some difficulty in its accounting associated with wear. The legislation did not provide ways to resolve this difficulty. The soft inventory manager should regularly monitor:

• the amount of new inventory received on the balance;
• the number of units of products in use;
• the period of use of soft inventory.

"Primary" for soft inventory

To justify this type of inventory, the following types of documentation are provided for in accounting (based on Order No. 52n):

• receipt order for acceptance of non-financial assets (upon receipt on the balance sheet);
• shipping documentation - if it is properly executed, it is not necessary to issue a receipt order, unless disassembly is required;
• an acceptance certificate is issued if the actual quantity of inventory does not correspond to the documented one;
• cards of quantitative accounting of material reserves;
• invoice requirements - to account for the movement of soft inventory within the organization;
• property issuance book - records the issuance and return of soft inventory (it indicates the norms, standard service life and the number of issued units);
• write-off act - reflects the disposal of soft inventory.

Soft inventory accounts

For accounting of this type of property, a special account 105 00 “Inventories” is provided. This type of inventory can be attributed to especially valuable property, taking into account 0 105 25 000 on the account, or simply as movable property - there is an account 0 105 35 000 for this.

Receipt accounting entries

Accounting for soft inventory goes through the following balance transactions:

• debit 0 105 25 340 or 0 105 35 340, credit 0 302 34 730 or 0 208 34 660 - soft inventory purchased from a supplier;
• debit 0 105 25 340 or 0 105 35 340, credit 0 304 04 340 - soft inventory arrived as part of the supply of the organization;
• debit 0 105 25 340 or 0 105 35 340, credit 0 401 10 180 - soft inventory received free of charge;
• debit 0 106 24 340, credit 0 302 34 730 - formation of the cost of soft inventory in the amount of delivery;
• debit 0 105 25 340 or 0 105 35 340, credit 0 106 24 340 or 0 106 34 340 - soft inventory is taken into account at the formed cost.

ATTENTION! If the soft inventory is made in the institution itself from its own materials, it is carried out in the same way as the purchase from the supplier, in addition, the materials are written off and the manufacturers are paid.

Write-off accounting entries

Soft inventory can be written off due to:

• with depreciation - debit 0 401 10 172;
• disposal for other reasons (theft, detection of shortages, etc.) - debit 0 401 10 172;
• with a state of disrepair due to external factors (accidents, disasters, natural disasters, etc.) - debit 0 401 20 273.

ATTENTION! Each type of disposal is recorded from a different debit account, the credit will be the same - 0 105 25 440 or 0 105 35 440.

If, as a result of writing off worn-out soft inventory, rags are obtained that will be used, it must be evaluated and credited: debit 2,105 36,340 “Increase in the cost of other inventories - other movable property of the institution”.

Soft inventory of a wide range

Who does not know what soft stock is? Most consumers are familiar with the concept of textiles and materials from it. But this does not cover the broad meaning that soft stock and its range have.

Textile products

The concept of soft inventory is very broad and includes many products intended not only for the home, but also for various public or private institutions. It is used:

in hotels,

In pioneer camps

These are a wide variety of bedding, towels, bathrobes, bedspreads, pillows and blankets, shoe covers for hospitals, surgical diapers, mattresses and covers for them. All these goods are of very high quality to be durable enough: textiles are used very actively, especially in public institutions. Hospitals and rest homes

For public institutions such as hospitals, textile stores receive government orders for the supply of soft goods. All textiles in the hospital are subjected to frequent sanitization and therefore its strength must be high. Change of bedding, gowns and caps of medical personnel, doctors, nurses' suits, even mattresses and covers for them - everything is processed in disinfection chambers. Service life of soft goods depends on compliance with the rules of GOST in its manufacture. In order for rest homes, hotels and pioneer camps to function smoothly, they must be fully provided with textiles. Stores offer different types towels: terry and waffle, all sizes. The assortment is wide and offers: blankets, pillows, duvet covers, mattress covers made of waterproof fabric, blankets, bathrobes and many other textiles, including curtains, tablecloths, napkins.

Current offers

The bed linen set intended for kindergartens and having special qualities is in great demand:

It is made of soft material, eco-friendly,

Sets of different sizes, designed for small children,

Beautiful coloring, using cartoon characters,

Color fastness, rich color,

High wear resistance of the material.

For hotels and hostels, you can order linen sets at a lower price in the store: service life of soft goods it will be just as high; it is simply made of coarse calico - colored or bleached. Buying such underwear will help reduce the cost of living in boarding houses and hostels. All textiles entering the store are provided with a quality certificate.

Topic 18.

RECEPTION DEPARTMENT OF CHILDREN'S HOSPITAL. HOSPITALIZATION, SANITATION AND TRANSPORTATION OF SICK CHILDREN. ORGANIZATION OF SANITARY-HYGIENIC AND ANTI-EPIDEMIC REGIME. PERSONAL HYGIENE OF MEDICAL STAFF

Functions of the admission department of a pediatric hospital

The admission department is a structural subdivision of the children's hospital.

The main functions of the receptionist include:

- reception of sick children;

- their hospitalization in the department according to the profile;

- providing, if necessary, emergency assistance;

- organization of appropriate measures to prevent the occurrence of infectious diseases in the hospital;

- preparation and maintenance of medical records.

The reception department has a certain organizational and functional structure and the number of relevant premises that meet the profile and capacity of the hospital. It is very important that the staff of the admission department should always be attentive to the sick child; took into account the condition of the child, the excitement of the parents; patiently listened to the complaints of both the child himself and those accompanying him.

The work of the reception department is carried out in a certain sequence:

1. Registration of a child entering the hospital in the hospitalization log.

2. Filling in the title page of the inpatient medical record (medical history).

3. Examination by a doctor who records the data of the anamnesis and objective examination of the child in the medical record of the inpatient (medical history).

4. Primary diagnosis of the disease and provision of necessary medical care.

5. Measurement of body temperature and anthropometry (determination of height, weight, head and chest circumference).

6. Examination of a child for scabies and pediculosis. Carrying out the necessary sanitization, the method of which is prescribed by the doctor.

7. Transportation of a sick child to the department of the appropriate profile.

Documentation of the admission department of the children's hospital

1. Journal of registration of patients entering the hospital - registration form No. 001 / y,

2. Journal of refusal from hospitalization - registration form No. 001-1 / y.

3. Medical record of an inpatient - registration form No. 003 / y.

4. Statistical card of the patient who left the hospital - registration form No. 066 / y.

5. Sheet of medical appointments - registration form No. 003-4 / y.

6. Temperature sheet - accounting form No. 004 / y.

7. An emergency message about an infectious disease, food or chemical poisoning, an unusual reaction to a vaccination - registration form No. 058 / y.

8. Register of infectious diseases - registration form No. 060 / y.

Sanitary and hygienic regime of the admission department. Hospitalization, sanitation and transportation of sick children

The operating mode of the pediatric hospital provides for the implementation of the necessary sanitary and hygienic requirements and disinfection.

The implementation of the sanitary and hygienic regime begins with the admissions department. The examination room and the bathroom of the reception department must be kept in perfect cleanliness. Upon completion of the examination of the child, the objects (spatulas, thermometers) and furniture (couch, chairs, etc.) that the sick child touched are processed. The sheet on the couch should be changed after each patient. Oilcloth pillow and oilcloth on the couch after each patient are treated with a 0.2% solution of chlorantoin or another disinfectant

After examining the child, the doctor of the emergency department, if necessary, prescribes a hygienic bath or shower. If the child's condition is extremely serious or unconscious, he is immediately provided with emergency care and sent to the intensive care unit.

Hospitalization of sick children. Sick children are admitted to the hospital in the direction of the local pediatrician, emergency doctor, consultant doctor of a specialized clinic. In the event of an urgent condition, the child can be delivered by the parents without a referral (by self-delivery).

Indications for inpatient treatment, as well as the profile of the children's hospital, are determined by the doctor who refers the child, however, if new symptoms appear, or the child's condition worsens during the examination in the admission department, these issues are determined by the doctor of the admission department. Young children are hospitalized with one of the parents. When distributing sick children who are admitted to the hospital, it is necessary to adhere to the phased filling of the wards, which provides for the absence of contact with children who are in the recovery period.

If a child has an infectious disease (measles, scarlet fever, whooping cough, chicken pox, intestinal infection, etc.), the child is hospitalized in an infectious disease hospital.

Children with non-infectious pathologies (congenital malformations, malnutrition, rickets, chronic diseases of various organs and systems, metabolic disorders, etc.) are hospitalized in specialized somatic departments.

In case of acute surgical pathology or for a planned operation, the child is hospitalized in the pediatric surgical department of a multidisciplinary hospital or a specialized department: cardiac surgery, urology, thoracic, etc.

Sanitary and hygienic treatment of a sick child in the admissions department is carried out taking into account the severity of his condition. If the child needs urgent care, sanitary and hygienic treatment is carried out after the condition improves.

In the examination room of the admission department, the child is prepared for a hygienic bath. Before treating the child, the bath is thoroughly washed and treated with a disinfectant solution.

They wash a sick child in a certain sequence: first the head, then the torso and lower limbs. Especially carefully washed places where sweat and secretions usually accumulate, which lead to diaper rash (groin, perineum). If a bath is contraindicated for a sick child for health reasons, a shower is prescribed, or other hygienic measures are taken in accordance with his condition (washing, treatment of natural skin folds, contaminated areas of the body, etc.). After bathing the child, the bath is washed with a washcloth and treated with a disinfectant.

Examination for pediculosis. Pediculosis (lice) is transmitted by direct contact with the patient and by using his clothes and personal hygiene items. The occurrence of pediculosis is facilitated by: slovenliness, violation of sanitary and hygienic rules, large crowding of people (stations and the like), poor organization of sanitary and educational work .

In case of detection of pediculosis, a special sanitization is carried out: without undressing the child, the hair is treated with one of the insecticidal solutions:

– benzyl benzoate ointment 10-20%;

– "Nitifor" lotion;

– "Nock" cream-shampoo (1% permethrin solution);

– "Pedilin" emulsion or shampoo (0.5% malathion solution);

– "Para plus" aerosol - a combined preparation that contains malathion, permethrin, piperonyl butoxide;

– "Rod" shampoo (0.5% malathion solution);

– "Anti-bit" shampoo (0.5% malathion solution);

– "Itax" foamy lotion or aerosol (3% phenothrin solution);

– Nix shampoo (3% permethrin solution);

The exposure time is 10-30 minutes. depending on the chosen means and according to the attached instructions. After treatment with a special agent, the child's head is washed with hot water and regular shampoo. The hair is combed with a thick comb. The procedure is repeated after 7-10 days. The doctor notes the detection of pediculosis in the medical history, and sends an emergency notice to the district sanitary and epidemic station.

In case of clothing infestation with lice, it is boiled in a 2% solution of soda ash for 15 minutes, and then sent in a separate bag for disinfection by frying in a special chamber.

In children, atypical localization of the scabies mite is often found.

When scabies is detected, sanitization is carried out with special means according to the instructions:

- "Spregal" aerosol (esdepalethrin and piperonyl butoxide);

- "Spray-pax" aerosol (pyrethrum extract and piperonyl butoxide);

- "Itax" lotion or aerosol (3% phenothrin solution);

- Nix shampoo (3% permethrin solution);

- water-mile suspension of benzyl benzoate 20% (10-30 ml);

- benzyl benzoate ointment 10-20%;

Transportation of sick children . From the admission department, sick children are transported to the department, taking into account their general condition.

Transportation to the department is carried out:

a) on foot, accompanied by a health worker;

b) in a wheelchair;

c) on a stretcher;

d) in the hands of parents or medical staff.

The question of the type of transportation is decided by the doctor, depending on the condition of the sick child. If the condition is satisfactory, the older child is sent to the department, accompanied by a medical worker. Some patients are more appropriate to be delivered to the department in a wheelchair. Severe patients are transported on a stretcher, covered with a clean sheet and blanket (depending on the time of year) and installed on a special gurney.

In the ward, the child, who is in serious condition, is transferred from the stretcher to the bed. If a sick older child is carried by one person, then you need to put one hand under the shoulder blade, and the other under the hips, while it is desirable that the child wraps around the neck of the one who carries him. If a sick child is carried by 2 people, then one of them puts his hands under the child's shoulder blade, closer to the neck and lower back, the other - under the buttocks and shins. When transferring the sharply weakened and seriously ill, a third person is needed: the first holds the head and chest, the second - the lower back and hips, the third - the legs.

The concept of medical-protective and sanitary-hygienic regimes, the peculiarity of their observance in a children's hospital

In each children's medical institution there is a certain intrahospital regime.

One of the most important conditions medical and protective regime is the sparing of the psyche of a sick child and the mother who cares for him, the creation of favorable conditions that provide patients with maximum physical and psychological peace. To do this, it is necessary to establish the most rational regimen of the day in accordance with the age of sick children and the profile of the department, with the elimination of adverse external environmental influences (loud conversation, noise, slamming doors, etc.).

The change of medical staff, cleaning of premises, temperature measurement are carried out after the patients wake up and not earlier than 7.00 am.

It is important to eliminate negative emotions that may occur in sick children at the sight of medical examination and care items (bloody underwear, syringes and scalpels, basins with dirty cotton and bandages).

Of great importance is the organization of patients' leisure: placement of stands with books, magazines on child care, rational feeding, promotion of a healthy lifestyle, which parents and older children can get acquainted with. For convalescent children, a playroom should be provided. Walking in the fresh air, especially in summer, is also an integral part of the healing process.

To provide sanitary and hygienic regime, at least twice a day, in all departments of the children's hospital, general cleaning of the premises is carried out with a wet method using disinfectants. During cleaning, they first wipe the bedside tables, beds, door handles and window sills, clean the sinks, then wash the floor. Cleaning equipment must be labeled and stored in a separate room.

The sanitary and hygienic standards of the pediatric department provide for the allocation of a bed for each sick child, covered with clean linen, a bedside table for storing personal belongings. If necessary, the child is given a pot, a bedpan, items for individual use (a drinking bowl, a cup, clothes). Patients take personal hygiene items with them to the department.

The ward for infants is additionally equipped with a special baby bed with folding backs, which are fixed at different heights, a changing table, a wardrobe for linen, a bath for bathing a child, and a tank for soaking dirty linen.

The air temperature in the ward and rooms where sick older children are located should be 20-22 ° C; in the ward for infants - 23-24°C, for newborns, the optimal (safe) temperature is 25-28°C. When the temperature in the ward decreases, it is necessary to additionally heat them while maintaining the required humidity. High air temperature is undesirable, because it is possible for the child to overheat.

Room lighting can be natural or artificial and is 75-100 lux; noise level - no more than 50 dB.

A set of toys should be individual and appropriate for the age of the child. Toys should be easy to sanitize.

At least once every 7-10 days (more often if necessary), a sick child is given a hygienic bath with a complete change of underwear and bed linen. The child's toilet is carried out daily; washing hands is mandatory before eating. Seriously ill children are washed in bed.

It is very important to ventilate the wards with a transom at least 4 times a day, regardless of the time of year, as well as quartz them, according to the schedule drawn up directly in the department. During these events, children are taken to other rooms (corridor, dining room, playroom).

Wet cleaning of the premises of the children's department is carried out daily. The panels are washed or wiped with a damp cloth 1 time in 3 days. The upper part of the walls, ceiling, plafonds, is cleaned of dust once a week; with the same frequency they wipe window frames and doors. Daily wet wiping of radiators and central heating pipes is very important, since carbon monoxide can form when dust burns, which is unacceptable. Soft things (carpets, curtains, bedspreads, blankets, pillows) are knocked out and shaken out in the open air or vacuumed.

Particular attention in the pediatric departments is given to the collection of dirty linen, sterilization of nipples and bottles for baby food. Boiling nipples, washing bottles is a rather laborious process and must be carefully performed. This work is performed by a specially assigned junior nurse, who can also deal with the distribution of food.

In the infectious diseases department, all these activities must be carried out strictly in accordance with the requirements for sanitary and hygienic standards, which exclude the possibility of infecting other children.

In children's hospitals, it is necessary to prevent the spread infectious diseases and the occurrence of reinfection among children. This is achieved by obtaining data on the epidemic environment of children entering the hospital, the presence of boxes, the gradual filling of the wards, compliance with the anti-epidemic regime in the department and in the pediatric hospital as a whole.

The anti-epidemic regime in the hospital provides for:

- strict adherence to the rules for hiring staff;

- ensuring timely passage of mandatory preventive medical examinations;

- implementation of personal hygiene rules by staff and patients;

- a sufficient amount of detergents and disinfectants, overalls, cleaning equipment.

- strict compliance by junior medical staff with the requirements for cleaning and storage of cleaning equipment.

When a child is admitted to a hospital, it is necessary to find out whether the child had contact with infectious patients at home, at school or kindergarten for the last 3 weeks (this is the maximum duration of the incubation period for most childhood infectious diseases). It should be established whether the child had intestinal disorders during the last 3 days. The listed information should be displayed in the direction of the local pediatrician. Even in the absence of these data, the doctor of the emergency department necessarily examines children for the presence of an infectious disease.

If an infectious disease is suspected or diagnosed, the sick child is immediately isolated in a box or sent to an infectious diseases hospital, and the room where the patient was, objects and furniture are disinfected (disinfected). The main purpose of boxing is the isolation of sick children with suspected infectious disease. There are open and closed boxes. In open boxes, patients are separated by a partition, which is installed between the beds. An example of a closed box is the Meltzer box. The design of the latter provides for the elimination of any contact of a sick child with other children during the entire period of treatment. It consists of a vestibule, a ward, a bathroom, a separate entrance for medical staff (gateway).

A sick child enters the box directly from the street, and when discharged or transferred to another hospital, leaves it in the same way. The medical staff enters the gateway from the inner corridor, tightly closing the outer door, washes their hands, puts on a second gown, cap, mask, if necessary, and then goes to the room where the patient is. When leaving the room, all actions are performed in reverse order. In order to prevent the spread of infection, it is necessary to ensure that at the time of opening the door between the airlock and the corridor of the department, the door to the ward is tightly closed.

Proper organization of nutrition for children, food preparation, transportation, and distribution, as well as compliance with food storage conditions, is important in observing the anti-epidemic regime in the hospital. It is strictly forbidden to store food in bedside tables. To do this, there must be a refrigerator in the pantry or dining room.

Particular attention should be paid to the prevention of nosocomial (nosocomial) infections.

The system of measures for the destruction of pathogens and the creation of conditions that prevent their spread in the environment is called disinfection . Distinguish focal disinfection, which is carried out in the epidemic focus and preventive.

Spot disinfection by time and purpose, divided into current and final.

Current disinfection consists in neutralizing all pathogens immediately after their isolation from the source of infection: processing of patient items (vessels, inspection items, linen, eating utensils, etc.). Current disinfection is of paramount importance for intestinal infections.

Systematically carry out wet cleaning of the room where the patient is located, using disinfectant solutions, boiling toys, dishes. One of the means of current disinfection in case of drop infections is airing and ultraviolet irradiation (quartzization) of rooms where sick children are. During quartzization of the ward, children are taken to other rooms.

Final disinfection in the outbreak is carried out by employees of the disinfection station when the infectious disease is eliminated (hospitalization or complete recovery of the patient). Disinfection is subject to: the room where the patient was, all household items and clothing of the patient. For disinfection of premises, mechanical cleaning (washing, bleaching) using disinfectant solutions is used. Linen, dishes and household items are treated in the same way as during the current disinfection.

Preventive disinfection carried out to prevent infectious diseases in medical institutions. It includes disinfection of water (boiling), washing a bath, a ward, after discharge of patients using disinfectant solutions, washing hands before eating, pasteurization or boiling of milk, combating vectors (carriers) of pathogens of an infectious disease .

For disinfection, physical (mechanical, thermal, radiation) and chemical methods are used.

Mechanical methods include: washing clothes, washing hands, airing the wards, removing dust and dirt (with a vacuum cleaner, a damp cloth, etc.).

To thermal - boiling, ironing, burning, steam treatment (in autoclaves), roasting (in dry ovens). The thermal method is used to disinfect patient care items, dishes, underwear and bed linen.

Radiation methods include: ultraviolet irradiation, ultrasound, radioactive radiation. These methods are used to disinfect wards, treatment rooms.

Chemical methods of disinfection are the most common and consist in the use of various disinfectant solutions. There is an antiseptic for hands, skin and mucous membranes; disinfectants for the treatment of hard surfaces, tools and equipment, as well as wet cleaning of premises. All these tools are used in accordance with the attached instructions.

It should be noted that the effectiveness of disinfection measures increases with the combination different ways processing, such as mechanical and chemical.

Preventive and current disinfection in the epidemic focus is carried out by junior and middle nurses. Employees of sanitary and epidemiological control centers (sanitary and epidemiological stations) may be invited to carry out final disinfection in an epidemic focus.

Equipment for carrying out disinfection measures (buckets, mop, rag, etc.) is marked and used only in the premises for which they are intended.

Feature of sanitary-hygienic and anti-epidemic

modes of care for newborns

Work with newborns has a certain peculiarity, which is based on the WHO concept regarding the physiological care of the child and provides for the limitation of medical interventions (Order No. 152 of 04.04. medical care for a healthy newborn baby).

The main requirement for junior medical personnel when working with newborns is to maintain the necessary sanitary and epidemic regime in order to prevent nosocomial infections. This largely depends on the observance of the rules and techniques of washing and antiseptics of hands by the medical staff themselves, the mother and relatives who are caring for the child.

The main types of hand treatment.

1.Routine hand washing with soap is performed to remove dirt and transient microflora that contaminates the skin of the hands of medical personnel as a result of contact with infected objects.

Hand washing indications:

Before and after patient contact

After using the toilet

Before and after eating

In all other cases, when the hands are contaminated.

It is very important to adhere to a special hand washing technique, as routine hand washing leaves the fingertips and the inside surface contaminated.

Hand washing technique:

Remove rings and other jewelry, as they make it difficult to effectively remove microorganisms;

Under moderate pressure of warm water, it is necessary to vigorously lather your hands and rub one against the other for at least 15 seconds, after which you rinse your hands. You need to try to cover the entire surface of the palms and fingers;

Dry your hands with a paper towel, which close the faucet;

Do not use a shared reusable towel to dry your hands;

Rings, nail polish complicate the removal of microorganisms;

To wash your hands, you must use liquid baby soap with a dispenser.

Refillable dispensers become contaminated over time, so do not add liquid soap to a partially filled dispenser. First you need to wash the dispenser, dry it and only then fill it with a new portion of soap.

2. Hygienic antiseptic provides for the removal and neutralization of the transient microflora of the hands using antiseptic preparations. Alcoholic antiseptic is more effective than water-soluble.

Indication for hygienic hand antisepsis:

Before performing an invasive procedure

Before and after wound manipulation

Before and after catheter manipulation

Before using gloves and after removing them

After contact with secretions and objects that have contained blood or have the potential for microbial contamination.

Technique for hygienic antiseptics:

In case of severe contamination of the hands, they must first be washed with water and liquid soap, and then apply an antiseptic;

Alcohol antiseptic (5 ml) apply to hands and rub until it dries (do not wipe hands).

It should be noted that the use of gloves does not replace hand washing and antiseptic treatment. Remove gloves after patient care. The use of one pair of gloves for the care of two patients is not allowed, even if the gloves are washed and antiseptic.

Indications for the use of gloves:

In all cases where contact with blood or other potentially contaminated biological materials is possible;

Gloves reduce the risk of occupational exposure through contact with infected patients and their secretions;

Gloves reduce the risk of infecting patients with microbes that are part of the resident microflora of healthcare workers' hands;

Gloves reduce the risk of contamination of the hands of personnel with transient pathogens and their subsequent transmission to patients.

Also, the robot of the junior medical staff provides for cleaning the wards and contact with the cleaning equipment.

Wet cleaning of the premises of the joint stay of mother and child in the maternity hospital, as well as in the neonatal pathology department of the pediatric hospital, is carried out at least 2 times a day, of which 1 time - using detergents. Instead of quartzing rooms, it is recommended ventilate them. After the mother and child are discharged from the maternity hospital, the final disinfection is carried out in the shared ward, followed by ventilation. Curtains, curtains, artificial flowers, posters, if they are not soiled biological materials are not subject to disinfection. They are processed as needed. Cleaning equipment (buckets, basins, rags) after processing the premises is thoroughly washed using detergents, rinsed, dried and stored in a special sanitary room of the department.

At discharge, the used home linen of the mother and the newborn is given home in plastic bags without prior disinfection. Hospital linen is collected in a polyethylene or rubberized bag, taken out to the room for used linen, then immediately removed from the department to a specially designated room. After sorting, the laundry is put into a cotton bag, which is placed in a rubberized or polyethylene disposable bag, and delivered to the laundry. Washed hospital underwear for newborns, women in childbirth and puerperas is completed in individual bags and sterilized. After sterilization, linen must be dry.

Pillows, blankets, mattresses, sheathed with oilcloth, are treated with disinfectants, not sheathed - they are disinfected in a disinfection chamber.

Washing of work clothes of medical personnel is carried out at a temperature of 90 ° C (it is possible to use a household automatic washing machine). After that, ironing is carried out.

Non-compliance by junior medical personnel with the requirements of sanitary-hygienic and anti-epidemic regimes in the maternity hospital bears administrative and, in some cases, criminal liability.

The concept of personal hygiene of medical staff

The personal hygiene of medical personnel is one of the essential factors for compliance with the anti-epidemic regime in a children's hospital.

The medical worker must have a neat and tidy appearance, short-cut nails. You should not use perfumes with a strong smell, as this can cause an allergic reaction in the child. Before and after each manipulation, the nurse washes her hands with warm water and soap, or treats them with a special disinfectant solution. During the performance of appointments, wedding rings and watches are removed.

While on duty, the nurse puts on special shoes (slippers), which allows her to move silently in the department. Slippers should be easy to disinfect. At the end of the duty, the gown, headgear and slippers are left in a locker specially designated for the medical worker..

In some cases, namely in infectious diseases departments, neonatal departments, during the epidemic, it is mandatory for medical workers to wear a mask that should cover the mouth and nose. The use of a mask is also necessary when performing certain medical procedures or when sanitizing patients. The mask is usually made of 4 layers of gauze. Every 4 hours (in some cases - more often) the mask must be changed, since prolonged wearing reduces the effectiveness of its action as a filter for microbes. The used mask is placed in a separate bowl, boiled and ironed. Currently, disposable masks made of non-woven textiles are more commonly used.

Control questions

1. Functions of the admission department of the children's hospital.

2. Documentation of the admission department of the pediatric clinic.

3. Hospitalization, sanitization and transportation of sick children.

4. The concept of the features of sanitary-hygienic and anti-epidemic regimes in a pediatric hospital.

5. Requirements for junior medical personnel when working with newborns.

6. Personal hygiene of medical staff