Infectious diseases of medical personnel. Types of occupational diseases and their prevention in the working population
28.12.2012 08:12:09
In the process of labor activity, the worker is influenced by the factors of the working environment and the labor process, which can have Negative influence to health. There is no doubt that the complete exclusion of unfavorable factors from the working environment is impossible. This is practically impossible even in those industries where advanced process technology, modern equipment and for which a high culture of production, excellent medical care are introduced. And even more so it is unattainable at domestic enterprises in the conditions of the economic crisis, backward technology and outdated equipment. In this regard, the issue of prevention of occupational and occupational diseases arises sharply.
Prevention of occupational and occupational diseases - a system of medical (sanitary-epidemiological, sanitary-hygienic, treatment-and-prophylactic, etc.) and non-medical (state, public, economic, legal, environmental, etc.) measures aimed at preventing accidents incidents at work, reducing the risk of developing deviations in the health of workers, preventing or slowing down the progression of diseases, reducing the adverse consequences. The development of many occupational diseases and occupational diseases depends on the complex interaction of damaging factors and on the quality of working life. All employees must acquire hygienic knowledge and skills, comply with the norms and requirements that ensure occupational safety.
Development and implementation of the state policy on the protection of labor and health of workers;
Compliance with hygienic standards and regulations to ensure the safety of production processes;
Preliminary (upon admission to work) and preventive (periodic) medical examinations, taking into account general contraindications, individual sensitivity, prognostic risks of disease development;
Normalization of sanitary-hygienic and psychophysiological working conditions;
Rational use of collective protective equipment and means individual protection;
Conducting dispensary observation and health improvement;
Preservation of residual working capacity and the possibility of adaptation in the professional and social environment, the creation of conditions for optimal provision of the life of victims of accidents and diseases at work.
According to WHO, over 100,000 chemicals and 200 biological factors, about 50 physical and almost 20 ergonomic conditions, types of physical activity, many psychological and social problems can be harmful and increase the risk of accidents, illness or stress reactions, cause dissatisfaction with work and impair well-being, and therefore affect health. Impaired health and decreased performance of workers can lead to economic losses of up to 10 - 20% of GNP. Most of these problems can and should be addressed both for the health and well-being of workers and for the economy and productivity.
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Occupational diseases of medical workers in the Russian Federation in 2019. The main categories of diseases, the most vulnerable professions, the mechanism for obtaining material support from the state, methods of prevention - you can learn all this from this article.
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All types of human labor activity are associated with workload and, as a result, with occupational diseases and injuries.
The health sector is considered especially dangerous, since employees are constantly dealing with various diseases and electrical, magnetic and other devices.
The state takes measures to protect labor, carries out preventive measures, and also provides benefits and benefits to employees of medical organizations.
Important concepts
Who is most vulnerable
Occupational diseases in workers arise from difficult working conditions that cannot be improved but can be prevented.
The most harmful working conditions are recognized by the following personnel:
- resuscitator;
- anesthetist;
- surgeon;
- pathologist;
- forensic scientist;
- dentist;
- infectious disease specialist;
- nursing staff.
For employees of these areas, the presence of assistants (laboratory assistants and extras) is mandatory.
Classification of occupational diseases of medical workers
Due to the occurrence of occupational diseases, medical personnel can be divided into the following categories:
| Chemical toxic diseases | They manifest themselves in poisoning and intoxication of people. The cause of ailments can be the effect on the human skin of solutions of iodine, camphor, arsenic, can manifest allergic reactions and diseases (for example, bronchial asthma) |
| Biological damage | It occurs when medical personnel interact with people with infectious diseases (tuberculosis, HIV, viral hepatitis) |
| Physical and mechanical damage | This category of diseases is characteristic of employees dealing with radiation equipment. Magnetic radiation affects the cardiovascular and nervous system(hypothalamic syndrome, cancer) |
| Hypodynamia | This type of disease is characteristic not only of medical personnel, it occurs due to the sedentary lifestyle of employees. Physical inactivity occurs among workers who long time carried out in one position (surgeon, dentist), and affects primarily the musculoskeletal system: the spine, legs, as well as the organs of vision |
Legal framework
Occupational safety of medical personnel, as well as the stipulated payments and benefits, are regulated by the following laws:
| Federal Law No. 125 "On mandatory social insurance from industrial accidents and occupational diseases " | This decree provides for the possibility of receiving payments in cases of occupational diseases, obliges medical workers to provide insurance against accidents (Article 5), regulates the procedure for calculating benefits (Article 12) |
| Decree of the Government of the Russian Federation of 12/15/2000 "On approval of the Regulations on the investigation and registration of occupational diseases" | It establishes the calculation and accounting of benefits for medical workers. |
| Order of the Ministry of Labor No. 580n dated 10.12.2012 | The legislative act establishes the procedure for granting benefits |
| Order of the Ministry of Health No. 911 of 13.11.2012 | It regulates the list of diseases related to occupational |
Basic moments
Occupational health and safety of medical workers is an important and indispensable factor in establishing a work process. The state and the employer must make every effort to maintain the health of employees.
Support measures include maintaining a stable workflow, cleanliness and sterility of equipment, and, if necessary, the payment of benefits and benefits due to occupational diseases and injuries.
Algorithm for registration of occupational diseases
To confirm a person's occupational disease and subsequently receive benefits and benefits, a medical worker needs to take a few simple steps:
| First of all | You need to go to a medical institution for a diagnosis. Next, you need to notify your employer about the presence of a disease and sanitary and epidemiological supervision |
| In the second stage | The working conditions are checked by employees of special bodies. Next, an official act is drawn up. In case of disagreement, the employer can write an objection |
| Checking the executed act | Produced by the Ministry of Health and issues confirmation of the fact that the employee's illness is related to the professional |
| Solution | For rendering final decision on this issue the employee needs to contact the center for occupational pathologies |
What benefits can qualify for
If a medical worker is injured or acquired an occupational disease in the course of work, he can apply for one of the possible types of benefits:
Mechanism for obtaining benefits
To receive benefits, a medical worker must first of all contact a local doctor with an already obtained certificate of the presence of a disease, which is equivalent to a professional one.
The therapist gives the employee a referral for a general medical examination, which includes visiting all specialists and taking tests.
After passing a full examination, a citizen is issued a referral for a medical and social examination. This examination makes a decision on the presence or absence of an occupational disease in a person. In case of a positive answer, the degree of the disease is also announced.
These include:
- passport;
- the conclusion of the commission;
- an occupational disease act;
- work record book and its copy;
- salary certificate.
An application for receiving benefits is written together with an employee of the foundation. After it is written, the employees of the social insurance fund establish benefits and determine the amount of future benefits.
Is the employee insured
Every employee of any enterprise on the territory Russian Federation is subject to compulsory health insurance. Funding is provided by the employer.
In the event that medical personnel receive any injury in the process professional activity he is entitled to compensation for damage.
This opportunity is provided provided that the employee of the medical institution applied to the FSS to obtain a document on social insurance. Every working citizen must have such a certificate.
Prevention methods
Photo: causes of occupational diseases
Prevention of occupational diseases by medical workers is divided into two types:
Systematic screening should be carried out to reduce the risk of morbidity among healthcare workers. Prevention measures are carried out in each institution.
These include:
- maintaining the proper hygienic regime, waste disposal different classes danger;
- regular cleaning of offices, wards, operating rooms, disinfection of premises;
- issuance of personal protective equipment.
Thus, many groups of medical personnel in the course of their activities are exposed to harmful factors, such as radiation, interaction with infected patients, and a sedentary work pattern.
All this has a detrimental effect on health. The state provides support to medical personnel. It is expressed in the payment of benefits and the provision of benefits.
To obtain them, an employee of a medical institution only needs to undergo a full examination and contact the population insurance department.
An important fact of maintaining the health of employees is preventive measures... These include the constant maintenance of cleanliness in the offices, as well as medical checkup personnel to detect diseases in the early stages.
APPLICATIONS AND CALLS ARE ACCEPTED 24/7 and WITHOUT DAYS.
1An assessment of the level of occupational morbidity of medical workers working in healthcare institutions of the Russian Federation, carried out according to official statistical reporting data, showed that over the past 7 years, the indicator of occupational morbidity among medical workers per 10 thousand working population was 1.2–3.4 times higher than in all sectors of the Russian economy. From 1 to 8 cases of occupational diseases are registered annually, which is from 2.1 to 19% of the total number of cases of occupational diseases registered in the Russian Federation. Diseases associated with contact with infected material (82.3%) prevail in the structure of occupational diseases of medical workers. Prevention of occupational pathology takes the leading place in the system of treatment and prophylactic measures aimed at maintaining the health of the working population. Its structure and levels are directly dependent on the impact of harmful factors of the working environment and the labor process, adequately reflecting the specifics of working conditions.
infectious diseases.
occupational diseases
medical workers
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Currently, more than 668,000 doctors and more than 1,650,000 paramedical workers are employed in Russian health care. The medical staff of any medical institution is in daily contact with various factors of an infectious and non-infectious nature that affect its health and performance. Therefore, the hospital environment must be regarded as an extremely aggressive microecological environment.
Despite certain achievements in the field of labor protection of medical workers, today there is no single organizational system of occupational safety, including the scientific study of these problems. Hygienists working in the centers of the State Sanitary and Epidemiological Surveillance, exercising external control over working conditions, as well as the administration of medical and preventive institutions, do not pay due attention to the occupational safety and health of physicians, underestimating the degree of danger of the hospital environment as a factor occupational risk... Doctors and nurses themselves do not attach much importance to solving this problem, probably because traditionally, safety and health policies have been carried out mainly for patients, and not for employees. The lack of attention to their health can be explained by the fact that they are considered professionals who can take care of their health without anyone's help. The urgency of the problem of organizing the system of occupational health protection is determined by the influence of working conditions on the health status of physicians and the high level of their morbidity, which, according to various authors, exceeds that in many leading industries and ranges from 93.2 to 114.7 cases per 100 workers. To date, there are no occupational safety rules or recommendations that apply to all aspects of work in health care facilities, and most of the existing recommendations are non-specific. Regardless of the specialization of hospitals, there are common unfavorable factors of the working environment: neuro-emotional stress, chemicals, biological agents, high voltage analyzer systems, the possibility of injury, daily mode of operation, disrupting the biological rhythm.
The immediate causes of disease are hypersensitivity the worker's body to a number of factors, the lack or ineffectiveness of personal protective equipment, contact with infected patients, imperfection of tools and equipment.
The main factors of occupational hazard for medical workers can be systematized according to the sources of their receipt and the significance of the impact on the state of health. Protection of medical personnel from infection with infectious diseases in modern conditions of health care development is becoming an urgent state task. It has been established that the incidence of medical workers associated with professional activities has a high level. You cannot put up with the fact that while saving millions of human lives, medical personnel are exposed to an increased risk of infection. Among the almost 40 thousand currently existing professions, more than 3 million medical workers occupy a special social niche, of which 17% are doctors, 42.8% are nurses, 19.4% are junior medical personnel, another 1% are psychologists, biologists and representatives of some other professions necessary in health care.
According to the authors, among the occupational diseases of medical workers in our country, the first rank place is taken by respiratory tuberculosis (50.4-67.9%). The morbidity of the personnel of anti-tuberculosis institutions is 4-18, and the incidence of forensic medical experts is 50 times higher than that among the population. The increase in the incidence of tuberculosis among staff is due to the unfavorable situation in the country in relation to this infection, which "reacts" to socio-economic conditions, the circulation of antibiotic-resistant strains of the pathogen (40-70%), the material and technical condition of tuberculosis institutions and shortcomings in the complex of personal protection measures for personnel ...
Blood-borne infections have become a huge problem: viral hepatitis B, C, D, leading to chronicity of the process, liver cirrhosis, and the development of hepatocellular carcinoma. According to the WHO, one health worker is killed every day from viral hepatitis B. In our country, hepatitis B ranks second in the structure of occupational morbidity of medical workers (39.5%). According to the risk of infection, in descending order, three groups of medical workers can be distinguished: personnel in hemodialysis and hematological departments; staff of laboratory, intensive care and surgical departments; staff of therapeutic departments. A high frequency of markers of hepatitis C is found in dentists, and among them - in the staff of orthopedic departments and dental technicians (54-56%).
According to modern literature, the incidence among medical workers in the departments of purulent surgery, burn centers, where the main etiological agents are Staphylococcus aureus and pseudomonas, is increased, while the incidence rate of purulent-inflammatory diseases of the skin, mucous membranes, pneumonia among the staff is 7 times higher than among the population. The highest morbidity is observed in the first years of work in a medical institution of a medical worker. It is interesting that in the gastroenterological departments of specialists performing endoscopic procedures (gastro-, duodenoscopy), IgM and IgG for Helicobacteriosis were determined significantly more often than in the population.
In 2014, in the Krasnoyarsk Territory, 8 cases of diseases of a biological nature were officially registered in health care institutions.
Diseases from the influence of biological factors were registered in the following professions: nurse (3 cases), 1 case - medical assistant-laboratory assistant, pathologist, orderly, urologist, hostess nurse. At the same time, 6 patients were diagnosed with tuberculosis (focal, infiltrative) (75%), in 1 case - tuberculoma of the lung lobe, 1 case - viral hepatitis B.
We conducted a survey among doctors of surgical specialties (80 people) about the presence of chronic viral hepatitis. The number of those infected was 5%.
For medical workers, airborne infections are also very relevant in terms of infection. For example, during the diphtheria epidemic in Russia in the 1990s, 60 medical workers fell ill with diphtheria, and in 1994, in the most unfavorable year for the incidence of diphtheria, 107 healthcare workers fell ill.
With the rise in the incidence of influenza and acute respiratory viral infections (ARVI) among the population, nosocomial outbreaks occur in patients and medical personnel. The highest (1.5-1.8 times higher than the indicators of the adult population) is the incidence of acute respiratory viral infections during the seasonal upsurge among employees of polyclinics, emergency departments, infectious diseases, dental and multidisciplinary hospitals. The growth of temporary disability of medical workers disrupts the work of hospitals and polyclinic institutions. The use of immunomodulators, antiviral drugs and vaccines for prophylactic purposes only partially reduces the incidence.
In order to analyze the frequency of occurrence of acute and chronic infectious diseases among medical workers of various specialties (surgeons, resuscitators, gynecologists, infectious disease specialists, pediatricians), we conducted a survey. Among the proposed questions were the following: how often have you had infectious diseases in the last 2 years? How are you treated? Do you follow the vaccination schedule? Prevention measures?
Our survey among doctors and nurses (total group of 100 people) in Krasnoyarsk allowed us to conclude that in the city of Krasnoyarsk almost all of the respondents were sick with ARVI and influenza every year, while 60% of medical workers were sick from 2 to 7 times in year. As for specific prophylaxis against influenza (vaccination), only 80% of doctors carry it out, the rest are of the opinion not to be vaccinated, explaining this for various reasons.
Among doctors of various specialties, infectious disease specialists are the least likely to get sick (5%), more often pediatricians and therapists get sick (95%), which is probably due to more frequent contacts with acute patients in the first days of the illness.
Thus, it can be concluded that to minimize the spread of infectious diseases within medical institutions is necessary effective program infection control, since healthcare workers are under constant threat of mutual infection.
In order to ensure the rapid localization of infection and the timely use of personal protective equipment, it is necessary to carry out the most prompt examination of patients and health workers for signs or symptoms of an infectious disease.
The design of new and the reconstruction of existing buildings of medical institutions must be carried out taking into account the installation of modern technical controls (ventilation, the choice of wall and floor coverings, dividing curtains, disposable instruments instead of reusable instruments, etc.).
Globally, it is strongly recommended that vaccinations be mandatory for healthcare workers who have not yet received it or have documented evidence of post-infectious immunity against infections such as hepatitis B, influenza, measles, rubella, mumps, chickenpox and tetanus. Hepatitis A, pneumococcal infection also refers to diseases that are preventable by vaccination and which can be contracted in a medical facility, but currently vaccines against these infections are not yet mandatory for health workers. Today, shop doctors in occupational medicine play a large role in limiting those health workers who have had contact with infections or are already infected, since they can be carriers of an infectious disease. State and local laws should also impose restrictions on the activities of health workers with infectious diseases.
Reviewers:Vinnik Yu.S., MD, DSc, Professor, Head of the Department of General Surgery, Krasnoyarsk State Medical University named after prof. V.F. Voino-Yasenetsky, Krasnoyarsk;
Baksheeva S.S., Doctor of Biological Sciences, Associate Professor, Deputy Director of the EITI of the Krasnoyarsk Agrarian University, Krasnoyarsk.
Bibliographic reference
Sergeeva I.V., Tikhonova E.P., Andronova N.V., Kuzmina T.Yu., Zotina G.P. INCIDENCE OF INFECTIOUS DISEASES OF MEDICAL WORKERS, IS IT ASSOCIATED WITH PROFESSIONAL ACTIVITIES // Contemporary problems science and education. - 2015. - No. 6 .;URL: http: // site / ru / article / view? Id = 22914 (date accessed: 22.12.2019).
We bring to your attention the journals published by the "Academy of Natural Sciences"
Accurate statistics of specific, occupational diseases of doctors and their consequences do not exist in Russia. One of the reasons is the low detection rate of this type of disease, which does not exceed 10%. The fact is that often doctors do not document their own illnesses, they self-medicate (in this case, the term seems a little absurd, but still).The professional journal "The Main Nurse" quotes the opinion of the academicians of the Russian Academy of Medical Sciences Nikolai Izmerov and Valentin Pokrovsky: “At the beginning of the 21st century, the health care situation of medical workers has not changed significantly, there has been a tendency for 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, as well as due to the specifics of working conditions. "
The specificity of working conditions is as follows: air pollution of working rooms with aerosols of medicinal substances, disinfectants and drugs, the constant threat of infection with infectious diseases, ionizing and non-ionizing radiation of diagnostic and medical equipment. To this we add extra work, constant stress, burnout, physical activity.
Medical work is hard. According to the existing scale of the severity of labor, medical specialties are located from the second to the fifth category (there are six of them in total, with the sixth being the highest level of severity). The fifth category of labor severity includes the specialties of a surgeon, anesthesiologist, resuscitator, ambulance doctor, endoscopist, radiologist, pathologist, forensic expert. To the fourth - district doctors, dentists, doctors of a therapeutic profile working in a hospital, dermato-venereologists, otolaryngologists, obstetricians-gynecologists, bacteriologists, doctors of functional diagnostics. To the third - doctors of clinics, doctors-laboratory assistants, epidemiologists, hygienists, physiotherapists. The second - statisticians and valeologists.
Each specialty has its own occupational diseases. But there are also general ones, the degree of which varies slightly depending on the profession. And in the first place with a strong gap are infectious diseases (from 75.0 to 83.8% in the structure of occupational diseases, on average 80.2%). Which is understandable: every doctor regularly comes into direct contact with infectious patients, and other employees of medical institutions too.
Among the leaders in detectability - viral infections that can be picked up anywhere. This is followed by tuberculosis. As studies carried out in Samara have shown, from 1991 to 2004, the incidence of tuberculosis among medical workers here increased 10 times and 3 times exceeded the average urban indicator. The drug resistance of mycobacterium tuberculosis is extremely high among medical workers (31.3%).
The second place among occupational diseases of health care workers is held by allergic diseases (from 6.5 to 18.8%, on average 12.3%). There are many sources. High-grade allergens can be drugs that both doctors and other health care providers deal with. And in addition, chemical reagents used in laboratory practice: substances for anesthesia, disinfection, detergents, biological preparations (enzymes, vaccines, serums, blood products).
The third place among the occupational diseases of doctors is shared by intoxication and diseases of the musculoskeletal system. Constantly being on your feet or bending over a patient - this is not something you wish for an enemy. For example, the examination of Voronezh dentists showed that diseases of the musculoskeletal system among them occur in 75% of cases, and the defeat of osteochondrosis of the 2nd and 3rd divisions is combined with curvature of the spine and diseases of the joints in 30% and muscles in 17%.
Many doctors work in excess of the norm in order to somehow increase their income. And sometimes - because there is no one to work. However, shift work itself (daily shifts), which is common for doctors, carries additional psychoemotional and physical activity... This, coupled with increased responsibility for the result, easily causes stress. And stress, in turn, is a prerequisite for early changes in the cardiovascular system.
Surgeons are especially prone to stress. Moreover, they often encounter seriously ill patients, with dying ones. And this is another source of stress.
The result is burnout syndrome - a state of physical, emotional and mental exhaustion.
The list of "own" diseases and dangers for individual medical specialties is even wider and more diverse. For example, according to some studies, the concentration of fluorothane in the breathing zone of the anesthesiologist exceeds the permissible norm by 13 times. Those who serve X-ray rooms and radiology laboratories, as well as members of X-ray surgical teams, are exposed to ionizing radiation. This can lead to radiation sickness, local radiation injuries, neoplasms, skin tumors, leukemia.
There is such a concept - professional health. These are the characteristics of a specialist's health that ensure the high efficiency of his professional activity. For some reason, we treat this phrase simply as a phrase. Meanwhile, it contains the following thought: if a doctor is sick, then he will not be able to treat you at the proper level. Protect the Doctor - Protect the Patient. Seemingly simple thought. But for some reason it takes a long time to reach those who make decisions.
Makarenkova Yu. E.,
Lecturer of the branch of GAPOU JSC "AMK" in Severodvinsk
Occupational diseases of medical workers
Many, many medical workers work in harmful and unfavorable conditions (high neuro-emotional stress, uncomfortable microclimate, insufficient illumination of workplaces, biological agents, noise, ultrasound, radiation, laser exposure, etc.).
In addition, medical workers and, above all, nurses, have contact with potentially dangerous chemicals, for example, inhalation anesthetics in the air of operating rooms, intensive care units, delivery rooms.
One of the occupational hazards among medical workers of many specialties is constant contact with medicinal substances, among which there are often biologically highly active medicines with allergenic and toxic effects.
Nurses under the influence of biologically highly active drugs (antibiotics, analgesics, vitamins, hormones) may develop occupational diseases. The frequency, timing of occurrence and localization of professional pathological changes in the body of nurses are greatly influenced by the methods of drug administration (oral, inhalation, injection). The most dangerous is inhalation, in which medicinal product may be aerosolized in the nurse's breathing zone. When pills and solutions are dispensed, the skin can become contaminated, and when injections are given, you can become infected with serious diseases such as HIV infection and hepatitis B.
Medical workers who use anticancer drugs in the treatment of patients are at risk of developing occupational pathology. The harmful effects of cytostatics cause a sharp decrease in blood hematological parameters (hemoglobin, leukocytes, platelets).
The staff of the chemotherapy departments has a high incidence of diseases gastrointestinal tract and skin.
There is a constant threat of infection of medical workers with infectious diseases.
Taking into account the above, we can conclude that most of the occupational diseases in nurses occur as a result of nosocomial infections. The basis for the prevention of nosocomial infections should be taken: pre-sterilization cleaning of instruments by the ultrasonic method; sterilization of instruments; use of sanitary protective clothing (long-sleeved gowns, masks, shields, respirators, etc.); separate storage of personal and special clothing; improvement of sanitary facilities (dressing rooms, showers, food intake points, psychological relief rooms, etc.). Work on the implementation of the proposals will contribute to some improvement in working conditions and safety, preservation of the health of medical personnel of various treatment departments hospitals.