These factors encounter a broad spectrum of manufacturing harmful factors.

1. Hygiene of work of the medical staff. Physiological and psychological aspects of work and health conditions of medical stuff.

2. The medicine is one of the most abundant spheres of labor activity of society. It calculates more than 170 medical specialties. In the system of public health services of Ukraine more than 200 thousand doctors are employed, including dentists, over 500 thousand of nurses. • The work of the doctor should be referred to such kind of activity, which do not take part in production, creating material or spiritual values, at the same time ensures indispensable conditions for creation of such values, curing the people and reverting them to productive work.

3. The conditions and nature of labor activity of the doctors and other specialists of medical area require constant attention to protection of their health, because the activity of the medical worker bound with influencing both unfavorable working conditions, and dangerous factors of manufacturing environment on a workstation. These factors encounter a broad spectrum of manufacturing harmful factors. • а) Psycho physiological (psycho-emotional stress, specific work pose, excessive stress and other), • b) Physical (no comfortable microclimate, poor illumination of workstations, noise, chattering, ultrasonic, laser, radio irradiations, • Ionizing radiation), • c) Biological (promoters of infection illnesses, parasite - insect, helminthes, • Etc.), • d) Chemical (medical drugs, drug facilities and other). • It is known, that more than a half of professional diseases of the doctors - (59,8 % and more) is caused by physical and mental overstrain, and also the influence of the chemical factors.

4. These factors encounter a broad spectrum of manufacturing harmful factors. Psycho-physiological Physical Biological Chemical psycho-emotional stress, specific work position, excessive stress of analizators etc. non-comfortable microclimate, poor lightening of workstations, noise, chattering, ultrasound, laser, radioactive radiation, ionizing radiation causative agents of infectious diseases, parasites, insects, helminths, etc. medicines, drugs etc.

5. Hygienic features of the working conditions and state of health of the doctors of surgical specialties. • Surgical specialties are: the general surgery, thoracic surgery, and orthopedics, neurosurgery, obstetrics and gynecology, ophthalmology, oncology, facial surgery, surgical deontology, reanimation and anesthesiology. Except for enumerated, to surgical specialties referred anatomy, pathological anatomy, forensic medicine, surgical dermatology and other. • The professional feature of activity of the surgeons is more component character of their working process. Except doing operations, as main activity of the doctors of a surgical profile, the considerable endurance of operating time is spent for inspecting patients, diagnostic, postoperative routines, morning conferences, planning how to do operations, filling in documentation (case history, protocols of operations), talking with the relatives of the patients, for the manager of departments, hospitals - administrative duties, and so on.

6. The professional feature of activity of the surgeons is more component character of their working process. Except doing operations, as main activity of the doctors of a surgical profile, the considerable endurance of operating time is spent for inspecting patients, diagnostic, postoperative routines, morning conferences, planning how to do operations, filling in documentation (case history, protocols of operations), talking with the relatives of the patients, for the manager of departments, hospitals - administrative duties, and so on. • Operational loading of the doctors of a surgical profile, by counting of the explorers, compound: in communal surgery – more than 150 operations for one year, more than 3 for one week; in otolaryngology, accordingly, - more than 170 and to 4; in an obstetrics and gynecology - 370 and 7 (including abortions, abrasions - 230 and 5). With improvement of professional skill of the surgeon increase both amount, and complication of operations. Operational, X-ray diagnostically and reanimation loading increase also at daily duties of the emergency.

7. By physiological feature of work activity of the surgeon in operational is obliged working pose, with static stress of the muscle system. Is established, that 37,6 % of all period of the operation a trunk of the surgeon pitched forward and 27 % - with additional rotation in one or other side, and only 26 % of time its trunk is in vertical position. The blood pressure in legs is increased in 2 times, in the field of a basin - on 50 %. Takes place lack of blood supply of brain.

8. Psychophysiological factors of the surgical specialities (working time of the surgeon) 1. of all operation period trunk of the surgeon is turned forward and during. 2. of all operation period trunk of the surgeon is turned forward and during. 3. of time his trunk is in vertical position.

9. The working area of the surgeon, occupies up to 60 sm in diameter, which causes to hold arms forward in one position, thus the angle of a brachium from a trunk oscillates from 35 up to 1800. Among the unfavorable factors of the physical nature is warming microclimate. For example, at 3 hourly operations in conditions of absence of a forced ventilation are created such conditions, that temperature of air is increased till 26-28 C, relative humidity till 70-80 of %. The level of an infrared radiation of the no shadowing lighting above an operating table reaches up to 442 W / м2, all this results in a stress of dodges of thermal control, reinforced sweating (up to 700 ml and will go away for the operation). Considerable sweating is also by high psycho-emotional stress for the surgeons and character of used clothes (cotton costume (suit) and sterile dressing gown, hat, gauze mask).

10. Working area of the surgeon 1. the angle between shoulder and trunk varies from 35 to 1800. 2. that air temperature is increased to 26-28°C. 3. relative humidity – to 70-80%

11. By physiological feature of work activity of the surgeon in operational is obliged working pose, with static stress of the muscle system. Is established, that 37,6 % of all period of the operation a trunk of the surgeon pitched forward and 27 % - with additional rotation in one or other side, and only 26 % of time its trunk is in vertical position. The blood pressure in legs is increased in 2 times, in the field of a basin - on 50 %. Takes place lack of blood supply of brain. From here – headaches. The working area of the surgeon, occupies up to 60 sm in diameter, which causes to hold arms forward in one position, thus the angle of a brachium from a trunk oscillates from 35 up to 1800. Among the unfavorable factors of the physical nature is warming microclimate. For example, at 3 hourly operations in conditions of absence of a forced ventilation are created such conditions, that temperature of air is increased till 26-28 C, relative humidity till 70-80 of %. The level of an infrared radiation of the no shadowing lighting above an operating table reaches up to 442 W / м2, all this results in a stress of dodges of thermal control, reinforced sweating (up to 700 ml and will go away for the operation).

12. The physical factors of the surgical specialities

13. At conducting operations in conditions of hyperbaric oxygenation the surgeons and their helpers will experience the effect of warming microclimate, heightened atmospheric pressure and heightened infiltration into an organism of azotes. The pressure in hyperbaric operational room reaches З and more atmospheres, that is considered pre-drug, in relation to azotes. But the poor cubage in an bar camera, sometimes necessity of pressure increase up to 7-8 atmospheres, can condition of nitrogen narcosis for terms of operational team. The unfavorable operating constructs also process of a compression and, in particular, decompressions. Under operating of azotes for terms of operational crew occur euphoria, the behavior (groundless laughter, slowing-down of motive reacting, decrease of attention, clearness of manipulations) is inflected. • The feature of a compression is the rise of air temperature in bar camera from original, for example 20С, up to 27 and even 37 degrees. At a decompression, on the contrary, temperature is slashed till 17-15 C and even 12С.

14. It is necessary to mark, that on the participants of surgical crews, except the indicated physical factors, the toxic chemical agents affect. It, first of all, chemicals, which are used for inhalation narcosis: dioxide of azotes (Mine), Ftorotanum (fluotane, halotane), Aether ethanol, Chloroform (three - chlorethanum), three-clorethilenum, cyclopropane, chlorethyl and other.

15. They are first of all drugs for inhalation narcosis

16. The diseases of the surgeons with a temporary disabiility • place – acute respiratory deseases • place – influenza • place – illnesses of organs of blood circulation • place – digestion • place – nervous system Chronic diseases Diseases of the system of blod circulation – nervosisms

18. Concentration of inhalation narcotics in a zone of breathing of members of surgical crews depends on time of a surgical intervention (at the operation on lungs concentration to Ftorotanum reaches 1000-1500 mg/m), cubage of operational room, activity of drugs. • From the point of view of hygiene of work the speed of elimination of drugs from an organism is also important. It was found, that diethyl Aether has rather quick output from an organism. The signs of Ftorotanum are discovered in exhaled air of the anesthesiologist in 64 hours after operation. At once after the operation the concentration of Ftorotanum in exhaled air is equal 42мg/м3. It is considered, that takes place material accumulation of Ftorotanum at its repetitive inflow in an organism. Chloroformium is not stored in an organism, and the ethanol stays for two days.

19. During operations anesthesiologists, surgeons, gynecologists are in a state of a high mental and nervous - emotional stress. At continuous operations (3-6 hours) are degraded speed of reactings, the coordination of moves of a hand and fingers, slashed memory and attention, the brake processes in a CNS dominate. • The frequency of cardiac pumps of the surgeon, anesthesiologist that are getting ready to the operation is higher on 5-10 pumps/min, reaching 88-110 pumps/min, increasing in accountable periods of the operation. • After operational interferences, depending on their endurance, for the surgeons the diameter of legs is larger on 0, 5-0, 8 cm, the feet increases on 2-4 %.

20. Among diseases of the surgeons with a temporary disability on the main place comes the acute respiratory diseases, influenza, illnesses of organs of blood circulation, digestion, nervous system. • Among chronic diseases of the surgeons, gynecologists, which are discovered by results of the deepened medical browses, the greatest specific weight is borrowed by the diseases of the system of blood circulation, by nerve systems, which are interlinked with high psycho-emotional and physical stress. In them most often the pains are localized in the field of heart, high arterial pressure, considerable changes of ECG, and dissonances of the nervous system. The high case rate on gynecological diseases, failure of pregnancy are discovered in the women - surgeons, which is interlinked, except of a psycho-emotional stress, with effect of anesthetics and drugs.

21. During operations anesthesiologists, surgeons, gynecologists are in a state of a high mental and nervous - emotional stress. At continuous operations (3-6 hours) are degraded speeds, the coordination of moves of a hand and fingers, slashed memory and attention, the brake processes in a CNS dominate. • The frequency of cardiac pumps of the surgeon, anesthesiologist that are getting ready to the operation is higher on 5-10 pumps/min, reaching 88-110 pumps/min, increasing in accountable periods of the operation. • After operational interferences, depending on their endurance, for the surgeons the diameter of legs is larger on 0, 5-0, 8 cm, the feet increases on 2-4 %. • Among diseases of the surgeons with a temporary disability on the main place comes the acute respiratory diseases, influenza, illnesses of organs of blood circulation, digestion, nervous system.

22. Among chronic diseases of the surgeons, gynecologists, which are discovered by results of the deepened medical browses, the greatest specific weight is borrowed by the diseases of the system of blood circulation, by nerve systems, which are interlinked with high psycho-emotional and physical stress. In them most often the pains are localized in the field of heart, high arterial pressure, considerable changes of ECG, and dissonances of the nervous system. The high case rate on gynecological diseases, failure of pregnancy are discovered in the women - surgeons, which is interlinked, except of a psycho-emotional stress, with effect of anesthetics and drugs. • The greatest amount of occupational diseases of the medical workers recorded for the doctors, including surgeons, in age of the highest working activity - 25-50 years. Behind frequency the greatest amount of cases of occupational diseases of the medical workers belongs to zygotic illnesses, of which one most often are sick, except for infusionists, surgeons, pathologists.

23. The series of occupational diseases of the doctors is occupied by illnesses, which one are developed from a forced position of a body, stress of separate muscle groups; a radiculates, osteochondrosis, discynesias, epicondylites - for the orthopedist - traumatologists. • Among reasons of progressing of occupational diseases for the doctors - surgeons select: a hyper sensibility of an organism, absence or inefficiency of individual means of protection, non-compliance of the safety regulations, sanitary regulations, irregularity and deterioration of medical engineering, instruments, rigging.

24. The series diseases which are developedof forced body position

25. Among diseases, which one has reduced in physical inability, 60 % are necessary on destiny of illnesses of chemical agents, 20 % - on illnesses conditioned by the biological factors, and till 10 % - on illnesses aroused by the physical factors and an overstrain of organs and systems. • As a result of originating professional disease the doctors were forced to inflect a place of operation through illnesses of chemical agents in 80 % of cases, through illnesses aroused by the biological factors in 11 % of cases and in 9 % through a functional overstrain

26. The reasons progressing of professional diseases for surgeons are: hypersensibility of the organism absence or insufficiency of individual protection measures

27. Hygienic features of the working conditions and state of health of the doctors of a therapeutic profile. • To specialties of a therapeutic profile are referred: therapy with its derivation (gastroenterology, and cardiology), neurology psychiatry, and emergency. • From the point of view of features of operation and influencing of the unfavorable factors on the doctors of the enumerated specialties it is necessary to arrange on polyclinic, with a local principle of service ill, and on working in hospital. • Among unfavorable psycho-emotional factors, the influencing will experience one of the divisional therapeutics, the carrying role belongs to excessive physical loading, which one depends on a season of year (amount of calls), sizes of a medical lease, such as building (one – multistoried building, availability or absence of lifts).

28. The specialities of therapeutic profile are:

29. Among unfavorable psycho-emotional factors, the influencing will experience one of the divisional therapeutics, the carrying role belongs to excessive physical loading, which one depends on a season of year (amount of calls), sizes of a medical lease, such as building (one – multistoried building, availability or absence of lifts). • Besides the divisional therapeutics and podiatrists, ER doctors, doctors - psychiatrists, the neuropathology’s score constant psycho-emotional stress. It is conditioned by gravity of illness of the patients, complication of diagnostic, bounded ness of possibilities of the doctor to help ill, feature of contacts of the doctor with ill and their with close. • The particular unfavorable operating on the doctors of a therapeutic profile is done by modern facilities of a hardware of medical entities - X-ray equipments, source of a radioactive radiation, electronic, ultrahigh-frequency, super high-frequency, ultrasonic, laser sets, source of ultraviolet radiation, chemical factors - pharmacological drugs, which one operate on medical staff by the way of solutions, gases, vapors and aerosol.

30. Among unfavorable psycho-emotional factors to excess physical loading such as building sizes of medical lease depends on season

31. For the doctors of leprosarium, infusionists, hematologists, laboratory assistants ant plague, bacteriological, virology, helminthological labs, disinfectors, epidemiologists particular professional unfavorable factors – exciters of the applicable zygotic diseases. • Among diseases of the doctors - therapeutics with a temporary disability on the main place the acute respiratory diseases, influenza, illnesses of organs of blood circulation, digestion, nervous system. Thus the doctors - therapeutics are sick considerably frequently and lengthy in matching with the doctors - surgeons, which work in a hospital (accordingly 103,4 cases and 128 dawned and 48,4 cases and 76,9 dawned disabilities on 100 working).

32. Among diseases of therapeutists with temporary disability

33. In pattern of chronic diseases trough therapeutics the main rank places occupied by illnesses of digestion organs - (chronic gastritis, peptic ulcer of a stomach, duodenum), illness of the nervous system and sense organs. Are then routed: an itch radicalizes conditioned by often variation of stay in building and outdoor at service or at home. It is necessary to note, that the considerable proportion of the doctors are engaged in services of the colleagues without the applicable decor of disease in medical documents. This feature essentially influences quality and endurance of treatment, entirety of the registration and, accordingly on an index of a case rate, that is why officially, of taking medical advices up to 600 cases on 1000 working, and on retrospective interrogation - up to 1500 on 1000 register. • To occupational diseases of the doctors of a therapeutic profile belong

34. The chronic diseases among therapeutists

35. Professional diseases of doctors of therapeutic profile are: • - infectious diseases which are handled by doctor, medical sister, laboratory assistant, desinfectors (lepra, tuberculosis, plague, cholera, malignant anthrax, rabies, brucellosis, helminthiases etc.); • - diseases which may occur at work of sources of ionizing radiation - X-ray, gamma – therapeutic sets, at work with opened radionuclides (acute, chronic radiation illness, leukosis, radiation cataract, carcinoma cutaneum, hyperceratosis, papillomas, dermatitises, eczema, toxicodermias, melanodermias etc.);

36. - diseases caused by work of physiotherapeutic equipment - oscillators of UHF, UV, hydrosulphuric, radon cabinets of separations engine driven laundries, autoclave installations, etc. (radioundular disease, photoophthalmia, traumas, casualties); • -diseases caused by work with medicines, drugs, disinfectants, other chemical substances (acute and chronic poisonings, medicamental allergy, dermatosis etc.);

37. - diseases developed at continuous work with mentally sick - professional psychoneurosis), - diseases conditioned by considerable constant psycho-emotional stress (idiopathic hypertensia, stenocardia with their complications).

38. Hygienic features of the working conditions and state health of the doctors – dentist. • At usage of seats and instrumentation of vertical constructions the doctor - dentist works standing rakish trunks 34 % of operating time. At usage of seats of a horizontal construction - sitting rakish and bending of a backbone in the side of the patient 75 % of operating time, and with a strong tilt and bending of a backbone - 22 % of operating time.

39. The muscle loading of the dentist by operation in a pose costing increases in 1,6 times, and rakish trunks - almost in 10 times. By operation in a pose sitting rakish trunks the muscle loading is augmented in 4 times. • Operation with minor defects in dents, their restricted accessibility to examining predetermine a stress of the visual evaluator and excessive convergence of an eye owing to nearing an organ of vision to plant of distinguishing. • From among the essential physical unfavorable factors for the doctors – dentist there is a noise from operation of a drill, compressors, and suctions. In particular dangerous is local chattering from operation of a drill, which one is transmitted to arms of thedentist.

40. From among the essential physical unfavorable factors for the doctors – dentist there is a noise from operation of a drill, compressors, and suctions. In particular dangerous is local chattering from operation of a drill, which one is transmitted to arms of the dentist. • The applying of photo polymeric valves of local lighting predetermines influencing on the doctor of powerful visible and UV- radiation, and usage of polymeric materials and know-haws is tracked inflow in a zone of breathing of toxic matters of a miscellaneous genesis.

41. The applying of photo polymeric valves of local lighting predetermines influencing on the doctor of powerful visible and UV- radiation, and usage of polymeric materials and know-haws is tracked inflow in a zone of breathing of toxic matters of a miscellaneous genesis. • The operation with mercurial amalgams is tracked by influencing on medical staff of vapors of metallically Mercury.

42. Owing to operating local chattering from a drill occur of tag of percussive illness: tiredness, cramp and pain in fingers, feel of a numbness of arms, losses tactile and thermo parentheses. • As a result of a constant stamping of the hand lever metallically instruments on the same place can be developed contracture. • The stress of the visual evaluator can result in to a spastic stricture of accommodation and originating of a so-called artificial myopia, and the operation with photo polymeric valves can invoke photo-ophthalmic, combustions of a cornea, clouding of crystalline. In this connection the characteristic complains on tiredness of vision, feel of “sand in eyes ", discomfort.

43. Measures on environmental sanitation of the working conditions of the medical workers. • By one of main conditions of environmental sanitation and protection of operation of the medical workers, the creation of optimal conditions for effective conducting of the medical process is plane-architectural solution of treatment-and-prophylactic entity. The building of major hospitals (on 600-1000 beds) scientifically meliorates the working conditions of the medical workers. This building is carried out presently according to building norms. These norms stipulate the enumeration of indispensable buildings, according to assigning of hospital, separation, two corridor system, oversize of main functional buildings, operational, minor surgery, procedural, manipulating. For the doctors foreseen «rooms of psychological discharging ", specialized gymnastics, room of personal hygiene of staff.

44. So, at budgeting surgical separations the insulated building of two surgery blocks - aseptic and septic, with airlock passes to department is stipulated. In a surgery block the gateway servers, supplementary putting are guessed a floor broker, preoperational, sterilizing, narcosis, hardware, putting for a synthetic circulation of blood, putting for staff. The surgery block should be endured in the separate body, with the covered transferring to the major body, to separation. Should be isolated clean and purulent Minor surgery. The floor space of a floor broker - at the rate of 36-48. М2 on one operating table, altitude not smaller 3,5г. The surgical department should be counted on 60-90 of beds, room section - for 20 beds. Norms of the floor space in 2 - 4 beds room not smaller 7м2, in one bed room - 9 м2.

45. Designed separate special building both sanitary regulations and rules for tubercular, infectious diseases hospitals and separations, X-ray cabinets, separations, labs, clinical-diagnostic, bacteriological, helminthological, virology labs, radon departments, psychiatric, hospitals, protesting labs, disinfectant servers engine driven laundries, boiler-houses, which one are esteemed in the applicable partitions of guiding from municipal hygiene. • The relevant value in environmental sanitation of the working conditions of the medical workers has rational arranging of medical furniture and machineries in the medical cabinet.

46. Concerning other chemical combinations, with which one the medical staff can work, first of all it is necessary to determine, that it is necessary to conduct operations with medicines, disinfectants, acids, meadows in fume hoods, for the patients - in inhalation cabs. Besides it is necessary to utilize individual means of protection - rubber gloves, defensive oculars, masks, respirators, film skirts and even overalls. For arms with the purpose the preventing to progressing of allergic reacting is necessary to utilize defensive creams. With same purpose it is necessary to prefer tablet medicines.

47. The synthetic general lighting for the majority of hospital putting (diagnostic, manipulations etc. of cabinets) should be ensured with cold light lamps on equal 500 lx, in customary studies -300 lx, in chambers, corridors - 150 lx. The communal synthetic lighting operational should also be ensured with cold light lamps, behind a spectrum by close to day time, which ensures exact perception of colors, and to be not the lowest 500 lx. The illumination surgery field should reach 2000-3000 lx or the score no shadowing of lightings with a spectrum, also by close to day time, but to not invoke blinding effect on the surgeon and other members of operational crew, without light shadows, influence a temperature schedule in operational (temperature in a zone of operation of crew should to be increased more as on 2-3С). It is necessarily necessary to provide availability of independent abnormal synthetic lighting.

48. To security of shortening of operating time for this category of the medical workers is from time to time referred also. • Security of spacing interval most effective, as the radiation dose is slashed proportionally to quadrate of spacing interval, and is reached by definition of zones of inaccessibility for sources X-ray and gamma-ray, usage of positioning devices by operation with enclosed and opened sources of ionizing radiation, rational budgeting of buildings and sufficiency of their sizes. • The security by screening is reached by operation with X-ray and gammas - radiating with the help of lead screens by the way of pods, screens, ant radiation rubber skirts, etc. Shields for sources of a beta radiation are aluminum, organic glass. For security of terms of surgical crew against X-ray beaming at orthopedic operations will be provided by new X-ray -diagnostic, roving defensive screens.

49. The preventive measures of fatigue power up also autogenously, which resolves to reduce a nervous stress, to remove a headache, to normalize bloody stress, cerebral circulation of blood, to construct feel of freshness, vivacity; a complex of exercises of manufacturing gymnastics for putting off of static fatigue, periodic breath holding for gymnastics of bulbs of a brain (operating of an excess С02), deep diaphragm breathing.

50. The relevant value has psychophysiological culling for specialities with theme or other professional risk factors. In a ground(basis) of such culling there should be trusted to morally - ethical, physiological, psychological performances of the person, speed and fidelity sight and hearing reacting, stability of attention, speed of waste-handling of the information, and etc. • In the system of public health services of the medical workers the relevant place borrow precursor, at employment with unhealthy conditions, and periodic(batch) medical browses of the doctors, medical sisters, laboratory assistants, other specialists, architecture of the qualified treatment-and-prophylactic help on a place of their operation, or in specialized medical entities; a dispensary observation, in-depth analysis of a case rate of the medical workers, their examination LSEC, LKK, transistorizing temporarily or permanently on one more mild or more safe operation, exclusion for them of night duties and etc.