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occupational morbidity of medical workers
c.c. Kosarev, S.A. Babanov, Samara State Medical University
Babanov Sergey Anatolyevich - e-mail: [email protected]
In the article, based on the data of the department of occupational pathology of clinics of the Samara State Medical University, the occupational morbidity of medical workers in the Samara region was studied over a five-year period, the causes, trends and patterns of the formation of occupational morbidity among medical workers in the Samara region were named.
Keywords Keywords: medical workers, occupational diseases, viral hepatitis B and C, tuberculosis, prevention.
On the basis of the data of the department of profpathology of clinics of State Educational Institution of Higher Professional Education "Samara State Medical University" the occupational morbidity of medical workers in Samara region during 5 years has been studied, the reasons, tendencies and regularities of the formation of the occupational morbidity of medical workers in Samara region have been given in the article.
Key words: medical workers, occupational diseases, viral hepatitis B and C,
tuberculosis, preventive measures.
According to the director of the State Research Institute of Occupational Medicine of the Russian Academy of Medical Sciences, Academician of the Russian Academy of Medical Sciences N.F. Izmerov (2005) and Director of the Central Research Institute of Epidemiology of Rospotrebnadzor Academician of the Russian Academy of Medical Sciences V.I. Pokrovsky (2008) at the beginning of the 21st century ““the situation with the health care of medical workers leaves much to be desired, as there has been a trend towards an increase in accidents and occupational diseases. This is despite the fact that the level of general morbidity in the industry has always been quite high due to direct contact with patients, and also due to the specifics of working conditions.
At the same time, medical workers (the first class of occupational risk) occupy a leading position in occupational diseases. Thus, among all sectors of the economy in terms of occupational diseases among women, nurses rank first - 9.4%, medical specialists in eighth place - 1.3%, the incidence among female pharmacists is 0.5%, among junior medical personnel ( nurse-washer) -2.3% per 10 thousand employees. At the same time, the incidence in other professions is: milkmaid - 6.3%; painter - 3.9%; crane operator - 3.6%; plasterer - 3.0%, that is, in terms of the risk of occupational morbidity among women, the profession of a nurse is in first place.
In general, the detection rate of occupational diseases in the Russian Federation is extremely low. So, according to the report "On the state of occupational morbidity in the Russian Federation in 2005" the rate of occupational morbidity in 2005 was 1.61 per 10,000 workers (for objects of all forms of ownership); occupational diseases - 1.59; occupational poisoning - 0.02.
By the nature of their activities, a doctor (as well as a middle and junior medical worker, a pharmacist and a pharmacist) is affected by a complex of factors of physical, chemical
chemical, biological nature, as well as high neuro-emotional stress. Also, in the course of professional activity, a medical worker is subjected to functional overstrain of individual organs and systems of the body (from functional overstrain of the musculoskeletal system to overstrain of the organ of vision).
Table 1.
Occupational morbidity of medical workers
Year Number of primary patients in total (according to the statistics of the department of occupational pathology of clinics of the Samara State Medical University) Occupational diseases of medical workers
Number of patients %
2004 389 61 15,68%
2005 312 37 11,86%
2006 317 38 11,99%
2007 231 32 13,85%
2008 343 40 14,23%
Occupational morbidity was analyzed according to the data of the department of occupational pathology of clinics of the State Educational Institution of Higher Professional Education "Samara State Medical University" for the period 2004-2008. It was found that in 2004 the number
primary cases of occupational diseases was 389 (61 cases - 15.68% - occupational diseases of medical workers), in 2005 - 312 (37 - 11.68%
Occupational diseases of medical workers), in 2006 - 317 (38 - 11.99% - occupational diseases of medical workers), in 2007 - 231 (32 - 13.85%
Occupational diseases of medical workers), in 2008 - 343 (40 - 14.23% - occupational diseases of medical workers). When analyzing the structure of occupational morbidity (Table 2), it can be seen that the incidence of viral hepatitis is decreasing, not
the incidence of tuberculosis, the detection of allergic diseases is growing, occupational diseases are detected from exposure to non-ionizing and ionizing radiation (including radiation sickness).
We analyzed the case histories of medical workers who applied to the clinical expert commission of the Samara Regional Center for Occupational Pathology over the past 15 years. In total, during the specified period, occupational diseases were diagnosed in 397 people.
All persons with identified occupational pathology were divided into groups depending on their professional affiliation. Among the examined were 147 doctors, 196 nurses, 15 pharmacists, 3 pharmacists, 18 laboratory assistants, 4 dental technicians, 14 junior medical personnel.
Depending on the current causative factor, we divided all the examined medical workers into 6 groups and obtained the etiological structure of occupational diseases of medical workers.
Group 1 - medical workers who have an occupational disease due to exposure to biological factors (253 people, 63.6%);
2nd group - medical workers who have been diagnosed with occupational allergies (90 people, 22.6%) due to exposure to penicillin antibiotics, B vitamins, acids, alkalis, solvents, latex, disinfectants;
group 3 - medical workers diagnosed with occupational diseases of toxic-chemical etiology (39 people, 10%);
4th group - medical workers who had an occupational disease from overexertion of individual organs and body systems (12 people, 3.0%), this group included surgeons with varicose veins and dentists with cervico-shoulder radiculopathy.
5th group - medical workers diagnosed with occupational diseases from the action of physical factors - vegetative-sensory polyneuropathy from exposure to contact ultrasound in 1 doctor of ultrasound diagnostics and recurrent basalioma of the skin in 1
a radiologist from exposure to x-rays - only 2 patients - 0.5% of the detected pathology;
6th group - occupational neoplasms (1 patient, 0.25% of the detected pathology).
During the analyzed period, the Clinic of Occupational Diseases of Samara State Medical University carried out special diagnostic studies, as a result of which it turned out that 157 people (39.5% of all cases of detected pathology) were sick with viral hepatitis. Among the sick were 82 doctors, 72 nurses, 2 laboratory assistants of health care facilities and 1 nurse. The work experience of physicians with viral hepatitis (before the diagnosis of an occupational disease) varied from 8 to 38 years.
According to the etiological basis, two main groups of diseases were distinguished - chronic hepatitis B, diagnosed in 62 people, chronic hepatitis C - in 80 people, mixed hepatitis was rare - 15 people (B + C, B + C + Delta). In medical workers, the risk group for parenteral forms of viral hepatitis B and C includes surgeons, anesthesiologists, resuscitators, obstetrician-gynecologists, laboratory assistants, medical procedural nurses and all other medical workers in contact with blood and other body fluids. The "entrance gate" for the infection was the skin damaged during operations, injections, endoscopic examinations of patients (93%) or infection occurred when infected material (blood, ascitic fluid) got on the mucous membranes (7%).
So, out of 82 doctors infected with viral hepatitis, there were 28 surgeons, 12 traumatologists, 11 obstetrician-gynecologists, 6 resuscitators, 5 doctors of hemodialysis departments, 4 dentists, 3 therapists, two of them were sick among infectious disease specialists, urologists, laboratory assistants, ophthalmologists and 1 case of the disease was recorded among hematologists, neuropathologists, dermatovenereologists, endoscopists, and acupuncturists.
Among the 72 nurses infected with viral hepatitis, there were 33 procedural nurses, 18 operating rooms, 9 "ward" nurses, 6 infectious disease nurses, 3 anesthetist nurses and 3 hemodialysis nurses.
Viral hepatitis B was detected in 62 people, of which 28 people were doctors (7 surgeons, 5 hemodialysis doctors, 5 traumatologists, 3 obstetrician-gynecologists, 2 dentists,
table 2.
The structure of occupational morbidity of medical workers
Year of observation Total Tuberculosis Viral hepatitis 3 n £ « £ ? $ and o r 3 n Ї £ | K 2
2004 61 6 29 24 2 -
2005 37 9 7 12 1 -
2006 38 3 14 11 -
2007 32 3 10 11 4 1 1 1
2008 40 7 9 14 5 1 1 0
1 hematologist, 1 neurologist, 1 dentist, 1 urologist, 2 resuscitators); 33 nurses (22 - procedural and ward, 5 anesthetists, 5 operating rooms, 1 laboratory assistant of the ITU bureau); from junior medical staff, 1 laboratory nurse was injured as a result of wounding her hands with glasses of a broken test tube containing blood.
Among doctors, viral hepatitis C was detected in 39 people (14 surgeons, 3 anesthesiologists, 8 traumatologists, 8 ophthalmologists, 1 emergency doctor, 1 dermatologist, 1 infectious disease specialist, 1 laboratory assistant, 1 radiologist, 1 urologist).
Among nurses, 41 cases of viral hepatitis C were recorded. Of these, 12 were operating nurses, 11 were procedural nurses, 5 cases were anesthetists, 6 were nurses of infectious diseases departments, 4 were “ward” nurses of surgical hospitals and 3 were nurses of hemodialysis departments .
Currently, there is a slight decrease in the incidence of hepatitis B, which is associated with the immunization of medical workers, greater care of doctors for their health (more regulated use of personal protective equipment), as well as with the introduction of antiviral therapy regimens and, accordingly, with the effectiveness of the treatment of the disease.
For the diagnosis of occupational viral hepatitis and the connection of the diagnosis of hepatitis with the work performed, it is necessary to describe in the sanitary and hygienic characteristics or the map of the epidemiological investigation the cases of damage to gloves, skin, etc. during manipulation and indicate the names of patients with positive markers of viral hepatitis.
Tuberculosis infection of medical workers can occur both in anti-tuberculosis institutions and in medical institutions of the general medical network. The analysis of the length of service of medical personnel before infection showed that medical workers with a short work experience (up to 5 years) are more likely to be infected. At the same time, middle and junior medical personnel are more likely to suffer from tuberculosis than doctors.
During the analyzed period, 69 medical workers with tuberculosis were identified. Among the sick are 30 doctors: 2 phthisiatrician surgeons, 17 phthisiatricians, 5 therapists, 2 radiologists, 1 pulmonologist, 1 infectious disease specialist, 1 extra doctor, 1 abdominal surgeon.
53 cases of tuberculosis of the nursing staff have been identified. Among them are 30 nurses of TB hospitals, 6 laboratory assistants of the TB dispensary, 3 nurses of the general hospital, 8 forensic laboratory assistants, 3 nurses of the TB hospital for convicts, 2 ambulance paramedics, 1 dental technician.
Junior medical personnel are also susceptible to tuberculosis (out of 13 nurses who fell ill, 1 is a nurse of the pathological and anatomical department of a general medical facility, 1 is from a forensic medical examination bureau, 11 are nurses of anti-tuberculosis facilities). Tuberculosis of medical workers, as a rule, occurs in the form of "small forms" - focal, infiltrative tuberculosis, tuberculoma of the upper lobes of the lungs, tuberculous pleurisy.
Occupational bronchial asthma is one of the most common allergic diseases in medical workers. Thus, among the examined medical workers, professional bronchial asthma was diagnosed in 56 people, which is 62.2% of all identified allergic diseases for this period (for comparison, allergic urticaria is 18.9%, allergic rhinitis 8.9%, allergic dermatitis 10.5%). Occupational bronchial asthma was diagnosed in 9 doctors, 6 pharmacists, 39 nurses and 2 pharmacists. The predominance of nurses, mainly procedural nurses among patients with occupational bronchial asthma, is due to the fact that they have contact with more a wide range substances with an allergenic effect. According to our data, the leading etiological factors causing bronchial asthma among medical workers (in all the medical workers we observed it was allergic) are latex, disinfectants - sulfathiazole, chloramine, formaldehyde, as well as antibiotics, herbal medicinal raw materials, chemical components of diagnostic kits .
Among the occupational diseases of physicians from harmful production factors of physical nature in our practice, there were occupational diseases of medical workers from exposure to contact ultrasound - 1 person (vegetative-sensory polyneuropathy) and X-ray radiation (1 radiologist - recurrent basalioma of the skin).
Conclusion
The high level of occupational morbidity of medical workers and its more severe course is determined in our opinion:
Unfavorable and harmful working conditions of a physical, chemical, biological nature, depleting the body's defenses and making it more susceptible to the action of a causative factor;
A high frequency of comorbidity caused by several causative factors (mixed hepatitis, hearing loss associated with the action of ototoxic drugs and noise, etc.), which is more severe and with a more unfavorable prognosis;
Work in conditions of constant neuro-psychological overstrain (chronic stress), associated with a high responsibility for the health and life of patients;
Non-physiological working conditions - part-time work, night and shift work, uncomfortable microclimate of the premises, often - the inability to comply with the rules of personal hygiene, etc .;
The resistance of some medical workers to drug therapy, requiring an increase in doses of drugs, lengthening treatment courses, which can more often cause complications of pharmacotherapy. This may be due to:
The phenomena of mithridatism, addiction, resistance to medicinal substances in normal doses (deterioration of their absorption, acceleration of metabolism and excretion);
Decreased sensitivity of pharmacological receptors to drugs with which the physician may have constant contact in the process labor activity;
In the case of infectious diseases - the immunity of hospital strains of microorganisms to widely used antibacterial drugs (multiple drug resistance);
Widespread self-treatment among healthcare workers without observing the principles of clinical pharmacology - shortened courses, inadequate doses, etc., due to the relative availability of drugs;
Formal, low-quality conduct of decreed medical examinations, which sometimes turn into simple execution or self-registration of the relevant documentation. During preliminary medical examinations, this leads to the admission to work of persons with medical contraindications, for example, to surgical activities - with pathology of the venous system of the lower extremities; and during periodic medical examinations - to the chronicity and irreversibility of diseases;
A biased assessment by medical workers (including managers) of the potential danger of a particular medical profession, for example, when
translations and employment for medical reasons (diagnostic, physiotherapy (microwave, ultrasound) rooms, etc.);
Neglect, fear of specific preventive measures, in particular, vaccination, which not only leaves the physician virtually defenseless against this or that infection (for example, viral hepatitis), but can turn him into a source of infection for patients, and in case of illness, it is significantly more difficult to obtain appropriate compensation.
In addition, the high level of occupational morbidity of medical workers (the first class of occupational risk), exceeding the levels of occupational morbidity in professions with a higher class of occupational risk, raises both the question of the need to revise the occupational risk class of medical workers, and indirectly the question of underestimation (low detectability) occupational pathology in professions with a higher class of occupational risk. And
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The work of doctors is one of the most complex and responsible types of human activity. It is characterized by a significant intellectual load, and in some cases - by great physical exertion and endurance. Higher requirements are imposed on medical workers, including the amount of operational and long-term memory, attention, and high working capacity in extreme conditions.
The result of the activity of medical workers - the health of patients - is largely determined by the working conditions and the state of health of employees. By occupation, a doctor (as well as a middle and junior medical worker, a pharmacist and a pharmacist) is affected by a complex of factors of a physical, chemical, biological nature. Doctors experience high neuro-emotional stress. In addition, in the course of professional activity, a medical worker is subjected to functional overstrain of individual organs and systems of the body (from functional overstrain of the musculoskeletal system to overstrain of the organ of vision).
The results of studying the case histories of medical workers made it possible to identify the following etiological structure of occupational diseases:
The impact of biological factors - 63.6% of patients;
Allergies (due to exposure to antibiotics, enzymes, vitamins, formaldehyde, chloramine, latex, detergents) - 22.6%;
Diseases of toxic-chemical etiology - 10%;
Overvoltage of individual organs and systems of the body - 3%;
The impact of physical factors (noise, ultrasound, x-rays) - 0.5%;
Neoplasms - 0.25%.
Allergies. Allergic reactions to natural latex dust are highly prevalent among healthcare workers. The prevalence of latex allergy is 22.61%. Clinically, latex allergy in medical workers in 32.5% of cases proceeds according to the type of immediate hypersensitivity and is manifested by bronchial asthma, allergic rhinitis, urticaria, including in 6% of cases - acute allergic reactions (Quincke's edema, anaphylactic shock) requiring immediate medical attention. In 67.5% of cases, allergic reactions upon contact with natural latex proceed as delayed-type hypersensitivity and are manifested by contact dermatitis.
The most severe and prognostically unfavorable allergic disease among medical workers is anaphylactic shock - an allergic reaction of an immediate type. It is characterized by rapidly developing predominantly general manifestations: a decrease in blood pressure, body temperature, a disorder of the central nervous system, an increase in vascular permeability and spasm of smooth muscles. Anaphylactic shock develops in response to the repeated administration of the allergen, regardless of the route of entry and the dose of the allergen (it may be minimal).
For example, a case of anaphylactic shock is known as a reaction to traces of penicillin in a syringe remaining in it after it has been processed, washed and boiled. An allergic reaction of an immediate type is characterized by rapid development, violent manifestations, extreme severity of the course and consequences. The type of allergen does not affect the severity of anaphylactic shock. Its clinical picture is varied. The less time has passed since the allergen entered the body, the more severe the clinical picture. The largest percentage deaths anaphylactic shock gives when it develops 3-10 minutes after the allergen enters the body.
Occupational bronchial asthma (OBA) is one of the most common allergic diseases in healthcare workers. PBA is defined as a disease caused by exposure to allergens on the respiratory tract at the workplace of a medical worker or pharmacist. The leading etiological factors causing PBA are latex, disinfectants (sulfathiazole, chloramine, formaldehyde), antibiotics, herbal medicinal raw materials, and chemical components of diagnostic kits. Many occupational factors that medical and pharmaceutical workers come into contact with have a strong irritating effect on the nasal mucosa and lung tissue. The main symptoms of the disease are itching and irritation of the nasal cavity, sneezing and rhinorrhea, often accompanied by nasal congestion.
The research results confirmed that viral hepatitis is the leader among all occupational diseases of medical workers - 39.5% of patients. According to the etiological basis, three groups of diseases were distinguished: chronic hepatitis B, chronic hepatitis C and mixed hepatitis B + C, B + C + D, with hepatitis C predominating. The relative regression of hepatitis B is apparently associated with the immunization of medical workers, as well as their greater attention to their health, more regulated use of personal protective equipment.
The risk group includes not only persons who have direct contact with the blood of patients (surgeons, resuscitators, operating and procedural nurses, etc.), but also physicians of therapeutic specialties who periodically perform parenteral procedures, who have practically no anti-epidemic alertness.
Potentially hazardous body fluids include cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, and seminal fluid. Their contact with microdamaged skin and mucous membranes can cause infection of a medical worker.
Features of viral hepatitis in healthcare workers are:
Frequent development of mixed (mixed) forms of hepatitis (B + C), which aggravates the clinic of the disease and its prognosis;
The development of viral hepatitis against the background of previous toxic-allergic liver damage (drug, chemical, toxic-allergic hepatitis);
The presence of varying degrees of resistance to drug therapy; more frequent development of complications of hepatitis: liver failure, cirrhosis, liver cancer.
Infection with tuberculosis of medical workers is possible as in anti-tuberculosis institutions. and in institutions of general medical profile - departments of thoracic surgery, pathological-anatomical and forensic medical bureaus, i.e., where contact with tuberculosis patients - bacilli excretors or infected material is possible (employees of bacteriological laboratories).
The clinical picture of tuberculous skin lesions is reduced to the development of characteristic elements, the professional nature of which is confirmed by localization typical for warty tuberculosis of the skin (at the site of skin microtraumas during work, mainly on the fingers). In some cases, professional skin tuberculosis can be diagnosed by pathologists on the skin of the fingers and the back of the hands (“cadaveric tubercle”). For medical workers, influenza and childhood infectious diseases (measles, diphtheria, mumps) are also very relevant in terms of infection.
These diseases in epidemiological, etiological and clinical terms combine such features as transmission by airborne or airborne dust, a high incidence rate that periodically takes on the character of an epidemic, the involvement of large contingents of medical workers in the care of patients (for example, during influenza epidemics), often without experience in difficult epidemiological conditions, lack of natural or insufficient effectiveness of artificial immunity to influenza and childhood infectious diseases. At the same time, the diagnosis of a chronic occupational disease is possible only in persons with persistent residual effects after an infection.
It is possible for a healthcare worker to become infected with HIV through contact with the blood and other biological fluids of AIDS patients and HIV-infected patients.
Occupational diseases of toxic-chemical etiology. In most cases, toxic and toxic-allergic hepatitis develops in medical workers due to exposure to anesthetics and antibacterial drugs. When studying the microclimate of operating rooms, it was found that even with a normally functioning ventilation system, the concentration of the most widely used anesthetic, ether, in the anesthesiologist's breathing zone exceeds the maximum allowable concentration by 10-11 times, and in the surgeon's breathing zone - by 3 times. This leads to diffuse lesions of the hepatic parenchyma, pigment metabolism disorders, and the development of toxic-allergic hepatitis.
Defeat upper respiratory tract irritant chemicals was typical for junior medical personnel, laboratory workers and manifested itself in the form of non-specific catarrhs of the mucous membrane. In workers with a long work experience, the outcome of catarrhal rhinitis was chronic atrophic rhinitis.
Occupational diseases from overexertion of individual organs and systems of the body. Staying in an irrational posture leads to a rather rapid development of functional insufficiency of the musculoskeletal system, which is manifested by fatigue and pain. The first signs of fatigue (for example, the muscles of the hands of otorhinolaryngologists) appear after 1.5-2 years of work and are associated with hand fatigue. With a constant stay in a forced working position of otorhinolaryngologists, surgeons, dentists and other specialists, the violations become persistent, up to the formation of individual diseases of the musculoskeletal system, nervous and vascular systems. In practice, varicose veins of the lower extremities and cervicobrachial radiculopathy were more common among medical workers.
Chronic venous insufficiency of the lower extremities is one of the most common diseases. Among the professional factors influencing its development, physical overstrain, a long-term static load of persons performing standing work, such as surgeons, are important.
Patients complain of pain in the veins throughout the lower limb, which, unlike obliterating endarteritis or atherosclerosis of the arteries, is associated with long standing, and not with walking. Walking, especially at the beginning of the disease, even brings relief. On examination, the convolutions and tangles of dilated veins are determined on the inner or posterolateral surfaces of the lower leg and thigh. The skin at the beginning of the disease is not changed.
With a far advanced process, pigmentation (hemosiderosis) of the skin on the lower leg, atrophic and eczematous changes, edema, scars, ulcers are noted. Acute infectious complications (thrombophlebitis, lymphangitis) are manifested by areas of inflammatory hyperemia, often in the form of stripes. A varicose ulcer is localized, as a rule, on the lower leg, its shape is round, less often scalloped, the edges are slightly undermined. The ulcer is a flaccid, often cyanotic granulation surrounded by a flat, pigmented scar.
Prevention of occupational varicose veins in the legs of medical workers consists of the following areas:
Qualified professional selection for work related to prolonged stay on the legs (surgeons, operating nurses, etc.). Persons with chronic diseases of the peripheral nervous system, obliterating diseases of the arteries, pronounced enteroptosis, hernia, and anomalies in the position of the female genital organs are not allowed to work. When vocational guidance for future specialists, it is necessary to exclude the constitutional weakness of the connective tissue, for example, flat feet;
Qualified periodic medical examinations, the purpose of which is to diagnose the compensated stage of varicose veins and the corresponding timely employment of patients without reducing qualifications. Retraining is possible taking into account the main profession, active medical rehabilitation;
Rational organization of the work regime, if possible excluding a long stay on the legs (rationally organized operating days, comfortable microclimate, rooms for physical and psychological unloading, etc.), physiotherapy exercises.
Coordinating neurosis is an occupational disease of the hands. The most typical symptom of professional hand dyskinesia is the specific handwriting of medical workers whose work is associated with the constant filling out of medical records.
The development of dyskinesia is based on a violation of the functional state of the central nervous system. More often, coordinating neuroses develop as a result of prolonged monotonous work against the background of emotional stress.
Premorbid features also contribute to the development of dyskinesia:
Inferiority of the musculoskeletal system (insufficient development of the muscles of the shoulder girdle, scoliosis of the thoracic spine);
Personal characteristics;
Age-related changes and other additional factors that negatively affect the functional state of the nervous system (mental trauma, infections, etc.).
The most favorable effect in the treatment of occupational hand dyskinesias is noted with complex treatment: a combination of acupuncture with electrosleep, autogenic training, hydroprocedures, therapeutic exercises. In addition, patients are prescribed salt-coniferous or pearl baths, depending on the nature of functional disorders, sedatives and small tranquilizers.
The work of certain categories of medical specialists is characterized by visual strain - when working with laboratory, operating microscopes, computers, in microsurgery, dentistry, otorhinolaryngology (small sizes of objects of distinction) and leads to a deterioration in visual functions, which is manifested by an accommodation disorder.
A worker whose eyes cannot cope with these conditions quickly develops visual and general fatigue. There are complaints of a feeling of weakness, rapid fatigue when reading and working at close range, pain of a cutting and breaking nature in the area of the eyes, forehead, crown, blurred vision, the appearance of periodic doubling of objects, etc. A complex of visual functional disorders develops, which is commonly called asthenopia.
To prevent the development of asthenopia and myopia, careful professional selection is necessary when applying for a job related to the performance of precise operations. The ophthalmologist, in addition to identifying diseases of the organ of vision, should examine the refraction of the eyes, color perception, the state of convergence, stereoscopic vision, and muscle balance.
When refractive errors are detected, the correct selection of corrective glasses is recommended. Correction of refractive errors is a necessary condition in the fight against rapid eye fatigue during visual work. Corrective glasses must be selected taking into account the distance from the working surface to the eyes.
Preventive measures include physical exercises, gymnastics for the eyes, rational nutrition with the addition of calcium, vitamin D, hardening of the body.
Occupational diseases from the action of physical factors. Among the harmful production factors of a physical nature (vibration, noise, various types of radiation), the causes of the development of occupational diseases in medical workers are primarily various types of ionizing and non-ionizing radiation (radiation, ultrasound, laser radiation, microwave radiation), which can cause radiation sickness, local radiation injuries, vegetative-vascular dystonia, asthenic, asthenovegetative, hypothalamic syndromes, local tissue damage by laser radiation, vegetative-sensory polyneuropathy of the hands, cataracts, neoplasms, skin tumors, leukemia.
The most exposed to radiation are medical personnel serving X-ray rooms, radiological laboratories, as well as some categories of surgeons (X-ray surgical teams), employees of scientific institutions. With frequent performance of procedures, in which X-ray control is associated with the nature of the surgical intervention, radiation doses may exceed the permissible ones. The exposure dose of medical workers should not exceed 0.02 Sv (Sv (Sievert) - the dose of any type of ionizing radiation that produces the same biological effect as the dose of X-ray or gamma radiation equal to 1 Gray (1 Gy = 1 J / kg)) in year.
A large place among the occupational morbidity of medical workers is occupied by diseases associated with exposure to laser radiation and ultrasound. Laser systems generate electromagnetic radiation, which is characterized by monochromaticity, coherence, and high energy density. The energy of laser radiation in biological tissues is transformed into thermal energy, it can potentiate photochemical processes and have a damaging effect.
The maximum absorption of laser radiation energy occurs in pigmented tissues; therefore, the organ of vision is often damaged. In mild cases of eye damage, transient functional disorders are usually noted - dark adaptation disorders, changes in corneal sensitivity, transient blindness. In more severe eye diseases, scotoma occurs (loss of part of the visual field) without any pain. Systemic effects on the nervous system are also characteristic - vegetative-vascular dystonia, asthenic, astheno-vegetative, hypothalamic syndromes.
Along with direct exposure to the beam, the development of occupational pathology among those working with medical lasers is facilitated by:
Diffuse-reflected and scattered laser radiation;
Insufficient illumination of objects of influence, manipulation technologies that require an increased load on vision;
Stable and impulsive noise that accompanies the operation of laser systems;
Significant neuro-emotional stress due to the great responsibility of medical personnel.
Contact with sources that generate ultrasound can lead to occupational diseases of the hands in the form of angioedema, polyneuropathies (vegetative-sensitive and sensorimotor forms of polyneuritis), often accompanied by a functional disorder of the nervous system (neurasthenia syndrome, vegetative-vascular dystonia). Cerebral microorganic symptoms are possible.
Among healthcare professionals, dentists are the most exposed to noise (and vibration). High sounds generated during the operation of dental equipment lead to adverse changes not only in the hearing organ, but also in the nervous system. The treatment is aimed at improving the functional state of the labyrinth receptors.
Rarely enough, a vibration disease occurs in dentists, the most characteristic of which are angiodystonic, angiospastic, vegetative-sensory and other clinical syndromes. The disease develops slowly, after 5-15 years from the start of work associated with vibration, with continued work, the disease increases, after cessation, a slow (within 3-10 years), sometimes incomplete recovery is noted. Patients complain of pain and paresthesia in the hands, chilliness of the fingers, they are concerned about diffuse pain and paresthesia in the hands, less often in the legs, decreased pain, temperature, and tactile sensitivity of the polyneuritic type.
Diseases of the nervous system. Neuroses are psychogenic functional disorders of mental (mainly emotional-volitional) and neurovegetative functions, while maintaining the patient's fairly correct understanding and critical assessment of symptoms, himself and those around him with a mild violation of social adaptation. Occupational neuroses can develop with prolonged direct service to mentally ill people.
Increased excitability is noted by all analyzers: the usual noise is annoying, the light is blinding, the conversation is tiring. Increased excitability is manifested by impatience, haste, fussiness. Frequent complaints of a painful feeling of emptiness in the head. Remembering names, numbers, dates presents insurmountable difficulties. As neurasthenia develops, patients become more lethargic, lazy, weak-willed, apathetic. Mood swings increase with a hint of melancholy, hypochondriacal symptoms appear, extreme concentration on one's painful sensations.
The so-called depression of exhaustion can develop, with a duration of neurosis of more than 2 years, a restructuring of the personality structure occurs in the form of new stereotypes in behavior and emotional defensive reactions, changes in attitudes, a hierarchy of motives and values. The way of life and the patient's reactions to domestic and industrial circumstances acquire a stereotypical neurotic character, the painful state turns into a habitual way of existence (neurotic development of the personality according to the asthenic, hysterical, hypochondriacal type).
With appropriate psycho-correction, rational organization of work, excluding (or reducing) the possibility of mental trauma, patients remain able-bodied
In any field of activity there are problems and ailments characteristic of certain specialties. A special line are occupational diseases of medical workers. Many do not even suspect that representatives of this profession put themselves at risk every day, dealing with pathologies of varying severity, pathogenic bacteria and electromagnetic devices. A combination of factors can provoke the development of irreversible changes in the body, which are considered to be occupational diseases.
Once in such a situation, a healthcare worker is entitled to receive benefits and subsidies. However, not everyone has an idea where to turn and what types of support you can count on.
Definition of occupational diseases. Legal side of the issue
There are two types of occupational diseases: acute and chronic. In the first case, we are talking about a short-term ailment that manifests itself during the working day. The causes of this pathology can be the impact of any external factors, for example, intoxication of the body, provoked by the action of a poisonous substance.
In the second case, we are talking about long-term exposure, as a result of which harmful factors accumulate in the body, becoming chronic. Depending on the type of pathology, the amounts of compensation differ: lump-sum payments, monthly benefits and packages of non-material benefits.
To resolve these issues, a number of legislative acts are provided. For example, Federal Law No. 125 of July 24, 1998:
- article 5: list of persons for whom social insurance against accidents and occupational diseases is mandatory;
- articles 11 and 12: the amount of insurance payments.
In addition, these include:
- Federal Law No. 323 dated November 21, 2011: the basics of protecting the health of citizens of the Russian Federation.
- Article 350 Labor Code: features of labor regulation of medical workers.
- Government Decree of December 15, 2000: indexation of one-time and monthly payments.
- Order of the Ministry of Health No. 417 of April 27, 2012: list of occupational diseases.
Varieties and categories
- anesthesiologists;
- surgeons;
- radiologists;
- dentists;
- pathologists;
- infectious disease specialists;
- medical staff of middle and junior level;
- pharmacists;
- laboratory assistants.
The risk group also includes employees of enterprises engaged in the production of medicines and other medical products.
In general, occupational diseases of healthcare workers are divided into 4 categories (Order of the Ministry of Health and Social Development of Russia dated April 27, 2012 No. 417n):
- Chemical-toxic poisoning. They appear as a result of prolonged interaction of the skin with dangerous chemicals: arsenic, camphor, iodine solution. They can be expressed by acute poisoning or severe intoxication of the body.
- Biodefeat. Ailments are manifested due to constant contact with patients suffering from infectious diseases. The main pathologies of this group are: HIV infection, tuberculosis, hepatitis.
- Physical and mechanical damage. Occupational diseases of radiologists and medical staff working with radiation equipment. Magnetic resonance and other radiation, with prolonged exposure, negatively affects the functioning of all organs and systems of the human body. The most affected are the cardiovascular and central nervous systems.
- Physical inactivity. It occurs in specialists whose professional activity involves a long stay in one position of the body. Here, atrophy of the tissues of the lower extremities, problems with the spine and organs of vision can be observed.
- damage to the nervous system;
- pathological changes in the spine;
- diseases of the upper respiratory tract, including bronchial asthma;
- conjunctivitis;
- connective tissue damage.
In fact, the characteristic features of all four categories are collected here. In addition, dental technicians can suffer from silicosis: a pathology that develops as a result of the ingress of cement particles into the oral cavity.
How to apply for an occupational disease
- notification of the management and a representative of the supervisory organization that controls the sanitary and epidemiological state of the medical institution;
- within 24 hours, upon the fact of the employee’s request, an inspection should be carried out to ensure that the workplace complies with safe working conditions;
- based on the results of the check, an act is drawn up, which is sent to a higher authority: the Ministry of Health, from where it is confirmed that the disease belongs to the category of occupational diseases;
- the employee receives a medical certificate confirming the fact of an occupational disease.
If an illness is detected, an employee can be transferred to another place of work, where the influence of factors that led to the development of pathology is excluded. If the symptoms pass, the person returns to their original place.
Important! There are a number of restrictions on work activity for medical workers who are faced with occupational ailments. In particular, persons infected with hepatitis or HIV infection cannot work with invasive drugs. Employees who have been ill with tuberculosis are allowed to perform their previous professional duties after recovery. Exception: pediatricians and other staff working with children.
Benefits and allowances
- one-time compensation for disability (professional) - the employee retains his job, but cannot perform his previous duties;
- monthly benefits - calculated personally, depending on the severity of the disease, paid as a percentage of the salary.
In addition, such employees must be provided with vouchers for sanatorium treatment, if there is a medical need for this and the direction of a medical expert commission. Travel in both directions is paid.
Registration procedure
To receive benefits, an employee who has received an occupational disease must act according to the following scheme:
- contact a general practitioner in your area, having a document certifying the presence of an occupational disease;
- pass necessary tests, undergo an examination by specialized doctors;
- after passing a medical examination, get a referral for a medical and social examination;
- members of the commission, based on the opinion of doctors, confirm the disease, determine the degree of its severity;
- having received the conclusion of the MES, a citizen must contact the social insurance department at the place of residence, collecting a package of documents necessary to receive benefits;
After that, the person is assigned benefits and material payments prescribed at the state level. Privileges are based on:
- passports;
- conclusions
- Medico-social expert meeting">MES ;
- an act certifying the fact of an occupational disease;
- work book (photocopy);
- information about the average salary.
An application for benefits is written at the place of application. This is best done in the presence of a social security officer to avoid filling out errors.
Preventive actions
To date, there are two types of preventive measures aimed at preventing the development of occupational diseases among healthcare workers. They are conditionally divided:
- primary;
- secondary;
The first category includes theoretical activities, which include lectures on this topic, mandatory training on safety at work, familiarization of employees with statistics.
Secondary measures are more effective and include the following procedures:
- conducting inspections at workplaces, the purpose of which is to control compliance with personal hygiene, rules for working with hazardous substances, waste disposal;
- providing personnel with personal protective equipment;
- conducting regular medical examinations to identify occupational ailments on early stages development, preventing their development into a chronic phase.
The combination of such measures allows timely identification of potentially dangerous factors and prevention of the development of ailments.
Occupational health insurance:
All employed citizens of the Russian Federation, including healthcare workers, are entitled to compulsory social insurance. All necessary contributions in such cases are paid by the direct employer. If this moment is framed in accordance with the letter of the law, the employee who has received an occupational disease acquires the right to material compensation for the harm caused to health.
Reimbursement is expected in cases where a citizen applied to the Social Insurance Fund to obtain an appropriate certificate. Such certificates should be in the hands of every employed citizen.
It is important to understand that many healthcare professionals are at risk of infection on a daily basis through contact with their patients. Therefore, the task of the state and departmental organizations is to reduce the likelihood of occupational diseases, and to provide medical staff with comprehensive support if workers are faced with this problem.
Prepared by: Kulagina Ekaterina Alexandrovna
In terms of the number of newly diagnosed occupational diseases, medicine annually ranks third. In the structure of occupational morbidity, the places were distributed as follows:
Tuberculosis
Viral hepatitis
2.Allergic diseases:
Contact dermatitis and/or allergic eczema
Bronchial asthma
Drug allergy (rhinitis, conjunctivitis)
Others (neoplasm, chronic bronchitis)
The most common adverse factor in the working environment of medical workers is air pollution of working premises with aerosols of medicinal substances, disinfectants and narcotic drugs, which can significantly exceed the permissible sanitary standards in pharmacies, operating rooms, treatment rooms and other premises. There is a constant threat and often there is infection of workers with infectious diseases, including especially dangerous ones, such as tuberculosis, viral hepatitis B, C, which are included in the list of occupational diseases of health workers. The workplace can be exposed to various types of ionizing and non-ionizing radiation, high, ultra-high, ultra-high (microwave) frequencies of electromagnetic waves.
At-risk groups
Doctors (surgeons, dentists, anesthesiologists)
Middle and junior medical personnel
Laboratory assistants, incl. employees of the Republican Scientific and Practical Center, centers of hygiene and epidemiology
Pharmacy staff
Employees of various enterprises of the medical industry, etc.
Labor severity scale
Diseases of medical workers caused by exposure to chemical factors: acute, chronic intoxications and their consequences, occurring with isolated or combined
damage to organs and systems.
In medicine, chlorine compounds are widely and constantly used among irritants (chlorine lime, hydrochloric acid) and sulfur (hydrogen sulfide, sulfuric acid), nitric acid, acetic acid, formaldehyde and others. They are used in clinical and biochemical laboratories, thanatological and anatomical departments, for disinfection and disinsection, etc. In the conditions of professional activity of medical workers, the effect of irritating substances is mainly chronic, although in certain situations, for example, during disinfection work with organochlorine compounds ( employees of dispensaries) there may be acute poisoning.
Health workers, depending on the specifics, in the workplace can be exposed to the whole range of physical factors
Ionizing radiation; radioactive substances and other sources of ionizing radiation
Non-ionizing radiation:
Electromagnetic radiation of the optical range (radiation from lasers of III and IV hazard classes)
Electromagnetic field
Ultraviolet radiation
Vibration
Ultrasound (contact transmission)
Increased atmospheric pressure
Low air temperature
Increased air temperature
thermal radiation
Diseases registered in medical workers from exposure to physical factors
radiation sickness, local radiation injuries;
asthenic, asthenovegetative, hypothalamic syndromes;
local tissue damage by laser radiation: vegetative-sensory polyneuropathy of the hands;
cataract;
neoplasms, skin tumors, leukemias.
Diseases associated with physical overload and overstrain of individual organs and systems
Severe varicose veins in the legs, complicated by inflammatory (thrombophlebitis) or trophic disorders I83
Progressive myopia H52.1
Coordinator neuroses, including writing spasm F48.8
Among the almost 40,000 currently existing professions, more than 4 million medical workers occupy a special social niche. The work of doctors is one of the most complex and responsible types of human activity.
It is characterized by a significant intellectual load, and in some cases - by great physical exertion and endurance. Higher requirements are imposed on medical workers, including the amount of operational and long-term memory, attention, and high working capacity in extreme conditions.
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That is why it remains in focus today.
The result of the activities of medical workers - the health of patients - is largely determined by the working conditions and the health status of employees. By occupation, a doctor (as well as a middle and junior medical worker, a pharmacist and a pharmacist) is affected by a complex of factors of a physical, chemical, biological nature.
Doctors experience high neuro-emotional stress. In addition, in the process of professional activity, it is subjected to functional overstrain of individual organs and systems of the body (from functional overstrain of the musculoskeletal system to overstrain of the organ of vision).
Prevention of occupational diseases of health workers
The works of Acad. RAMN N.F. Izmerova, V.G. Artamonova, N.A. Mukhin, the first monograph in the Russian Federation by the Honored Scientist of the Russian Federation, Professor V.V. Kosareva “Occupational diseases of medical workers” (1998).
The results of studying the case histories of medical workers who applied to the clinical expert commission of the Samara Regional Center for Occupational Pathology over the past 15 years (397 people: doctors, nurses, laboratory assistants, nurses) made it possible to identify the following etiological structure of occupational diseases:
Structure and full list occupational diseases of medical workers are enshrined in the order of the Ministry of Health and Medical Industry of Russia dated March 14, 1996 No. 90 “On the procedure for conducting preliminary and periodic medical examinations of workers and”.
Prevention of occupational diseases: allergies
Allergic reactions to natural latex dust are highly prevalent among healthcare workers. According to E.V. Makova (2003), the prevalence of latex allergy is 22.61%.
Clinically, latex allergy in medical workers in 32.5% of cases proceeds according to the type of immediate hypersensitivity and is manifested by bronchial asthma, allergic rhinitis, urticaria, including in 6% of cases - acute allergic reactions (Quincke's edema, anaphylactic shock), requiring providing emergency medical care.
In 67.5% of cases, allergic reactions upon contact with natural latex proceed as delayed-type hypersensitivity and are manifested by contact dermatitis.
The most severe and prognostically unfavorable is anaphylactic shock - an allergic reaction of an immediate type.
It is characterized by rapidly developing predominantly general manifestations: a decrease in blood pressure, body temperature, a disorder of the central nervous system, an increase in vascular permeability and spasm of smooth muscles.
Anaphylactic shock develops in response to the repeated administration of the allergen, regardless of the route of entry and the dose of the allergen (it may be minimal). For example, a case of anaphylactic shock is known as a reaction to traces of penicillin in a syringe remaining in it after it has been processed, washed and boiled.
An allergic reaction of an immediate type is characterized by rapid development, violent manifestations, extreme severity of the course and consequences.
The type of allergen does not affect the severity of anaphylactic shock. Its clinical picture is varied. The less time has passed since the allergen entered the body, the more severe the clinical picture. Anaphylactic shock gives the highest percentage of deaths when it develops 3-10 minutes after the allergen enters the body.
The examination is not determined arterial pressure, or it is very low, the pulse is frequent, thready; heart sounds are quiet, in some cases they are almost not audible, an accent of the II tone over the pulmonary artery may appear. In the lungs during auscultation, hard breathing, dry scattered rales are heard. Due to ischemia of the central nervous system and edema of the serous membranes of the brain, tonic and clonic convulsions, paresis, paralysis can be observed.
Bronchial asthma
(PBA) is one of the most common allergic diseases of medical workers and occupies a leading position in the prevention of occupational diseases. PBA is defined as a disease caused by exposure to allergens on the respiratory tract at the workplace of a medical worker or pharmacist.
In separate epidemiological studies, it has been shown that up to 14% of all asthma patients suffer from PBA.
Thus, among medical workers examined in the Samara Regional Center for Occupational Pathology, PBA accounted for 62.2% of all identified allergic diseases (for comparison: allergic urticaria accounted for 18.9%, allergic rhinitis - 8.9, allergic dermatitis - 10.5%). PBA is mainly diagnosed in nurses, especially procedural ones, which is associated with prolonged contact of this category of medical workers with a wide range of substances that have an allergenic effect.
The leading etiological factors causing PBA are latex, disinfectants (sulfathiazole, chloramine, formaldehyde), antibiotics, herbal medicinal raw materials, and chemical components of diagnostic kits.
One of the reliable methods for the specific diagnosis of PBA is a provocative inhalation test with minimal concentrations. aqueous solutions allergens.
It is important to recognize the disease early (peak flowmetry at the workplace and at home), stop further contact with the allergen and start treatment in a timely manner. To confirm the occupational genesis of bronchial asthma, it is necessary to determine the serum level of total IgE and allergen-specific IgE (skin testing, enzyme immunoassay, radioallergosorbent test) for household, pollen, fungal, and professional allergens.
allergic rhinitis
Prevention of occupational diseases includes early diagnosis of allergic rhinitis in order to prevent its occurrence.
Many occupational factors that medical and pharmaceutical workers come into contact with have a strong irritating effect on the nasal mucosa and lung tissue. The main symptoms of the disease are itching and irritation of the nasal cavity, sneezing and rhinorrhea, often accompanied by nasal congestion.
Occupational diseases from exposure to biological factors
Dysbacteriosis, candidiasis of the skin and mucous membranes, visceral candidiasis develop in contact with infectious diseased or infected materials, fungi-producers, antibiotics (work in outpatient and inpatient medical institutions, pharmacies, bacteriological laboratories, enterprises of the microbiological medical industry, etc.).
When determining the degree of loss of professional ability to work in a medical worker in each case, the severity of violations of body functions, the degree of compensation, the patient's ability to perform work in the main profession to one degree or another, including in normal or specially created conditions, as well as measures rehabilitation, including vocational training and retraining.
To reduce the level of occupational morbidity of medical workers, it is effective to carry out immunization, antiviral therapy, and more attention of doctors and paramedical workers to their health and the use of personal protective equipment is required.
