Adverse effects on the sister's body of waste anesthetic gases.
Harmful effects on the body of chlorine- and phenol-containing disinfectants, sensitizers (medicines), photosensitizers.
Plan.
Organizing a safe environment for staff. Risk factors for medical personnel.
1. Harmful effects on the body of chlorine- and phenol-containing disinfectants, sensitizers (medicines), photosensitizers.
2. Adverse effects on the sister’s body from waste anesthetic gases.
3. Adverse effects on the sister of harmful microbiological factors: types of pathogens, pregnancy and the danger of exposure to microbiological factors on the fetus.
4. Adverse effects of radiation. Measures aimed at preventing exposure of nursing personnel.
5. Symptoms associated with overexposure to certain toxic chemicals. Methods of protection against exposure to toxic substances: use of protective clothing, ventilation, personnel training, skin care.
6. Safety rules when working with mercury-containing equipment.
7. Biomechanics of the body, ergonomics.
The work of doctors is one of the most complex and responsible types of human activity. It is characterized by significant intellectual, and in some cases, great physical activity. Medical workers are subject to increased demands, including the volume of operational and long-term memory, attention, endurance and high working capacity in extreme conditions.
One of the most important tasks in creating a safe hospital environment is to identify, identify and eliminate various risk factors for medical personnel. In the activities of a nurse, four groups of professional factors can be distinguished that adversely affect her health:
1. Chemical factors:
Highly active chemotherapy drugs;
Antiseptics, disinfectants;
Medical gases, medicinal aerosols.
2. Biological factors:
Microorganisms;
Immunological drugs.
3. Physical factors:
Ionizing radiation;
Electromagnetic radiation;
Noise, vibration.
4. Physiological factors:
Increased psycho-emotional and muscle tension;
Voltage of the visual and auditory analyzers.
In the Moscow Region, nursing staff are exposed to different groups of toxic substances contained in disinfectants, detergents, medicines and other drugs that can cause local and general changes in the body. Chemicals enter the body through the respiratory tract in the form of dust or vapors and are adsorbed through the skin and mucous membranes. Their effects can manifest themselves in the form of skin reactions, dizziness, and headaches. Long-term consequences of exposure to toxic and pharmaceutical drugs can manifest themselves in the form of damage to the respiratory system, digestion, hematopoiesis, and kidney reproductive function (miscarriages, infertility). Various allergic reactions are especially common, including the development of serious complications in the form of attacks of bronchial asthma, Quincke's edema, etc.
The most common manifestation of the side effects of toxic substances is occupational dermatitis - irritation and inflammation of the skin of varying severity. Nurses are at risk due to the critical importance of frequent hand washing and exposure to pharmaceuticals, disinfectants and rubber gloves (due to their latex content).
Dermatitis can cause:
Primary irritants - they cause inflammation of the skin only in the area of direct contact with the substance. These include chlorine- and phenol-containing disinfectants (chloramine B, Javelion, Hykolin, Amotsid, Amotsid 2000);
Sensitizers. These substances cause an allergic reaction. Initially, this may manifest itself as dermatitis (local inflammation of the skin) even with minimal contact. With prolonged sensitization, the allergic reaction can be much more severe (swelling of the lips, eyelids, face, nausea, vomiting). The group of sensitizers includes some medications, especially antibiotics, cytostatics and hand washes (antibacterial soap);
Photosensitizers. Photosensitization is the phenomenon of increasing the sensitivity of the body (usually the skin and mucous membranes) to the action of ultraviolet or visible radiation. Some chemicals (including drugs - some antibiotics, sulfonamides, tetracyclines, fluoroquinolones, etc.) and/or products of their transformation in the body, accumulating in the skin, cause photoallergic, phototoxic and inflammatory processes in areas of the skin exposed to light (usually solar) radiation. Photoallergy occurs when UV radiation chemically changes a substance on the skin so that it causes an allergy. Photoallergy occurs approximately half an hour after the start of exposure to UV radiation and then spreads to areas of the skin protected from radiation. Photoallergies are often caused by cosmetics and perfumes containing musk, amber, bergamot oil, sandalwood oil, some antibacterial agents, as well as medications, for example, ibuprofen.
The dynamics of occupational morbidity shows that every year the number of cases of occupational diseases among nurses is increasing. Nurses under the influence of biologically highly active drugs (antibiotics, sulfonamides, vitamins, hormones, analgesics, psychotropic drugs) may experience occupational diseases. The most dangerous is the injection method, in which the drug may end up in the form of an aerosol in the nurse’s breathing zone. Drugs may enter the respiratory system of personnel during washing and sterilization of medical instruments; when distributing tablets, the skin may become contaminated.
Clinical observations of medical workers showed that the diseases found in them had characteristic allergic forms, toxic manifestations, and were accompanied by dysbacteriosis. With professional long-term contact with antibiotics, candidiasis or candidiasis of various localizations (usually in the intestines) often develops.
The group of medical workers who use antitumor drugs in treatment constitutes a risk group for the development of occupational pathology. A feature of the administration of antitumor drugs is the extreme importance of using several drugs at once in large dosages. As a result, staff have to open up to 15 ampoules per injection, while the ampoules often break and their contents contaminate the air in the treatment rooms.
There is evidence of manifestations of the harmful effects of cytostatics (cyclophosphamide, 5-fluorouracil, platinol, doxorubicin, rubromycin). Many doctors, nurses, and orderlies showed a sharp decrease in hematological parameters (hemoglobin, leukocytes, platelets), with simultaneous eosinophilia. A clinical examination of chemotherapy department staff revealed a high level of gastrointestinal diseases, cases of eczema and baldness. A hematological examination of employees revealed a decrease in hemoglobin content, a decrease in the number of erythrocytes and leukocytes. The noted pattern of hematological changes is the result of the cytotoxic effects of chemotherapy drugs. The dependence of hematological changes on the experience of working with chemotherapy drugs was also revealed.
Allergic diseases of the respiratory system develop less frequently: sinusitis, angioedema, rhinitis, asthmatic bronchitis and bronchial asthma. In the structure of medical morbidity, the largest share is made up of such nosological forms as gynecological diseases, complications during pregnancy and the postpartum period, hypertension, diseases of the musculoskeletal system, pneumonia, and a number of others.
A large amount of scientific information has been accumulated on the harmful effects of anesthetics. There are agents for inhalation anesthesia: fluorothan, nitrous oxide, methoxyflurane, ether for anesthesia (divinyl ether-vinitene), trichlorethylene (trilene), chlorethyl, cyclopropane. During inhalation anesthesia, part of the anesthetics introduced into the patient's body is released with exhaled air into the atmosphere of the operating room. It is worth saying that for non-inhalation anesthesia the following are used: barbiturates, hexenal, sodium thiopental, propanidide (sombrevin), predion (viadril), ketamine (calypsol, ketalar). It is known that women are most at risk of the disease. It has been established that in persons exposed to occupational anesthetics, the so-called triad occurs:
1. Spontaneous abortions.
2. Anomalies of newborns.
3. Infertility.
As a result, nurses in contact with anesthetic gases should be considered a high-risk group for both the mother and the fetus. Prolonged stay of members of the surgical team in an unfavorable air environment leads to a high level of anesthetics in their blood. The consequence of this is complaints of headache, nausea, dry mouth, tachycardia, dizziness, fatigue and some complaints of a neurotic nature. Biochemical blood parameters of anesthesiologists indicate a violation of pigment metabolism, phenomena of diffuse disorder of the liver tissue. At the same time, cases of increased incidence of cancer, especially lymphoid tissue, leukemia, mental disorders and decreased intelligence have been described.
3. Adverse effects on the sister of harmful microbiological factors: types of pathogens, pregnancy and the danger of exposure to microbiological factors on the fetus. Biological risk factors include the risk of infection of medical personnel with nosocomial infections. Prevention of occupational infection is achieved by strict adherence to the anti-epidemic regime and disinfection measures in the healthcare facility. This allows you to preserve the health of medical personnel, especially those working in emergency departments and infectious diseases departments, operating rooms, dressing rooms, manipulation rooms and laboratories, ᴛ.ᴇ. having a higher risk of infection as a result of direct contact with potentially infected biological material (blood, plasma, urine, pus, etc.). Work in these functional rooms and departments requires individual anti-infective protection and compliance with safety regulations by personnel, mandatory disinfection of gloves, waste material, use
disposable instruments and linen before their disposal, regularity and thoroughness of routine and general cleaning.
Healthcare workers are exposed to various infectious factors every day. The following main routes of transmission of pathogens from patients to medical staff are distinguished:
Contact;
Contact and household;
Airborne;
Airborne dust;
Through blood.
According to the degree of danger of infection, infections are divided into 3 groups:
1. Potentially dangerous, against which vaccines are available (viral hepatitis B, influenza, measles, mumps, rubella).
2. Infections with the utmost importance of post-exposure prophylaxis (meningococcal infection, scabies, whooping cough, HIV infection, etc.).
3. Infections for which post-exposure prophylaxis is not indicated (herpes simplex, rotavirus, cytomegalovirus infections, respiratory syncytial, etc.).
Among the registered infections, based on the mechanism of transmission of the pathogen and the possibility of infection, infections with high, medium and low levels of infection are distinguished.
With airborne and airborne infection, the risk of infection of health workers with measles, rubella, chickenpox, influenza, diphtheria, and meningococcal infection is high.
With the fecal-oral mechanism, a relatively low risk of infection of health workers with dysentery, salmonellosis, and viral hepatitis A can be noted. Herpes infection, viral conjunctivitis, scabies, and cytomegalovirus infection are more often transmitted by contact.
Direct contact of the patient's blood with the blood of a healthcare worker during injections, cuts with instruments and other medical procedures can lead to infection with viral hepatitis B and HIV infection, which pose a particular danger to healthcare workers.
It is especially important to note that a nurse is affected by rubella, herpes infection, or cytomegalovirus infection during pregnancy. With intrauterine infection, stillbirth is possible, as well as such malformations as: cataracts, heart defects, deafness, mental disability, physical deformities. For express diagnosis, pregnant women undergo ELISA (detection of Jg M); if detected in a woman with a term of up to 12 weeks, pregnancy is terminated.
Adverse effects on the sister's body of waste anesthetic gases. - concept and types. Classification and features of the category "Adverse effects on the sister's body of waste anesthetic gases." 2017, 2018.
Nursing staff are especially susceptible to infection because they are in direct contact with infected patients, their secretions, secretions, wounds, dressings, and bedding.
Filled vessels and urine bags, which sometimes remain open for a long time, containers with urine, prepared for delivery to the laboratory and left open, also pose a danger to personnel.
Medical institutions, which often do not have supply and exhaust ventilation, where large areas contain a large number of weakened or infected people, are an ideal breeding ground for microbes. Microorganisms penetrate into creams and ointments, into opened bottles of medicinal solutions. They reproduce well in stagnant tap water, flower vases, sinks, and breathing equipment.
Used linen, bedding and underwear, contains a lot of staphylococci from the skin of patients, and its transportation unpackaged through wards and corridors spreads dangerous microorganisms.
According to official statistics, the structure of occupational diseases among health workers is dominated by pulmonary tuberculosis (50%), viral hepatitis B (15%), and allergic diseases to drugs (8%). At the same time, the number of occupational diseases among nursing personnel is greater than among medical personnel. Therefore, a special place is given to preventive measures.
Of particular note are microbiological factors that are dangerous for pregnant nurses and their fetuses, as well as for male staff.
Microbiological factor
For information. Orchitis is an inflammation of the testicle, which involves all the structures and membranes of the organ.
It should be remembered - universal precautions when working with blood and body fluids
- Adverse effects of radiation
Nursing staff in health care facilities are exposed to danger when in contact with various sources of radiation:
· Equipment (X-ray, scanners, accelerators, electron microscopes)
Radioactive isotopes
Radioactive waste from patients (urine, feces, vomit)
In sealed containers (eg for treatment of cervical cancer)
Waste isotopes, equipment and contaminated surfaces
Unsealed sources (for example, for scanning and scintigraphy for thyroid cancer)
Of all the radiation sources in a medical institution, the largest share is made up of x-rays. Even small doses over a long period of time have a serious effect on the nurse's health and may cause fetal harm if the nurse is pregnant. There may also be genetic changes over many generations and diseases such as leukemia, breast cancer, and sarcoma may develop. Warning: There is no safe level of exposure! Distance, cover and speed reduce exposure to radiation.
Distance . The further a person is from the radiation source, the lower the radiation dose. This must be remembered if a mobile X-ray machine is used in the ward, as well as when caring for patients receiving radiation therapy.
It is important to reduce the radiation dose shelters; lead apron or movable screen. Despite the heaviness of the apron, this means of protection should not be neglected in the X-ray room.
Speed is a very important factor to remember when treating and caring for patients. Any manipulations must be done as quickly as skills allow.
- Measures aimed at preventing exposure of nursing staff
Measures to protect health workers from radiation exposure in health care facilities:
In the X-ray room, when participating in the examination of a patient, use protective equipment (lead apron, mobile screen);
Pregnant women should not participate in examinations of patients using radiation diagnostics /angiography, retrograde cholangiography, etc./;
Pregnant women should be exempt from caring for patients receiving intracavitary radiotherapy.
- Safety rules when working with mercury-containing equipment
Personnel requirements carrying out the current demercurization.
1. Persons carrying out demercurization must undergo special training.
2. Persons carrying out demercurization must be provided with special clothing (rubber gloves, an apron, closed shoes impenetrable to mercury vapor) and personal protective equipment (screens, masks, respirators, etc.).
3. Persons who carried out demercurization, after its completion, must take a shower, rinse the mouth with a 0.025% solution of potassium permanganate, and brush their teeth.
Demercurizers are chemical substances, the use of which reduces the rate of desorption of mercury (its compounds) from sources of secondary pollution and facilitates the mechanical removal of mercury from contaminated surfaces.
As demercurizer The following solutions can be used:
1. Soap-soda solution (4% soap solution in 5% aqueous soda solution)
2. 0.2% aqueous solution of potassium permanganate, acidified with hydrochloric acid (5 ml of acid, specific gravity 1.19 per 1 liter of potassium permanganate solution);
3. 20% bleach solution;
4. 20% aqueous solution of ferric chloride;
5. 5-10% hydrochloric acid solution;
6. pyrolusite (paste: 1 part pyrolusine (Mn O) + 2 parts 5% HCl);
7. 2-3% solution of iodine in 30% aqueous solution of potassium iodide, etc.
Procedure and hygienic requirements for current demercurization.
- To prevent the spread of mercury to other premises, it is necessary to fence off the contaminated area and exclude access to the contaminated area for personnel not directly involved in demercurization work and visitors to the institution. Remove all patients from the room and close the door to prevent the spread of fumes.
- Notify the department head.
- Change into special clothing (rubber gloves, rubber apron, mask, screen, etc.).
- The room in which the mercury was spilled should be ventilated.
- Mechanical removal. Collect mercury from the contaminated surface with a vacuum suction (rubber bulb or using a heated soap-soda solution) from the periphery of the contaminated area to its center, into a thick-walled glass vessel with a ground-in lid, after which fill the container with a demercurizer (or water, if the latter is not available). After collecting mercury, the rubber bulb is filled with a demercurizer and after 1.5-2 days is emptied into a container with a demercurizer; the overalls are treated twice with a demercurizer solution and, together with the bulb, are stored in a separate container until the next emergency. It is prohibited to use a household vacuum cleaner or broom to collect spilled mercury; Do not pour mercury into sinks or drains.
- Chemical demercurization. After collecting mercury, treat the contaminated surface with a demercurization solution (leave the demercurization solution on the contaminated area for 1 hour or more - according to the instructions).
- Cleaning the surface from demercurization agents. Wash the contaminated area thoroughly with soapy water and clean water.
- A container with demercurized mercury is handed over according to a report (about a broken thermometer) to the person responsible for the disposal of class G waste, and further in the UG SEN (act), mercury residues in the TsGSEN.
- An entry is made in the demercurization register.
Demercurization quality control : control tests at the Central State Sanitary and Epidemiological Center for mercury content in indoor air (twice with an interval of 7 days).
- Adverse psychological factors affecting personnel.
It is not only physical factors that pose a threat to health and safety in health care facilities. Often people in hospitals are under the influence of stress, in the grip of negative emotions caused both by their own painful condition and by the aggressive environment in which they find themselves. Even naturally calm people can lose control of themselves in our hospitals with their fantastic organization, endless queues and eternal confusion with medical records, not to mention psychologically unbalanced individuals. Such people can pose a direct threat to the safety of others, including medical staff of health care facilities.
Violence
The Emergency Nurses Association in the United States, which focuses on nurse safety in the workplace, reports that research shows that violence most often occurs in emergency services, psychiatric wards and intensive care units. And the most favorable in terms of the safety of medical staff are the obstetrics and gynecology departments, as well as the surgical and pediatric departments. Not all cases of violence are reported because many nurses do not report it, the researchers said.
According to a study published in the Journal of Clinical Nursing, three-quarters of nurses surveyed regularly experience violence in the workplace. Ninety percent suffer verbal abuse, and more than half of those surveyed have been assaulted while treating patients.
Application
Infection safety of personnel is ensured by the following conditions:
1. Washing hands before and after contact with the patient.
2. Treat blood and biological fluids as potentially infectious, therefore wear gloves. Linen contaminated with blood and secretions of the patient is considered infected.
3. If the integrity of the skin on the hands is damaged, cover the damaged area with a band-aid before manipulation.
4. When opening vials of blood and serum, it is necessary to avoid cuts and pricks using gloves.
5. Disposable instruments should only be used once.
6. Use reusable instruments after disinfection, PSO, and sterilization.
7. Each workplace must have labeled containers with lids for disinfectants.
8. Use PPE: gown, cap, mask, gloves, spare shoes, goggles, oilcloth apron.
Lecture No. 9
Correct biomechanics of a nurse's body
- Causes leading to back and spinal injuries in nursing staff
Throughout the history of medicine, one of the main problems has been nursing care, in which the most difficult and traumatic task was moving and lifting seriously ill patients. It is especially difficult to care for obese, frail, elderly and paralyzed patients whose body weight exceeds 80-100 kg or when the patient cannot change body position in bed.
To prevent back pain and handling-related injuries, you need to understand the causes. Causes of pain in the back can be reduced to three factors:
lack of knowledge among staff in the field of ergonomics and biomechanics;
lack of experience in posture-related work when moving patients;
back muscle strain or spinal injury.
Let's get acquainted with the rules that will help prevent damage to organs and tissues when carrying out various movements of a seriously ill person. Many of them are based on the laws of BIOMECHANICS.
- The concept of “body biomechanics”, “ergonomics”.
BIOMECHANICS is a science that studies the rules of mechanical movement of the body in space and in living systems. BIOMECHANICS IN MEDICINE studies the coordination of the efforts of the musculoskeletal, nervous system and vestibular apparatus aimed at maintaining balance and ensuring the most physiological position of the body at rest and during movement: walking, lifting heavy objects, bending, sitting, standing, lying down, as well as when performing daily life functions.
ERGONOMICS(from the Greek ergon - work, nomos - law), a complex applied branch of science engaged in the study of man in a production environment and engaged in the design of mechanisms, products and workplaces that are most convenient for the worker. In the USA this branch of science is called “research of human factors”, in Germany – “anthropotechnics”. That is, This the science of interaction between people and the environment. for safe work purposes.
A junior nurse caring for seriously ill patients should
- Correct body biomechanics when lifting weights and sitting.
Using the correct biomechanics of the body, the nurse ensures her safety, and therefore maintains her health.
Correct biomechanics in a sitting position.
We need to choose the right one chair. To do this, you need to sit on a chair and lean on its back. The height of the chair and its depth are selected correctly if:
1. 2/3 of the length of your hips is on the seat;
2. feet touch the floor without tension;
3. the seat should not be too soft and curved;
4. the back of the chair should be tilted back, and its upper bar should be located under the shoulder blades;
5. knees should be slightly higher than the hips (this will redistribute body weight and reduce the load on the lumbar spine);
6. The back should be straight and the abdominal muscles tense;
7. Shoulders should be straightened and positioned symmetrically to the hips;
8. To turn while sitting, turn your entire body, not just your chest or shoulders. If a nurse, due to her line of work, often has to turn to the sides while sitting on a chair, it is better for the chair to swivel on wheels.
When working while sitting - and generally when sitting for a long time - you should change your body position approximately every 15 minutes.
If the chair is not suitable, you can use various devices (stands, pillows). When sitting for long periods of time, it is advisable to use additional support for the lumbar spine (for example, a pillow).
Table same d.b. chosen correctly:
The height of the table should correspond to the height of the person (the table top is approximately at the level of the elbow of a bent arm, there should be enough space for legs under the table.
Correct biomechanics in a standing position:
1. the knees should be relaxed so that the knee joints move freely;
2.body weight should be distributed evenly on both legs;
3.feet should be shoulder-width apart;
4.in order to reduce the load on the lumbar spine, stand up straight and tense the muscles of the abdomen and buttocks, keeping your head straight so that your chin is in a horizontal plane;
5. Place your shoulders in the same plane as your hips;
6. To turn while standing, first turn your feet so that your body follows them. Don't start the turn from the waist.
Correct biomechanics when lifting weights:
1. stand next to the patient who needs to be lifted, keep your back straight, do not lean forward, work using the muscles of your thighs, not your back;
2. place your feet at a distance of 30 cm., since a wide support improves balance;
3. one leg should be pushed forward with the heel(antero-posterior position of the legs); this position of the legs allows the nurse to shift the center of gravity when performing physical activity, which reduces the force expended;
4. when lifting the patient, bend your knees, keeping your torso upright;
5. When lifting the patient, you must hold him close to you;
6. do not make sharp turns or movements;
7. if it is necessary to turn when moving the patient, then first you need to lift the patient, and then turn smoothly without bending the torso.
Team work : the role of leader is performed by one person. The actions of team members must be coordinated. The strongest member of the team lifts the heaviest part of the patient's body - the patient's pelvis and hips.
In addition to following the listed rules of biomechanics, it is also necessary to avoid straining at the height of inspiration. At this moment, a person may experience severe disturbances in the cardiovascular system: heart rhythm disturbances, deterioration of blood supply to the heart muscle (the Valsalva effect is an increase in blood pressure, to maximum, as a result of holding the breath). In this case, “tinnitus”, dizziness, headache, weakness, nausea appear, and even loss of consciousness is possible. A similar condition occurs in some patients with rapid changes in body position (postural reflex).
Preparation for relocation as a necessary condition for the safety of the sister.
The patient must be moved in stages: assess the patient's ability to participate in the procedure. For this set following questions:
- What is the purpose of the move?
- What is the patient's condition?
- What is the patient's weight?
- What aids do you have?
- What method of transportation is most optimal, how many people should participate in it?
- Who plays the role of leader(if two or more people are involved in the movement)?
-How safe is the environment(assess the humidity of the floor, the presence of foreign objects on the floor that are in the way of movement)?
Will he be able to support himself while standing on one leg? (this question should be asked of the patient who is being moved to a wheelchair and therefore needs to remain upright for some time).
- Does the patient maintain a sense of balance?
- Does he see and hear well?
- Does he understand you well?
- Isn't he afraid to move?
TO chemical production factors belong organic and inorganic chemical compounds in the form of gas, vapor, dust, smoke, fog, liquid. Based on the nature of their effect on the body, they are divided into toxic, irritant, sensitizing, carcinogenic, mutagenic, etc. (highly active drugs, chemicals and disinfectants). An essential feature of the effect of chemicals on medical workers is their complex (the same chemical compound enters the body in different ways, for example, inhalation and through the skin) and combined (the effect of several chemicals simultaneously through the same route of entry). Prevention: improvement of technological processes, introduction of automation and mechanization of operations, remote control, replacement of highly toxic substances with less toxic ones, compliance with personal hygiene rules.
35. Physical factors affecting the body of medical workers.
Physical production factors include temperature, humidity, air speed, infrared radiation, noise, ultrasound, vibration, non-ionizing and ionizing radiation, atmospheric pressure, illumination, etc. Prevention:technical measures, which consist of the introduction of remote control, improvement of movable tools, installation of shock absorbers under equipment and seating of chairs at workplaces, effective provision of a rational mode of work and rest, use of personal protective equipment, mechanical ventilation.
36. Biological factors affecting the body of medical workers.
Towards biological production factors include microorganisms, including pathogenic ones (bacteria, viruses, fungi, protozoa) and their metabolic products, protein preparations, vitamins, amino acids (organic substances of natural origin and microbiological synthesis. All biological factors of the production environment are divided into 2 groups: pathogens of infectious diseases, antibiotics and antibiotic-containing drugs. Among occupational infectious diseases, the most common are respiratory tuberculosis (pathogenic, airborne) and serum hepatitis, HIV infection (pathogenic, blood-borne). Various forms can develop in physicians who are constantly in professional contact with antibiotics. dysbacteriosis. Prevention. It is necessary to provide for an established maximum permissible concentration of antibiotics in the air of the working environment, limiting the use of antibiotics to those biological products that contain tetracycline. All workers must be provided with personal protective equipment for respiratory organs and hands. Periodic medical examinations are mandatory.
37. Psychophysiological factors affecting the body of medical workers.
Psychophysiological factors include intellectual and emotional stress, shift work, often with a lack of time and in extreme situations (neuro-psychological stress) and physical (static and dynamic) stress, i.e. ergonomic factors (working in a forced position and when using ergonomically inadequate equipment). As a result of the action of a complex of neuro-emotional factors, medical workers often develop asthenovegetative dystonia, neuroses, and pathologies of the cardiovascular system. Prevention. The design of equipment and organization of the workplace must correspond to the anthropometric data and psychological capabilities of a person. It is necessary that the employee is in a comfortable working position. A rational mode of work and rest during work changes, times, weeks prevents the development of overwork. Industrial gymnastics and psychophysiological relaxation sessions can be considered elements of a rational work and rest regime.
COURSE WORK
The influence of harmful risk factors on the health of mid-level medical workers
Introduction
therapeutic risk health staff
RelevanceThe proposed research topic “The influence of risk factors on the health of mid-level medical workers”, in our opinion, is completely obvious and is dictated, on the one hand, by the vital need for self-actualization, on the other hand, by the need to reduce the level of occupational diseases among mid-level medical workers.
It is known that a medical worker, regardless of his specialization and competence, is exposed to a huge variety of risk factors throughout his professional activity. The influence of these factors, unfortunately, is continuous and unpreventable, but more and more new innovations are being introduced into the modern healthcare organization aimed at reducing the harmful effects of risk factors that have a destructive impact on both the psychological and physical well-being of a medical worker.
Targettheoretical and practical research - establishing the relationship between the influence of occupational hazards on the occurrence of various diseases in small-scale workers.
Itemresearch - occupational hazards that have a negative impact on the health of nursing staff
An objectresearch - nursing staff of various structural divisions
Tasks research:
Conduct a case study
Determine the severity of harmful effects on medical personnel in different departments
Identify risk factors and determine the severity of their impact on medical personnel
Assess the effectiveness of current methods of individual and group protection
Analysis of the results obtained.
Methodsresearch - analytical review of primary sources, testing, survey.
Perceived significance of the workis in establishing the fact of the influence of harmful factors on the development of diseases among mid-level medical workers.
In the course of our work, we plan to visit departments of various medical institutions and identify risk factors characteristic of certain departments, as well as risk factors to which each medical worker is exposed.
In the process of research activities, we will focus on such groups of medical personnel as:
?Blood transfusion station workers
?Workers of the Oncological Dispensary
?Workers of infectious diseases departments and AIDS center
?Employees of the Children's Infectious Diseases Hospital
?Workers of the Dermatovenerologic Dispensary
?Workers of the anti-tuberculosis dispensary
?Intensive care workers
1. Theoretical study of the influence of harmful factors on the health of mid-level medical workers
Harmful and dangerous working conditions for nursing staff are associated, first of all, with direct contact with infectious agents, adverse effects on the body of medications, chemically aggressive substances and stress on the nervous system.
During their work, nurses have to constantly come into contact with a whole range of pharmaceutical agents that adversely affect the health of representatives of this profession. Medicines get on the skin, in the form of aerosols and vapors, they often end up in the nurse’s breathing zone, causing various occupational diseases, as well as infertility, miscarriages and fetal development abnormalities.
In addition, given the shortage of staff in hospitals and clinics, nurses often work part-time as orderlies. In this case, they inevitably come into contact with harmful factors such as chloramine, hydrogen peroxide, ammonia and other substances that can cause poisoning and various respiratory diseases, including allergic ones.
Harmful working conditions in healthcare involve the presence of stress factors. Doctors and nurses constantly interact with seriously ill patients, see their suffering, and witness deaths. This causes chronic emotional stress, depression, and severe neuroses.
The health status of nursing staff inevitably affects the quality of professional care provided to the population.
1.1 Risk factors for nurses in health care facilities
One of the most important tasks in creating a safe hospital environment is to identify, identify and eliminate various risk factors for medical personnel in health care facilities. In the activities of a nurse, four groups of professional factors can be distinguished that adversely affect her health:
) physical risk factors;
) chemical risk factors;
) biological risk factors;
) psychological risk factors.
Physical risk factors in health care facilities for nurses:
) physical interaction with the patient;
) exposure to high and low temperatures;
) the effect of various types of radiation;
Physical interaction with the patient.
In this case, we mean all activities related to the transportation and movement of patients. They are the main cause of injuries, back pain, and the development of osteochondrosis in nurses.
Exposure to high and low temperatures. The implementation of any nursing intervention strictly according to the algorithm will allow you to avoid the adverse effects of high and low temperatures (burns and hypothermia) in connection with the performance of manipulations.
Sources of radiation in health care facilities are X-ray machines, scanners, accelerators (radiation therapy machines) and electron microscopes. In medicine, preparations of radioactive isotopes are also widely used, used for the diagnosis and treatment of a number of diseases.
Currently, medical institutions use other radiations for therapeutic, preventive and diagnostic purposes that adversely affect the health of medical personnel:
ultra-high frequency;
ultraviolet and infrared;
magnetic and electromagnetic;
light and laser.
Violations of the rules for operating electrical equipment.
In her work, a nurse often uses electrical appliances.
Chemical risk factors in health care facilities for nurses.
Chemical risk factors in health care facilities for nurses include exposure to different groups of toxic substances contained in disinfectants, detergents, and medications.
The most common manifestation of the side effects of toxic substances is occupational dermatitis - irritation and inflammation of the skin of varying severity. In addition to it, toxic substances cause damage to other organs and systems.
Biological risk factors in health care facilities for nurses
The biological factors affecting a nurse in a healthcare facility include the risk of infection with nosocomial infections. Preventing occupational infection and ensuring the safety of medical staff is achieved by strict compliance with the anti-epidemic regime and disinfection measures in health care facilities. This allows you to preserve the health of medical personnel, especially those working in emergency rooms and infectious diseases departments, operating rooms, dressing rooms, manipulation rooms and laboratories, that is, those who have a higher risk of infection as a result of direct contact with potentially infected biological material (blood, plasma, urine, pus, etc.) Further.). Work in these functional units requires individual anti-infection protection and compliance with safety regulations by personnel
Medical waste tops the list of the most hazardous. Work with them is regulated by SanPiN 2.4.2.2821-10 “Rules for the collection, storage and disposal of waste from medical institutions.”
In matters of preventing nosocomial infections in hospitals, junior and nursing staff play the main role: organizer, responsible executor, and controller. Daily strict compliance with the requirements of the sanitary-hygienic and anti-epidemic regime during the performance of their professional duties forms the basis of the list of measures for the prevention of nosocomial infections.
Psychological risk factors in health care facilities for nurses.
In the work of a nurse, emotional safety is important. Work related to caring for sick people requires special responsibility and great physical and emotional stress. Psychological risk factors in the work of a nurse can lead to various types of psycho-emotional state disorders.
Psycho-emotional stress.
Psycho-emotional stress in a nurse is associated with constant violation of the dynamic stereotype and systematic disturbances of circadian biorhythms associated with working different shifts (day-night). The work of a nurse is also associated with human suffering, death, enormous stress on the nervous system, and high responsibility for the life and well-being of other people. These factors themselves already lead to physical and emotional stress. In addition, psychological risk factors include: fear of occupational infection, frequent situations associated with communication problems (anxious patients, demanding relatives). There are a number of other factors that increase overstrain: dissatisfaction with the results of work (lack of conditions for the effective provision of assistance, financial interest) and excessive demands on the nurse, the need to combine professional and family responsibilities.
Stress and nervous exhaustion.
Constant stress leads to nervous exhaustion - loss of interest and lack of attention to the people with whom the nurse works. Nervous exhaustion is characterized by the following symptoms:
physical exhaustion: frequent headaches, lower back pain, decreased performance, decreased appetite, sleep problems (drowsiness at work, insomnia at night);
emotional overstrain: depression, feelings of helplessness, irritability, isolation;
mental stress: negative attitude towards oneself, work, others, weakening of attention, forgetfulness, absent-mindedness
2. Practical study of the influence of harmful factors on the health of mid-level medical workers
Targetresearch - establishing the relationship between the influence of occupational hazards on the occurrence of various diseases among mid-level medical workers.
Itemresearch - occupational hazards that have a negative impact on the health of mid-level medical workers.
An objectresearch - nursing staff of different structural units.
Based on the purpose of the practical research, we determined tasks:
.Determine the severity of the harmful effects on medical personnel of various structural units
.Identify risk factors and determine the severity of their impact on medical personnel
.Assess the effectiveness of current methods of individual and group protection
Methodsresearch - testing, survey.
Research baseGroups of staff members from various functional departments of the city’s medical institutions appeared, numbering 174 people.
2.1 Research procedure and techniques
Descriptions, forms and keys of research methods are presented in the Appendix (Appendix 1)
The study involved 174 people aged from 20 to 70 years.
Table 1. Summary table by length of service
RecipientsC Tup to 5 years 5-10 years 10-15 years More than 15 years Quantity 32783628%18,644,820,616.0
According to the research plan, at the first stage, questionnaires were developed, followed by practical research.
At the second stage, the results obtained were subjected to quantitative and qualitative analysis.
2.2 Analysis of research results
The study began with workers blood transfusion stations.
After conducting a study, we found out that at the Kamchatka Blood Transfusion Station all conditions have been created for employees, providing for almost one hundred percent protection of a medical worker from contracting diseases specific to this profession. 22 employees of the blood transfusion station were examined. Based on the survey results, we found that station workers, following safety instructions throughout their professional activities, did not encounter an accident involving biological materials.
The majority of respondents rated their working conditions as satisfactory and the degree of severity as average.
But the threat to the employee is not only contact with blood, but also emotional stress. Therefore, the second stage of the study of medical workers was to determine the degree of development of emotional burnout syndrome (EBS).
The results showed that some employees have SEW in the initial stage.
Research results:
v Development of emotional burnout syndrome - 0.2%
v Acquisition of chronic diseases during professional activity - 0.01%
v Accidents with biomaterials - 0%
v Development of emotional burnout syndrome - 0.5%
v Acquisition of chronic diseases during professional activity - 1.9%
v Accidents with biomaterials - 0%
v Development of emotional burnout syndrome - 1.6%
v Acquisition of chronic diseases during professional activity - 2.6%
v Accidents with biomaterials - 0%
v Development of emotional burnout syndrome - 2%
v Acquisition of chronic diseases during professional activity - 3.5%
The next division was Infectious Diseases Department of the Kamchatka Regional Hospital.
During the study using a questionnaire, it was revealed that every employee of the infectious diseases department encountered an emergency situation while working with biomaterials, but this was facilitated not by a negligent attitude to work, but by great psycho-emotional stress (Appendix 2).
Research results:
Employees with up to 5 years of work experience.
v Accidents involving biomaterials -8%
v Development of emotional burnout syndrome -10%
Employees with work experience from 5 to 10 years.
v Accidents involving biomaterials -10%
v Development of emotional burnout syndrome -15%
v Acquisition of chronic diseases during professional activity - 3%
Employees with work experience of 10 to 15 years.
v Cases of accidents with biomaterials - 12%
v Development of emotional burnout syndrome - 25%
v Acquisition of chronic diseases during professional activity - 5%
Employees with more than 15 years of work experience
v Accidents with biomaterials - 0%
v Development of emotional burnout syndrome - 0%
A study was also conducted in oncology clinic. Compliance with safety regulations by the employees of this unit helped reduce accidents to almost a minimum. The majority of employees were diagnosed with emotional burnout syndrome in the progression phase. Some employees acquired chronic diseases in the course of their professional activities, but as the study showed, this is not related to their specific work (Appendix 2).
Research results:
v Accidents with biomaterials - 0%
v Development of emotional burnout syndrome -70%
Employees with work experience from 5 to 10 years.
v Accidents involving biomaterials -1%
v Development of emotional burnout syndrome - 85%
v Acquisition of chronic diseases during professional activity - 4%
Employees with work experience of 10 to 15 years.
v Cases of accidents with biomaterials - 5%
v Development of emotional burnout syndrome -97%
v Acquired diseases during their professional activities - 7%
Employees with more than 15 years of work experience.
v Accidents involving biomaterials - 2%
v Development of emotional burnout syndrome - 100%
v Acquisition of chronic diseases during professional activity - 0%
The next unit to take part in the study was skin and venereal disease clinic. The senior nurse at the skin and venereal disease clinic told us that indeed every medical worker is exposed to many risk factors. Of these, she identified the highest priority:
risk of infection
Having processed the data obtained, we came to the conclusion that the fear of transmitting diseases from patients prevails among employees of the dermatovenerological dispensary who have little experience working in this institution, which cannot be said about more experienced employees. The majority of workers are quite satisfied with existing personal protective equipment.
Research results:
Workers who have worked for up to 5 years.
v Fear of disease transmission to patients -95%
v Development of emotional burnout syndrome -1%
Employees with more than 6 years of work experience.
v Fear of disease transmission to patients -10%
v Development of emotional burnout syndrome -6%
We showed great interest in our employees children's infectious diseases hospital. After all, no matter how they face a huge variety of difficulties every day. When working with children, they cannot obtain complete information about the patient’s condition. After conducting a study and interviewing workers at a children's infectious diseases hospital, we came to the conclusion that working with infectiously ill children carries a heavy emotional burden. This work requires maximum concentration and responsibility.
The survey results showed that employees of a children's infectious diseases hospital are more susceptible to emotional burnout. Personal and mass protective equipment has reduced accidents involving biomaterials to a minimum.
Based on the data obtained, we also found out that stressful situations that arise when working with such a contingent of patients lead to the development of diseases such as:
Arterial hypertension
Cardiac ischemia
Peptic ulcer of the stomach and duodenum
Of this entire list, arterial hypertension predominates among employees of this institution.
Research results:
Workers who have worked for up to 5 years.
v Development of emotional burnout syndrome -7%
v Acquisition of chronic diseases during professional activity -0%
v Employees with work experience from 5 to 10 years.
v Accidents with biomaterials - 0%
v Development of emotional burnout syndrome -13%
v Acquisition of chronic diseases during professional activity - 0%
Employees with work experience of 10 to 15 years.
v Accidents involving biomaterials -0%
v Development of emotional burnout syndrome - 15%
v Acquired diseases during their professional activities - 25%
Employees with more than 15 years of work experience.
v Accidents with biomaterials - 0%
v Development of emotional burnout syndrome - 10%
v Acquisition of chronic diseases during professional activity - 57%
The main problem for the employees of the anti-tuberculosis dispensary is the contamination of the department with mycobacterium tuberculosis. The result of the study showed that modern personal protective equipment is quite satisfactory for the employees of the anti-tuberculosis dispensary. Compliance with safety regulations almost completely protected the employees of the anti-tuberculosis dispensary from accidents with biological fluids. Some of the hundreds of mines with a relatively long work history have burnout syndrome in its early stages.
Research results:
Workers who have worked for up to 5 years.
v Accidents involving biomaterials - 7%
v Development of emotional burnout syndrome -0%
v Satisfaction with personal protective equipment - 90%
Employees with work experience from 5 to 10 years.
v Accidents with biomaterials - 0%
v Development of emotional burnout syndrome -8%
v Satisfaction with personal protective equipment -100%
Employees with work experience of 10 to 15 years.
v Accidents involving biomaterials -0%
v Development of emotional burnout syndrome - 12%
Employees with more than 15 years of work experience.
v Accidents with biomaterials - 0%
v Development of emotional burnout syndrome -16%
v Satisfaction with personal protective equipment - 100%
The last unit we visited was intensive care units.
The survey results showed that the predominant risk factor in the intensive care unit is chronic fatigue and constant emotional stress.
Research results:
Workers who have worked for up to 5 years.
v Prevalence of chronic fatigue - 16%
Employees with work experience from 5 to 10 years.
v Chronic fatigue prevalence -29%
Employees with work experience of 10 to 15 years.
v Prevalence of chronic fatigue - 32%
Employees with more than 15 years of work experience.
v Prevalence of chronic fatigue - 86%
Conclusion
The goal and objectives of the practical study of the influence of harmful factors on the health of mid-level medical workers have been achieved and solved:
Conclusions:
· Based on a review of primary sources, the concept of “harmful factors” is defined
· Conducted a practical study of employees of various functional departments.
· We analyzed the results and made conclusions:
o By reducing the psycho-emotional load, you can improve the quality of work, as well as reduce the risk of emergency situations and infection of a medical worker with occupational diseases.
o Significant changes in the psychological picture of honey. the employee is promoted by:
§ High patient mortality;
§ Patient suffering;
§ The “young” patient population has increased recently;
§ “Gloomy” psychological microclimate in the department;
§ Heavy psycho-emotional load when performing manipulations with patients;
§ Constant contact with terminally ill patients and provision of palliative care;
o Oncology clinic employees are more susceptible to emotional burnout
During the practical research, it became necessary to expand its boundaries and cover additional departments.
The practical significance of the work lies in the fact that individual work was carried out with department employees and risk factors for the development of occupational diseases were identified.
Thus, our conclusion indicates the special role of preventing the influence of harmful factors on the occurrence and development of occupational diseases of paramedical workers.
In this regard, we have developed the following practical recommendations.
o In order to prevent the negative impact of stressful situations, the nurse in her work should rely on the following principles:
) clear knowledge of their job responsibilities;
) planning your day; define goals and priorities using the characteristics “urgent” and “important”;
) understanding the importance and significance of your profession;
) optimism, the ability to focus on the positive things that were accomplished during the day, considering only successes as the result;
) maintaining a healthy lifestyle, proper rest, the ability to relax, “switch”;
) balanced diet;
) compliance with the principles of medical ethics and deontology.
o When working with electrical appliances, you must follow safety rules.
o To reduce the risk of accidents with biomaterials during work, you should strictly adhere to OST 42.21.2.85
o Together with the scientific supervisor, a memo was developed containing information on ways to combat psycho-emotional stress.
Bibliography
1. Decree of the Government of the Russian Federation of December 1, 2004 No. 715 “On approval of the list of socially significant diseases and the list of diseases that pose a danger to others” // Collection of legislation of the Russian Federation dated December 6
g., No. 49, art. 4916.
Artamonova V.G. Occupational diseases: Textbook/ Artamonova V.G. Mukhin ON THE. - M.: Medicine, 2004.
Malov V.A. Nursing for infectious diseases: Textbook. - M.: Academy, 2007.
Marchenko D.V. Occupational safety and prevention of occupational diseases: Textbook. - Rostov n/d.: Phoenix, 2008.
Uryupinsk branch of GAPOU "Volgograd Medical College"
METHODOLOGICAL DEVELOPMENT
LESSON – CONFERENCE
.
Topic: Impact of toxic and harmful microbiological factors on nursing staff.
Name of academic discipline/MDK: By PM. 04: Performing work in the profession of “Junior nurse in patient care”
MDK 04.01 Safe environment for participants in the diagnostic and treatment process.
Course 2 Specialty: nursing
Form of study:
Number of hours: 6h - 270 min
Developer: Emelyanova Irina Nikolaevna
Methodological development
reviewed and approved
at the meeting of the UMO No. __
(protocol No.___, date _______)
Chairman of the UMO ________________
(signature)
_______________________________
(FULL NAME)
20_____
Uryupinsk, 2017
INTRODUCTION
Among all sectors of the economy in occupational diseases among women, the first place is occupied by nurses - 9.4%, medical specialists in eighth place - 1.3%, the incidence among female pharmacists is 0.5%, among junior medical personnel - 2 .3% per 10,000 employees.
At the same time, the incidence in other professions is:
Milkmaids – 6.3%
Painters – 3.9%
Crane operators – 3.6%
Plasterers – 3.0%,
We can say that the nursing profession ranks first in terms of the risk of occupational morbidity among women!
Structure of occupational diseases among medical workers:
The group consists of medical workers who have been diagnosed with an occupational disease caused by exposure to biological factors.
Group - medical workers who have been diagnosed with occupational allergies - due to exposure to antibiotics, B vitamins, acids, alkalis, solvents, latex, disinfectants;
The group consists of medical workers who have been diagnosed with occupational diseases of toxic-chemical etiology.
The group consists of medical workers who have been diagnosed with an occupational disease due to overexertion of individual organs and systems of the body.
The group is professional new formations.
According to medical experts, the first place in the structure of occupational diseases is consistently occupied by infectious diseases (on average 80.2%), in which medical workers are at increased risk. Thus, the risk of contracting HIV infection when pricked with an infected needle is about 0.3%, hepatitis C virus – 10%, and hepatitis B virus – 30%.
In second place are allergic diseases (on average 12.3%).
In third place are intoxications and diseases of the musculoskeletal system.
The mortality rate for medical workers under the age of 50 is 32% higher than the national average; for surgical and operating nurses this figure reaches 40%. Every year, 320 thousand doctors do not go to work due to illness. Economic losses in Russia from infections resulting from medical interventions reach 15 billion rubles per year. For comparison: in the USA this figure reaches 6.5 billion dollars per year. The morbidity statistics for medical workers is depressing. But let's look at these risk factors in the work of a nurse, and how you can protect yourself.
Integration links (intra- and intermodular, connection with academic disciplines):
Intra-module connections
MDK. 04.01. Topic 1.1.
Discipline connections
OGSE.04. Physical Culture.
EH. 02. Information technologies in professional activities.
OGSE. 05. Russian language in professional activities.
OP.05. Human hygiene and ecology;
OP 10. Legal support of professional activities.
OP. 09. Psychology. "Psychology of Interpersonal
relationships.
OP. 01. Basics of Latin with medical terminology
Intermodule communications
PM. 01
MDK, 01.01. A healthy person and his environment.
MDK.01.02. Basics of prevention.
MDK. 01.03. Nursing in the system of primary health care for the population.
Formed general and professional competencies :
OK 2. Organize your own activities based on the goal andways to achieve it, determined by the manager
OK 3. Analyze the work situation, carry out current andfinal control, assessment and correction of one’s own activities, and bear responsibility for the results of one’s work.
OK 6. Work in a team, communicate effectively with colleagues,patient guidance.
OK 8. Comply with labor protection, fire safety andsafety precautions.
PC 4.1. Communicate effectively with the patient and their environment during the process
professional activity.
PC 4. 6. Provide medical services within theirpowers.
PC 4. 8. Provide a safe hospital environment for patients and staff
Objectives of the lesson - conference:
Educational goal: create conditions for the formation of knowledge on preventionImpact of toxic and harmful microbiological factors on nursing staff.
know:
Adverse effects on the sister of toxic substances, radiation, chemicals and psychological factors in the LO.
Symptoms associated with sister's overexposure to harmful substances.
Measures aimed at preventing exposure to harmful substances on the sister’s body.
be able to
Wear protective clothing
Wash your hands before and after manipulation. -
treat skin and mucous membranes in contact with
biological fluids and chemicals
Developmental goals:
To promote the development of logical and clinical thinking in students,
Educational goals:
Promote a sense of responsibility towards yourself and your health
Lesson type: formation and improvement of knowledge.
Lesson form : problem conference.
Basic methods: explanatory and illustrative, method of problematic presentation of educational material, partially search and research.
Equipment: - laptop; - multimedia presentation
Location: Assembly Hall
Preparation for the conference:
The main problems are brought to the conference
Questions are distributed among students, and four groups are formed.
The teacher assigns “roles” in each group: speakers, opponents, reviewers, informants, experts.
Speakers. They work with original literature - (scientific, popular science) on the chosen topic, prepare a speech.
Opponents. They study the literature on the topic and the report, and write questions for the report. At the conference, together with the teacher, they are the organizers of the discussion.
Informants: review additional literature on the topic, prepare a computer presentation.
Experts: study the literature, identify their level of preparation at the conference, and participate in the discussion.
The conference leader is a teacher.
The speakers sit at a separate table - in the presidium
The speaker is given 5 minutes to speak. (Reading the report from a sheet is not allowed.)
Students clarify, deepen, and generalize knowledge on the proposed problem.
When discussing the second question, students receive a piece of paper with the task of writing a question for the speaker. After the report, the speaker sits down to work with questions for the group; he can invite a “support group”. The group answers questions from opponents and experts
To successfully conduct the conference, students must possess discussion skills, which are developed in theoretical classes devoted to the study of this topic.
Main stages
1 Organizational moment___3min_________________________________
2. Practical part___200min___________________________
3. Final control_15 min______________________________
4. Summing up the lesson_5min_______________________
5. Homework__2min________________________________
a) for students: Mukhina S.A. , Tarnovskaya I.I. “Theoretical foundations of nursing” Moscow 1996. part 1 p.131-149.
Mukhina S.A. , Tarnovskaya I.I. Practical guide to the subject “Fundamentals of Nursing” Moscow 1996 With. 201-208
Obukhovets T.P. Rostov-on-Don “Fundamentals of Nursing” Phoenix, 2003. p. 255-267.
Dvoinikov S.I. “Fundamentals of Nursing” Moscow 2005 With. 436-445.
LITERATURE FOR TEACHERS Mukhina S.A., Practical guide to the subject “Fundamentals of Nursing”: textbook. / S.A. Mukhina, I.I. Tarnovskaya. - 2nd ed., rev. and additional .-M.: GEOTAR-Media, 2009.- 506 p. ill.-ISBN 978-5-9704-1163-6.
Mukhina S.A., Theoretical foundations of nursing: textbook. - 2nd ed., revised. and additional - M.: GEOTAR-Media, 2010.-366 p.-ISBN 978-58-9704-1645-7.
Morozova G.I., Fundamentals of nursing. Situational tasks: workshop for medical professionals. schools and colleges.- M.: GEOTAR-Media, 2009.- 240 p.-ISBN 978-5-9704-960-2.
Manipulations in nursing: textbook. manual / ed. A.G. Chizha.- Rostov n/a: Phoenix, 2008.- 318 p. (Medicine).-ISBN 978-5-222-12899.
Fundamentals of nursing: textbook / I.Kh. Abbyasov, S.I. Dvoinikov L.A. Karaseva and others; edited by S.I. Dvoinikov.- M.: Academy, 2007.- 336 p.-ISBN 978-5-7695-3627-4.
Ostrovskaya I.V., Fundamentals of nursing: textbook /I.V. Ostrovskaya N.V., Shirokova.- M.: GEOTAR-Media, 2008.- 320 p.-ISBN 978-5-9704-0653-3.
Patient Transfer Guidelines"/ E.N. Corlett P.W., Lloyd K. Tarling; comp. and lane from English A.V. Borisova; edited by A.A. Skoromets. – St. Petersburg: “Polytechnika”, 2009 – 313 p.
"Safe handling of patients at home"/ lane from English O.V. Kamaeva, I.G. Lyapunova; edited by A.A. Skoromets. – St. Petersburg: “Polytechnika”, 2009 – 198 p.
Medical care, Complete reference book for nurses / ed. N.R. Paleeva.- M.: Eksmo, 2008.- 544 p.-ISBN 978-5-699-26053-9.
INTERNET RESOURCES:
Information and reference portal about medicine, health and beauty. The website contains educational medical films, medical books and teaching aids -
Regulations
Regulations
Guidelines for disinfectants, regulatory documents;
Regulations;
Regulations;
- regulationsand etc.
Legal database "Consultant
Legal database "Garant"
Progress of the lesson - conference:
Introductory speech from the teacher:It’s alarming and scary, but we humans have a unique ability: when faced with information that is unpleasant for us, we strive to forget it as quickly as possible. It’s like an iron curtain falls in front of facts that make you worry and thinkToday we will build our lesson in the form of a lesson - a conference on the topic
Impact of toxic and harmful microbiological factors on nursing staff during which we will find out the problems of safety and labor protection of medical workers
Solving them is not possible without an integrated approach. Significant problems must be solved by the administration of the medical institution, but much depends on each employee. Everyone must deeply understand the severity of the problem, eliminate indifference and a formal approach to issues of their labor safety.
It is necessary to know and strictly comply with regulations governing the safety of working conditions and health protection of medical workers. Along with the general requirements, there are specific safety features at each specific location. As a rule, they are specified in the relevant instructional and methodological materials.
Developing the ability to assess dangerous situations when performing the professional activities of a medical worker, developing a model of safe behavior is the most important educational goal of this lesson.
1 Risk factors for nurses .
Speaker1 In the activities of a nurse, four groups of professional factors can be distinguished that adversely affect the state of her health:
1. Physical risk factors.
These include:
Physical interaction with the patient;
Exposure to high and low temperatures;
Effect of various types of radiation;
Physical interaction with the patient.
These are activities related to the transportation and movement of patients. They are the main cause of injuries, back pain, and the development of osteochondrosis in nurses.
Exposure to high and low temperatures.
To prevent harmful effects on the body, it is necessary to follow safety precautions when working with relevant devices.
Violation of the rules for operating electrical equipment.
Electrical shocks are caused by improper use of equipment or equipment malfunction.
2. Chemical risk factors.
In health care facilities, nursing staff are exposed to different groups of toxic substances contained in disinfectants, detergents, and medications.
The most common manifestation of toxic substances is occupational dermatitis.
Toxic and medicinal drugs can affect organs: respiratory, digestive, hematopoietic, reproductive function. Compliance with preventive measures will reduce harm from exposure to toxic substances.
3. Biological risk factors.
This is a danger of infection of medical staff with nosocomial infections. Prevention of occupational infection is achieved by strict adherence to the anti-epidemic regime and disinfection measures in health care facilities. Medical waste is considered particularly hazardous. Working with them is regulated Sanpin 2.1.3.2630-10
"sanitary and epidemiological requirements for organizations,
carrying out medical activities"
Sanpin 2.1.7.728-99 “Rules for the collection, storage and disposal of health care waste.”
4.. Psychological risk factors.
In the work of a nurse, psychological safety is important. Psychological risk factors in the work of a nurse can lead to various types of psycho-emotional state disorders.
Psycho-emotional stress.
It is associated with constant disruption of the daily biorhythm associated with working different shifts. In addition, the work of a nurse is associated with human suffering, death, responsibility for the life and well-being of other people. Tension leads to physical and emotional stress.
Stress and nervous exhaustion.
It is characterized by the following features:
Physical exhaustion: frequent headaches, lower back pain. Decreased performance, decreased appetite, sleep problems;
Emotional stress: depression, feelings of helplessness, irritability, isolation;
Mental stress: negative attitude towards oneself, work, others, weakened attention, forgetfulness, absent-mindedness.
Professional burnout syndrome.
This is a syndrome of physical and emotional exhaustion that occurs against the background of chronic stress caused by interpersonal communication.
Burnout is a long-term dynamic process that occurs in several stages. There are three stages of development of professional burnout syndrome.
At the first stage, the person is emotionally and physically exhausted and may complain of headaches and general malaise.
In the second stage, the nurse may develop a negative and impersonal attitude towards the people with whom she works or irritation that patients cause her. Feeling tired and exhausted is observed even after a good sleep or a weekend.
The third stage is complete burnout, which is manifested by complete disgust for everything in the world. The nurse is unable to express her emotions and is unable to concentrate.
Prevention of the development of professional burnout syndrome is achieved by using muscle relaxation methods and utogenic training techniques. It is advisable to carry out training in these techniques under the guidance of a specialist - a psychologist in a psychological relief room.
Speaker 2Adverse effects on the sister's body of pharmaceuticals and chemicals in the Leningrad region.
Exposure of health care workers to hazardous drugs, which means unintentional chemical contamination
The list of dangerous drugs includes 136 items, the most toxic of which are:
cytotoxic drugs
antibiotics
bioengineered drugs
monoclonal antibodies
hormonal drugs
other complex medicines
Modern literature mentions two ways for toxic substances to enter the human body: through contact with skin and inhalation of aerosol
There are various sources of chemical contamination through skin contact, such as:
surface of infusion bottles
surface of medicinal packaging
biological fluids of patients undergoing chemotherapy spilled solutions
filled infusion system.
Inhalation of aerosol occurs during:
preparing medicines
administering medications
Risk of chemical contamination
Upon skin contact:
with the surface of the bottles
with the surface of drug packaging
with biological fluids of patients undergoing chemotherapy
with spilled solutions
with filled infusion line
Aerosol exposure:
while preparing medicines
during medication management
The degree of damage caused by chemical contamination depends on the type of drug. Therefore, it is necessary to distinguish toxic drugs from non-toxic ones.
Non-toxic drugs
Exposure to non-toxic drugs, such as antibiotics, is not harmless and often causes inflammatory skin diseases and hypersensitivity reactions, which consequently reduces the effectiveness of medical personnel.
Toxic effects of drugs
Acute symptoms
Medicines, for example, such as Paclitaxel, in the attached instructions for use initially indicate the toxic effects of the drug and the side effects associated with its use. The instructions indicate that the drug can cause the following symptoms of acute intoxication: nausea, alopecia (baldness) and bradycardia
Studies show an increase in similar symptoms between the control group and the group using anticancer drugs (diarrhea, sore throat, redness of the skin). However, the main acute symptom is mutagenicity. Various studies demonstrate various mutations, for example, changes or aberrations of the sister chromatid. The occurrence of chromosomal mutations is random and can be caused by just one molecule of a substance. For this reason, there is no official information on the minimum amount of a damaging substance that can cause mutations.
InformantChronic manifestations
Carcinogenicity
Mutations that arise as a response to the damaging effects of chemicals can also lead to the development of cancer.
The relationship between exposure to high doses of cytotoxic drugs and secondary malignant neoplasia was demonstrated in studies conducted by the International Agency for Research on Cancer. As a result of these studies, anticancer drugs were classified as the first group of risk of mutations. The random nature of the occurrence of the carcinogenic effect makes exposure to even low doses of antitumor drugs dangerous from the point of view of the development of cancer. As a result of processing the research dataSessinkIt revealed. That theoretically, 95-475 million healthcare workers remain at lifetime risk of leukemia. ResearchSkovalso confirm the increased risk of leukemia among health care workers
Some studies demonstrate an increase in cases of miscarriage and reveal a relationship with the teratogenic effect of chemicals
Chronic liver diseases such as hepatitis and fibrosis are increasing due to exposure to toxic drugs.
In the event of chemical contamination of the skin or mucous membranes of personnel, hospital regulations require thoroughly rinsing the contaminated surface for 10 minutes. If a chemical comes into contact with the eyes, an ophthalmologist examination is required.
OpponentPreventive actions
Preventive actions
Measures aimed at preventing the harmful effects of chemotherapy on personnel are established by various regulatory documents.
Prevention methods:
Centralized preparation of pharmaceuticals protects personnel from contact with chemotherapy drugs. In this case, the preparation of medicines is carried out by specially trained personnel. The use of special infusion equipment and accessories helps prevent chemical contamination. These devices prevent the release of aerosols, for example, droplets of solution falling on surfaces.
It is necessary to use special rooms, since the surface of the bottles can become a source of chemical contamination:
The use of laboratory fume hoods or specially equipped rooms for preparing and mixing chemotherapy drugs avoids chemical contamination.
Contact with chemotherapy drugs can be avoided by using special medical clothing: gowns, masks, gloves.
Regular examinations, including blood tests, are recommended to monitor the extent of the harmful effects of chemotherapy on medical personnel. Only with strict adherence to safety rules during chemotherapy can the harmful effects on the health of personnel be reduced.
Routes of entry of drugs into the body:
By direct contact: on skin, in eyes;
Through the respiratory tract: when using medicinal aerosols or gases, crushing or counting tablet drugs, when displacing air from the syringe before injection;
Through the digestive tract: unwashed hands, accidental ingestion.
InformantRecommendations for preventing harmful effects of medicinal products on healthcare workers:
When working with medications, the skin of your hands should be free of damage;
if there are cuts or abrasions, apply a waterproof bandage to them;
Do not touch topical medications (tablets, ointments, creams, suppositories) with unprotected hands - wear gloves or use a spatula;
Push excess air from the syringe into an empty container without splashing the solution into the environment or onto the skin of your hands;
Wash off splashed or scattered medications immediately;
When working with cytostatic (antitumor) drugs, when indicated, wear a full set of protective clothing - a long-sleeved gown, safety glasses, a mask, gloves;
After handling medications, wash your hands thoroughly;
OpponentSafety rules when working with disinfectants.
When working with disinfectants, they can enter the respiratory tract by inhalation; when splashed - into the eyes, on the skin;
in case of accidental ingestion - into the digestive tract
1. Follow the rules for storing chemical disinfectants.
2. The packaging of disinfectants must have a passport indicating the name, purpose, date of preparation and expiration date.
3. Observe the rules of personal hygiene when preparing disinfectant solutions (special gowns, headscarf, respirator, safety glasses, rubber gloves, spare shoes).
4. Prepare disinfectant solutions and package them in a fume hood or room with supply and exhaust ventilation.
5. If disinfectants come into contact with your skin, wash them off immediately with water.
6. In case of contact with eyes - rinse with water, 2% soda solution, if necessary, drip Albucid (30%), if the pain does not subside - eye drops with novocaine (2%).
7. If the respiratory tract is irritated, immediately go to another, ventilated room, or into fresh air, take warm milk with soda, and rinse the mouth with a 2% soda solution. If necessary, cardiac, sedative and antitussive drugs are prescribed.
8. Only persons over 18 years of age who have undergone instruction are allowed to work.
9. After work, take off overalls, gloves, a respirator, wash your hands and lubricate them with cream.
Chemicals that come into contact with the skin should be washed off immediately with water, and if they come into contact with clothing, change them.
The toxic effect of drugs is often manifested by allergic skin reactions - antibiotics, antihistamines.
Some antibiotics have a teratogenic effect - they reduce the ability to get pregnant, increase the number of miscarriages, reduce fetal weight, lead to congenital deformities, and reduce the number and motility of sperm.
The greatest danger to the health of medical personnel are cytostatic (antitumor) drugs.
Speaker 3 Adverse effects of microbiological factors on the sister’s body
Due to accidental sticks and cuts from sharp instruments, healthcare workers are at increased risk of contracting HIV, hepatitis B and C.
The main cause of injury is needles from syringes, transfusion systems and blood collection systems. They are followed by surgical needles and scalpels.
Preventing injuries with sharp medical instruments: ( Excerpt from the film)
Before starting the injection, make sure that there is a container nearby for disposal of the instrument - at arm's length, below eye level;
Never recap or break needles after use; use a needle cutter or needle destructor for this - standard containers for medical waste are equipped with them;
After using a sharp instrument, immediately transfer it to a tight container;
Containers for collecting used sharp disposable instruments, after they are 3/4 full, should be tightly closed, labeled and prepared for disposal;
If an injury occurs with a sharp instrument, immediately report it to your immediate supervisor to get help;
Refrain from using sharp instruments if a safe and effective alternative is available;
Inform health facility administration of anything that increases the risk of injury from sharp instruments in your facility.
OpponentIn the near future, safety auto-disable (SA) and auto-disable (AD) syringes will be introduced everywhere.
The principle of self-destruction: after administering the drug, the piston is fastened to the needle holder and, with the reverse stroke of the piston, the needle holder together with the needle is retracted into the cylinder
Self-locking principle: the piston gets stuck in the barrel after injection, which prevents the syringe from being reused :( Excerpt from the film)
InformantPrecautions when working with biological fluids:
The basis for the prevention of bloodborne infections is vaccination against hepatitis B, post-exposure prophylaxis of HIV infection with antiretroviral drugs;
the attitude towards blood and other biological fluids of all patients should be the same as for potentially infected ones;
When carrying out injections and other manipulations in which contact with biological fluids is possible, use gloves and, if necessary, other barrier personal protective equipment - a respirator, sealed goggles, a protective transparent screen, film aprons, oversleeves; (insert a set of protective clothing)
Immediately after contact with blood or other biological fluids, wash your hands or treat them with an alcohol antiseptic, even if you were wearing gloves;
If the skin is contaminated with blood or other biological fluids, immediately treat them for 2 minutes with a swab moistened with 70% alcohol, wash under running water and soap and dry;
If you suspect that blood has entered the mucous membranes, immediately treat them with a stream of water, 1% boric acid solution, or inject a few drops of silver nitrate; treat the nose with 1% protargol solution; Rinse your mouth and throat with 70% alcohol or 1% potassium permanganate solution.
Speaker4 Adverse effects on the sister’s body from radiation and anesthetic gases
Sources of radioactive exposure in a medical institution:
X-ray machines;
Radiation therapy devices;
Radioactive isotopes;
Radioactive excretions of patients after their radioisotope study - urine, feces, vomit.
The risk of exposure of medical personnel arises when:
Participation in X-ray examination of the patient and radiation diagnostics;
Caring for patients after their radioisotope examination;
When caring for patients receiving internal radiation and radionuclide therapy.
Measures to protect medical workers from radiation exposure:
In the X-ray room, when participating in the examination of a patient (angiography, fistulography), use protective equipment (lead apron, mobile screen);
Pregnant women should not participate in the examination of patients using radiation diagnostics, as well as in the care of patients receiving intracavitary radiation therapy.
Exposure of waste anesthetic gases to medical personnel
– a patient who has undergone inhalation anesthesia exhales anesthetic gases into the environment for 10 days.
InformantSafety precautions when working with gaseous narcotic substances :
When administering anesthesia, waste anesthetic gases must be discharged outside the operating room - to the street;
Pregnant women should be exempt from participation in administering anesthesia with gaseous narcotic substances and caring for patients who have undergone such anesthesia;
All patient care procedures should be performed as quickly as possible, without bending towards the patient's face
Speakers5 Physical risk factors.
In the process of performing their work, medical workers (mainly nurses and aides) have to repeatedly lift and move heavy objects (patients from the operating or dressing table to a gurney, from a gurney to a bed, etc.). At the same time, failure to comply with the basic rules of these actions can lead to serious consequences and even disability.
InformantSafety precautions when lifting and moving heavy objects:
Estimate the weight of the object you are going to lift;
Stand as close to the object as possible, place your feet on both sides of it, shoulder width apart;
Sit down with a straight back;
Bring one hand under the object from below, grab it with the other from above, and grasp it tightly;
keeping your back straight and slightly leaning forward, stand up in one smooth movement with the help of your leg muscles; the load should be as close to the body as possible;
Never rise and turn at the same time: first, fully straighten, and then turn your whole body in the desired direction;
When carrying heavy objects, it is unacceptable to sharply bend forward or bend backward;
In order not to overload the spine, divide the heavy load into two parts and carry it in both hands;
If the item is too heavy, don’t be shy to ask for help.
from others;
Do not move bulky objects alone, even if it seems to you that they are quite light, you will not be able to maintain your balance correctly, and as a result the load will fall on your back and neck;
Make sure there is no wet floor on your way, as you may slip and get seriously injured;
If possible, it is better to lift and carry loads using available tools, such as a cart or stretcher.
Speaker6. Risk factors for the patient
Risk factors that negatively affect the patient in health care facilities can be divided into two groups:
1. Psychosocial
2. Threatening the safety of human life.
Psychosocial factors.
This group includes the following risk factors:
Changed role function;
Reduced individual ability to adapt and overcome stressful situations;
High degree of risk from instability of life activity;
Decreased response to social interaction;
Displacement stress syndrome;
Violation of self-esteem.
InformantAmong the measures to ensure emotional safety in health care facilities are:
Maintaining a quiet, calm, friendly environment in the department;
Communicate with the patient in a low voice only with a positive intonation;
Creating a comfortable interior;
Organization of leisure time for patients;
Elimination of negative emotions;
Providing an appropriate environment and psychological support during each manipulation;
Rational filling of wards;
Ensuring silence during the daytime rest and night sleep of patients.
Factors threatening human life safety.
The following factors can be identified:
Reduced protective functions of the body;
Violation of the body diagram;
Indecision, inconsistency when making decisions;
High risk of complications of drug therapy;
High risk of nosocomial infections;
High risk of injury, damage;
High risk of burns, hypothermia;
High risk of electric shock during procedures;
Decreased physical activity;
General weakness;
Insufficient self-hygiene.
OpponentTo prevent these facts, you must adhere to certain rules:
1. The patient’s bed and bathroom must be equipped with emergency bells.
2. There should be no high thresholds, wires or other objects on the floor.
4. Dry floor.
6. Corridors and stairs must be equipped with railings.
7. Monitor the technical condition of transport for moving and transporting patients.
8. Frail and elderly patients should not close the door when using the bathroom or toilet.
9. The bed of a seriously ill patient must have side rails.
10. Patients with urinary and fecal incontinence should not use heating pads.
11. Do not smoke or turn on electrical appliances near oxygen devices.
12. Implement hygiene measures in a timely manner.
Analysis of clinical examples.
Justify the answer why a medical worker received an occupational disease
M-ov, 34 years old,examined in 2007. Anesthesiologist. She has been working in this specialty since 1998, operating days are 5 times a week, operations last up to 4-6 hours, and she mostly has to work while standing. Already two years from the start of work, moderate pain in the left shin began to bother me, mainly at the end of the working day, a feeling of heaviness in the leg, night cramps in the calf muscles, and a year later, varicose veins appeared in the popliteal region. During the examination, he complained of a feeling of heaviness of pain, a burning sensation in the left shin, transient swelling in the area of the left ankle joint in the afternoon. Objectively: internal organs are without pathology. No concomitant diseases were identified. When examining the lower extremities: on the right - without any features, on the left - the color and temperature of the skin are not changed, there is a slight pastiness in the ankle joint.
Sick M-ch, born in 1989.Anamnesis: since 2011, he worked in the cath lab, performing complex X-ray contrast studies, including probing of the cardiovascular system. The radiation background was increased during the research. He constantly combined his main work with the position of an x-ray technician in other medical institutions. For a long time he worked part-time on gamma therapeutic devices. This continued until 2011, when dull pain in the abdomen, high temperature (38°C), and weakness appeared. The examination revealed enlargement of the lymph nodes of the abdominal cavity. In 1991, a splenectomy was performed. For three years he was treated in Obninsk: chemotherapy and radiation therapy. The last course of treatment took place in January 1993. I felt satisfactory. He was admitted to the clinic with complaints of itching in the groin area, enlarged inguinal lymph nodes, and an increase in temperature to 38°C for 20 days. On the day of admission, excision of two inguinal lymph nodes measuring
Sick F-ko,Born in 1944, a nurse worked in a treatment room and had constant industrial contact with antibiotic solutions and sulfonamides. The working conditions were ordinary - a treatment room without local supply and exhaust ventilation, syringes and other instruments were also sterilized here, work was done in shifts. Changes in the skin of the hands first appeared 8 years after the start of work (in 1970) - redness, itching.
The treatment had no effect; in 1976, a dermatologist recommended that she find employment without contact with antibiotics, but due to loss of earnings, the patient refused. In 1978, the condition worsened, and skin changes (dermatitis) became more generalized.
Sick T-na,1938, b. Case history no. 1770/80, senior midwife. From profamnesis:
has been working in medical positions since 1958, since 1968 as a senior midwife, performing the duties of a procedural nurse, as before: daily contact with antibiotic solutions - penicillin, streptomycin, monomycin, and other antimicrobial agents. Performed up to 50 intravenous and 90 intramuscular infusions and injections per day, mainly antibacterial drugs - antibiotics. She herself was not treated with antibiotics. There was no forced ventilation in the treatment rooms; instruments were sterilized there.
During examination at the professional center, the patient was found to have visceral dysbiosis (intestinal candidiasis) and was bacteriologically confirmed. When examined by a neurologist: complaints of irritability, tearfulness, sleep disturbance, fatigue
Fill out the table
Waste anesthetic gases
influence on the reproductive system influence of ether anesthesia on
operating room nurses
Women Men
Symptoms associated with the harmful effects of anesthetic gases
for medical staff
Radiation sources in health care facilities
Effect of irradiation on
Men Women
Tanks containing harmful microbiological factors,
surrounded by his sister in a hospital
Microbiological factors dangerous for nursing staff
male pregnant nurse
Control questions
1. Describe psychosocial risk factors.
2. List the measures to ensure emotional safety in health care facilities.
3. Name the factors that threaten human safety.
4. What are the rules for patient safety?
5. Describe the physical risk factors for a nurse in a healthcare facility.
6. What are the methods of protection against radioactive radiation?
7. Provide a rationale for safety precautions when working with electrical appliances.
8. Describe chemical risk factors for a nurse in a healthcare facility.
9. What are preventative measures to reduce exposure to toxic substances?
10. Describe the biological risk factors for a nurse in a healthcare facility.
11. Name the psychological risk factors for a nurse in a healthcare facility.
12 Indicate at least 4-5 factors that pose a threat to the safety and health of medical workers.
13. What dangers can body fluids pose to a healthcare worker?
14. What are the harmful effects of drugs on health care workers?
15. Under what circumstances of professional activity can a medical worker be exposed to electromagnetic and radioactive radiation?
16 How does the traumatic impact of the hospital environment on a medical worker manifest itself?
17. Name the rules of infection safety known to you when performing the duties of a guard nurse.
18. Provide recommendations to your colleagues on the prevention of acute injuries
medical instruments and items.
19 What safety rules should be followed when working with chemicals?
20. What are the rules for medical workers when getting up and
moving heavy objects?
21. The role of special clothing and personal hygiene in safety
