CC BY
60
UDC 613.6.02:615.83
COMPLEX HYGIENIC EVALUATION OF WORKING CONDITIONS OF MEDICAL PERSONNEL FOR PHYSIOTHERAPEUTIC PROCEDURES
Altai State Medical University, Barnaul
B.A. Balandovich, A.A. Krasikov, C.I. Kudryavsky, A.S. Nagornyak, N.Yu.Tulin
This article deals with the problem of a comprehensive hygienic assessment of the working conditions of medical personnel involved in performing physiotherapeutic procedures for the purpose of rehabilitation of various population groups. Different degrees of occupational risk, classes of working conditions and indices of occupational morbidity for doctors and nurses with hydrotherapy, mud treatment, paraffin treatment, radon procedures and therapeutic massage are determined. A set of preventive measures has been developed to prevent occupational morbidity and increase morbidity with temporary disability.
Key words: medical personnel, sanatorium treatment, professional risk, physiotherapy procedures, class of working conditions, occupational morbidity index.
Introduction
The labor of medical personnel is one of the most complicated types of activity, as it is characterized by a considerable psychological tension, often intense physical load and high degree of responsibility for the safety and health of patients, combined with occupational risk for the own lives of doctors and nursing staff [1].
The influence of unfavorable work-related factors leads to the high degree of risk of professional diseases development in medical personnel (professional infections, allergic dermatitis, intoxication by medicinal drugs, anesthetic gases and decontaminating materials, diseases of the musculoskeletal system, radiation injuries of skin and organs of vision, etc.), and also causes the growth of overall chronic morbidity and emporary disability. The structure of overall incidence of the medical personnel, as a rule, is defined by 46% of respiratory diseases, by 14% of cardio-vascular diseases and by 5-6% of diseases of the digestive, nervous and musculoskeletal system [2].
A considerable part of medical personnel bares visual overstrain, works in an inconvenient working posture, contacts with the sources of infection (mainly tuberculosis, as the most common occupational infection), toxic chemical agents, works with the sources of electromagnetic, radioactive, laser, ultraviolet radiation and ultrasound [3].
Objectives.
The objective of the current study was to conduct the complex hygienic evaluation of the working conditions of medical personnel by complex use of physiotherapeutic procedures in the medical institution "Sanatorium of the Central Union of the Russian Federation" of resort-city Belokurikha of Altai Krai. The main goals consisted in the conduction of measurement of physical and chemical factors of the occupational environment at the working sites of doctors, nursing and auxiliary
personnel, determination of the classes of working conditions and degree of occupational risk with further elaboration of a complex of preventive measure aimed at the reduction of influence of harmful factors.
In terms of the work there were conducted the studies of physical and chemical factors of the occupational environment at 45 working sites of the medical personnel of the Municipal Institution "Sanatorium of the Central Union of the Russian Federation". In total, according to the current regulatory and procedural documents, there were made 180 measurements of microclimate by means of the microclimate tester "Meteoskop" and a combined device "TKA-PKM/43", 289 measurements of the parameters of the light environment (artificial lighting, pulsation coefficient, brightness, daylight factor) by lux meters "TKA-PKM/08" and "TKA-PKM/02", 135 measurements of the air ion composition (concentration of air ions of positive and negative polarity, coefficient of unipolarity) by means of the small-size air ion meter "MAS-01", 247 measurements of electromagnetic radiation by the three-component measuring instrument of parameters of electric and magnetic fields "BE-METR", 48 measurements of noise and equivalent levels of sound pressure by the noise meter-analyzer of spectrum "OKTAVA-110A", 270 measurements of the power of ambient equivalent of gamma-radiation dose by means of dosimeter-radiometer "DRBP-03" and 28 measurements of noxious substances in the air of working zone (hydrogen sulphide and petroleum hydrocarbon) by means of analyzer-leakage detector "ANT-3M" with the photoionization detector on the basis of the source of ultraviolet radiation with power 10,6 eV. The total number of changes of physical and chemical factors during the research constituted 1197.
The classes of labor conditions at workplaces of medical personnel for the separate factors of working environment were determined on the basis
of R 2.2.2006-05 "Guide on hygienic assessment of factors of working environment and work load. Criteria and classification of working conditions."
By the calculation of the occupational risk in accordance with R 2.2.1766-03 "Guide on the evaluation of occupational risk for the personnel health. Organizational and methodological frameworks. Principles and criteria for evaluation" there were considered coefficients characterizing the index of occupational diseases (Iod): for the class of working conditions 3.1 - 0,05-0,11; class 3.2 - 0,12-0,24; for the third degree of harmful working conditions - 0,25-0,49; for the class 3.4 - 0,51,0 which was further reflected by the construction of job profile diagrams for various working places of medical personnel.
Data processing.
For the evaluation of joint action both for physical and chemical factors of occupational environment there was used the integrated index of working conditions (IIWC) of Karmolin-Syromyatnikov [4], calculated according to the following formula:
IIWC =
Yi&rdf)
i>j=l
0.5
n
-0.5
(1)
where
di - real value of i unfavorable factor of working environment;
n - number of factors;
dj - variable value ranging depending on the factor value in the following way: if di<do, then dj= di; (2)
in case, if di>do, then dj=do, (3)
where
do - maximum permissible level (concentration) of i factor of working environment.
The integrated index of working conditions has 4 gradations which are characterized by particular value intervals with corresponding levels of professional risk:
• by IIWC<1 there are registered maximum permissible professional loads;
• by IIWC from 1,1 to 4,0 there is registered the first degree of occupational risk, characterized by functional changes in the organism, as a rule, restored by interruption of contact with harmful factors;
• by IIWC from 4,1 to 8,0 there is registered the second degree of occupational risk, causing steady functional changes in the majority of cases leading to the increase of professionally determined incidence and appearance of early symptoms of occupational diseases;
• by IIWC from 8,1 to 10,0 there is observed the third degree of professional risk leading to the development of medium and severe forms of professional pathology;
The statistical processing of the results of measurements of occupational environment factors and main indexes of working conditions of medical personnel were calculates by means of computer software «Statgraphica».
Results and discussion.
In terms of the research there was made the hygienic characteristics of technological processes and harmful working factors for separate physiotherapeutic procedures.
Thus, by hydrotherapy which includes a wide range of physiotherapeutic methods of treatment using fresh and mineral water (balneotherapy), the medical worker is involved into the process mainly from the controlling point of view, that is why the influence of air humidity is indirect and, in our case, corresponds to the permissible working conditions in terms of microclimate parameters. The integrated evaluation of working conditions at the mentioned workplace was characterized by 1,1 index which corresponds to the first degree of occupational risk combined with 3.1 class of labor conditions in consequence of noncorrespondence with the hygienic norms according to the light environment parameters (artificial lighting and pulsation coefficient).
During the process of mud therapy were used the packs with therapeutic mud prepared in advance which were mixed with water in particular proportions. It should be noted, that among the most frequently used types of mud - silt, turfy and pseudovolcanic, exactly the silt mud contains a considerable amount of sulfur compounds producing or evolving hydrogen sulphide by the procedures. The maximum one-time concentration of hydrogen sulphide in the air of the working zone by mud therapy constituted 3,25±0,3 mg/m3 which corresponded to TLV=10 mg/m3. The integrated index of working conditions (IIWC) for the nurse of mud therapy room constituted 1,4 which corresponds to the 3.1 class of labor conditions and first degree of occupational risk due to the state of light environment and air ion composition (by the unipolarity coefficient), and also index of professional incidence 0,05-0,11 which is shown in Figure 1.
By the characterization of paraffin therapy, it should be noted, that in the conditions of sanatorium-resort there were used several methods of the conduction of this procedure, in particular, cuvette-applicable method, method of layering and cloth applicable method. Since the above stated procedure required implementation of melted paraffin (the temperature of medical paraffin melting is 52-55 degrees Celsius), for the complex evaluation of microclimate at workplaces there was determined the index of thermal stress (ITC), the values of which varied in the
Figure 1.
Job-specific depiction of working conditions of the nurse of mud therapy room
ranges 21,7-22,3°C, not exceeding the hygienic norm constituting 25,1°C for ITC in compliance with the category of work intensity. It should be mentioned, that the process of melting was accompanied by evaporation of paraffin which leads to the evolvement of hydrocarbons into the air of the working zone. Meanwhile, the average shift concentration of petroleum hydrocarbons was 36,0±7,2 mg/m3 which also corresponded to TLV=300 mg/m3.
Radonic procedures performed in the sanatorium included both general radonic baths and local radonic irrigation (oral cavity, eyes, pelvic organs). The priority factor of harmful influence at workplaces of the radonic department personnel was the radiation factor, presented by the radon equivalent equilibrium volumetric activity (EEVA) in the air of sanatorium rooms combined with the equivalent dose rate (EDR) of gamma-radiation. Radon, contained in water used for the procedure, emanated both from the water itself into the air of working zone and was removed through the respiratory passages of patients after entering the organism. The results of the radiation control prove, that the values of radon EEVA at working places of radonic department personnel varied from 226,7±15,4 bK/m3 to 258,7±12,6 bK/m3, while EDR of gamma-radiation ranged from 0,15±0,02 mcSv/h to 0,17±0,03 mcSv/h which corresponded to the hygienic norms of "Radiation safety standards" RSS-99/2009 .
The procedure of the medical massage, performed in the sanatorium, as a rule, did not require the implementation of any additional physiotherapeutical equipment or other means,
creating the conditions for the change of levels of physical factors at working sites. The integrated index of working conditions of massage therapists ranged between 1,4 and 1,8, determining the first degree of occupational risk and 3.1 labor conditions class due to the increased air temperature, insufficient artificial lighting and noncorrespondence of the air ion composition to hygienic norms. The influence of factors of working load for massage therapists should also be mentioned - inconvenient working position with overload of particular groups of muscles, high load on the wrists and lumbar spine which determines the first degree of harmful labor conditions by the intensity of working process.
Conclusion. Consequently, the performed complex of hygienic studies of various types of physiotherapeutic procedures by sanatoriumresort treatment showed, that the labor conditions of medical personnel is mainly characterized by the first degree of occupational risk causing functional changes in the organism which, as a rule, are restores by the interruption of contact with harmful factors, but at the same time can lead to the development of non-specific pathology in the personnel with index of professional incidence 0,05-0,11.
The list of measures aimed at the prevention of influence of harmful working factors should include, firstly, the measures for the normalization of light environment parameters (insufficient artificial lighting and increased pulsation coefficient), the reduction of levels of electromagnetic radiation from the used computer equipment and normalization of air ion composition.
References
1. Avkhimenko M.M. Some factors of medical personnel occupational risk factors. Medical care. 2003; 2: 25-29.
2. Gorblyansky Yu.Yu. Topical issues of professional morbidity of medical personnel. Occupational labor and industrial ecology. 2003; 1: 8-12.
3. Ushakov A.A. Practical physiotherapy. 2nd ed. Moscow: MIA; 2009.
4. Karmolin L.A., Syromyatnikov Yu.P. Integrated evaluation of occupational conditions. Hygiene and sanitation. 1987; 9: 41-42.
Contacts:
656038, Barnaul, Nekrasova Pereulok, 65.
Institute of occupational hygiene and industrial
ecology
Tel: (3852) 566898.
Email: dr.balandovich@mail.ru
