1 / 49

Hospital hazards

issac
Download Presentation

Hospital hazards

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. Hospital hazards Hospital workers are exposed to various risk factors: Physical risks: radiation (ionising, UV, Laser), noise, vibrations, temperature, humidity Biological agents Chemicals: » toxic effects, » skin irritation effects, » allergic effects, » genotoxic effects Great physical load Extreme neuropsychical load

    3. Physical factors Ionizing radiations: in the following wards and departments: - radiology and radiotherapy - nuclear medicine - cardiovascular haemodynamics - orthopaedics (plaster room and operating theatre) - digestive endoscopy - urologic endoscopy - anaesthesia Hospital staff assisting patients who undergo diagnostic and therapeutic procedures involving ionizing radiations may also be occasionally exposed.

    4. Ionizing radiation The ionizing process may cause DNA damage. If not adequately repaired this damage may lead to cell death or alteration. Non-stochastic effects If the number of dead cells is high enough a serious, clinically evident, functional damage may occur in an organ or tissue. Stochastic efects In the second case, the modified cell is still able to reproduce itself and this can lead, after a variable latency period, to a neoplastic condition (in the case of a somatic cell) or to a damage to the offspring (in the case of a germinal cell).

    5. Ionizing radiation Non-stochastic effects - after the whole body exposition or partial irradiations - irreversible damage especially of highly proliferating tissues: bone marrow and the digestive system mucosae The bone marrow damage leads to a reduced haemopoiesis which is followed by peripheral pancytopenia. GIT damage is followed by diarrhoea, intestinal bleeding, septicaemia and shock. The worst cases also involve cerebral tissue damage followed by coma and death. Prognosis is related to the absorbed dose.

    6. Ionizing radiation Whole body irradiation with lower doses causes: early aging, reduction of average life; alterations of skin - dystrophic alterations especially to the hands: flat fingerprints, hair loss, telangiectasia, wart formation; reproductive organs damage; bone marrow damage - chronic anaemia, leucopenia and thrombocytopenia; crystalline lens damage - cataract formation. Partial irradiation can cause: acute effect (that arises immediately after the irradiation) or delayed effect (in the case of prolonged exposure to small doses).

    7. Ionizing radiation High dose partial irradiation mainly affects the skin and the reproductive organs. Skin alterations are represented by erythema, blisters and desquamation with ulcer formation. Exposure of the reproductive organs to doses of 0,1-1 Gy is responsible for temporary sterility, whereas exposure to doses over 5 Gy causes definitive sterility. Stochastic effects (statistical and casual in nature) occur when a cell that has been modified by the ionization maintains the capacity to divide and is therefore able to give rise to a malignant neoplasy. No threshold dose exists for such effects. The most likely neoplasies linked to chronic exposure to ionizing radiations are leukaemias and skin cancer. Furthermore, epidemiological studies have shown an increase in thyroid carcinoma following external irradiation and/or contamination with I131. Similarly, an excess of bone and breast tumours has been found in the exposed subjects.

    8. Ionizing radiation Hereditary effects Ionizing radiations can affect his/her offspring as well. Such effects follow the DNA damage induced by the radiations in the germinal cells or the irradiation of the embryo or fetus during intrauterine life. Genetic effects include: - genetic mutations - chromosomic aberrations Genetic mutations can be dominant or recessive; in the first case the effect will show itself in all the offspring, whereas in the second instance it will appear only in part of them. Chromosome aberrations can concern structure (translocations, deletions) or number. Irradiation of the embryo or fetus be exposed during intrauterine life can cause: - death of the embryo or fetus - malformations and growth alterations - mental retardation - malignant tumours induction - hereditary effects.

    9. Ultraviolet rays Ultraviolet rays represent the non-ionizing radiations of smallest wave length. They are electromagnetic waves whose wave length ranges between 400 and 200 nm. They are present in the solar spectrum and they can be artificially produced by means of a voltaic arc with carbon electrodes or by mercury-vapor lamp. UV A, B, C Ultraviolet C radiations (280 and 200 nm) are harmful to the organism. Those waves are stopped by the ozone barrier. Nowadays such barrier is progressively reducing itself and this could represent, in the future, a further risk factor for workers that carry out their job outdoor. UV-C is used in the for sterilization procedures (germicide lamp) and for diagnostic and therapeutical purposes.

    10. UV radiation UV-C radiations of short wave length (mainly 254 nm) given out by mercury-vapour lamp are widely used: in the sterilization of air in confined spaces (such as operating theatres, etc), where the usual disinfectant methods do not satisfy. For sterilization of liquids For sterilization of materials' surfaces. UV-B waves are used in the diagnostic and therapeutical fields, mainly for the treatment of dermatological pathologies: phototherapy of icterus neonatorum, phototherapy of skin disorders photochemotherapy of psoriasis applications in dentistry.

    11. UV radiation Odontological applications mainly involve the employment of UV radiations for the polymerization of resins to seal cavities or reconstruct missing portions of the teeth. The biological effect: UV radiations basically involve the skin and the eyes with short and long term damage. The skin damage: erythema and cutaneous pigmentation, basal cell carcinoma, squamous cell carcinoma and malignant melanoma. The bands of UV rays responsible for such neoplastic effects are those of wave length between 280 and 315 nm. Eyes damage: conjunctivitis and keratitis; some bands of UV radiations of wave length bigger than 295 nm can reach beyond the cornea, as far as the crystalline lens and provoke cataract.

    12. Laser Light Amplification by Stimulated Emission of Radiation indicates an instrument capable of giving out electromagnetic waves both in the visible and in the infrared and UV fields. A laser device is essentially made up of three parts: - an active medium made of solid, liquid or gaseous material (solid, liquid or gas lasers); - an energy source (pumping system) to excite the active medium's atoms. This source can be represented by a lamp (optical pumping), by electrical systems (electric pumping) and by chemical systems (chemical pumping) or by another laser; - an optical resonance system (optical cavity) made up of two mirrors that delimit the active medium from the outside, one of which is reflecting and the other partly reflecting.

    13. laser The laser has some peculiar characteristics: - it can produce high energy radiations from a low power source - it can produce unidirectional rays that are propagated in a straight line. In fact it must be remembered that radiations of light produced by a conventional source are propagated in all directions!!! - it can produce radiations of a single wave length. - it can concentrate high energy intensity on small areas. For such characteristics lasers are widely used in dermatology, eye microsurgery, ENT surgery, gynaecology surgery and surgical endoscopy.

    14. laser Lasers employed in the medical-surgical field can be divided in three groups according to their action: - surgical lasers - photocoagulative lasers – used in Ophtalmology to treat retinal detachment, small haemorrhages and proliferative retinopathy - photodynamic lasers – used in Oncology. Professional health risks: skin and eyes damages - can occur after exposure to laser's radiations because of thermical effect. Ocular effects depend on the wave length of the radiation: - visible spectrum radiations are electively absorbed by the pigmented epithelium of the retina and may lead to retinal or choroid burns (this effect is exploited for the treatment of retinal detachment and of lesions of retina and choroid.)

    15. laser Infrared and UV radiations are absorbed by the eye adnexa, the cornea, the lens and by the vitreous where they can give rise to opacities. Skin effects range from erythema to blistering skin to the carbonization of the tissue.

    16. Noice Chronic acustic trauma – Professional hypacusis (Professional hearing loss) Vibrations Damage of joints, bones, tendons, muscles, blood-vessels, nerves Traumatic vasoneurosis

    17. Photocopying machine Photocopying activity is nowadays widespread. As this activity is based on ultraviolet light action ozone formation from air oxygen occurs, although in very small quantities. Furthermore products of thermoplastic resin pyrolysis, of extremely various composition, develop. These make up about 95% of the toner and of the roller lubricants. Ozone can cause acute irreversible pulmonary changes within a short time and at relatively low concentrations. Furthermore ozone can increase the bronchial responsiveness to histamine so that asthmatic subjects can show a worsening of their clinical condition.

    18. Biological risks Hepatitis B virus Hepatitis B is caused by a DNA virus. Hepatitis B virus (HBV) is a very resistant pathogen: it survives at room temperature (up to six months), it endures cold (below 20°C up to several years), heat (60°C up to 4 hours) and UV irradiation. It is inactivated by high temperatures (121°C) and by stove and autoclave treatment. HBV virus is highly infective, in fact it has been estimated that it is 100 times more infective than HIV virus. The virus is present in all bodily liquids and secretions (blood, saliva, sperm, vaginal secretions, urine).

    19. HBV The virus is mainly spread by: - the parenteral or percutaneous route: injections, cuts, transfusions, blood products. - the sexual route: genital mucosa lesions, oral mucosa lesions. - the vertical route: from mother to fetus. - the perinatal route: mixing of blood during delivery. In the hospital environment the transmission of HBV can occur through accidental percutaneous prick with needles or sharp contaminated objects, contact with infected blood through solutions of continuity of the skin, contamination of mucous membranes. 90% of the subjects recover completely. 5-10% become chronic carriers of the virus. Amongst them 20-25% develop active chronic hepatitis which may lead to cirrhosis and liver carcinoma. prick - píchnutíprick - píchnutí

    20. HBV infection About 0.5-1% of the subjects develop acute fulminant hepatitis which generally leads to death. The risk of HBV infection following one single accidental exposure is between 2 and 40% depending on the HBsAg state of the patient source of infection. General preventive measures Health education, training programmes for the personnel at risk. Scrupulous compliance with the "universal precautions" to be followed at all times with all patients, regardless of their pathology and certainty of diagnosis. Use of appropriate personal protective devices (gloves, mask, white coats). Abolition of the manoeuvre of needles' covering. Collection of sharp materials, syringes and needles in appropriate containers before disposal. Compliance – dodržení, precaution – bezpecnostní opatrení; abolition – úplné zniceníCompliance – dodržení, precaution – bezpecnostní opatrení; abolition – úplné znicení

    21. HBV infection Specific preventive interventions Passive immunization with specific antihepatitis B immunglobulin (human IgG rich in HBsAg) may be given to non-immune contacts after high-risk exposure. Vaccination: an effective vaccine is available against hepatitis B and it grants 95% protection to non-immune subjects. It consists of three doses (at time 0, 1 month and 6 months). In the case of an accident at work the vaccination plan involves four doses at time 0, 1 month, 2 months and 12 months and it seems more immunogenic. The first dose must be given within 96 hours of the accident. In the case of non-immune workers, the specific IgG must be given within 48 hours of the exposure.

    22. Hepatitis C virus Health risks: chronic hepatitis (progressive form with the development of cirrhosis and hepatic failure; slow form with very few clinical signs). Hepatitis C cirrhosis has a benign course, with a long interval before any complication arises, if compared to alcoholic cirrhosis. Patients with chronic HCV infection and cirrhosis can develop hepatocellular carcinoma. General preventive measures dtto VBH Specific preventive interventions At present, no vaccine is available against hepatitis C and neither is any measure of post-exposure prophylaxis.

    23. Tuberculosis - Mycobacterium tuberculosis Specific measures to reduce the risk of transmission of the disease include: information and training of the health operators; health surveillance of the health workers: 1. screening programme (tuberculin test) 2. BCG vaccination in the tuberculin test negative 3. isoniazid chemoprophylaxis in the cuticonverted subjects structural interventions (artificial ventilation systems, filtering plants, UV lamps, pressurized rooms); use of respiratory personal protective devices.

    24. HIV infection The occupational risk of HIV infection after percutaneous exposure to infected blood is estimated to be around 0.3%, but it is significantly higher if: - the health worker's wound is deep; - there is evidence of blood on the tool responsible for the injury; - the tool responsible for the injury had been previously put in an artery or vein of the infected patient; - there is a massive conjunctival contamination; - the patient source of infection dies of AIDS within 60 days from the exposure of the health worker.

    25. General preventive measures Health education, training programmes for the personnel at risk. Scrupulous compliance with the "universal precautions" to be followed at all times with all patients, regardless of their pathology and certainty of diagnosis. Use of appropriate personal protective devices (gloves, mask, white coats). Abolition of the manoeuvre of needles' covering. Collection of sharp materials, syringes and needles in appropriate containers before disposal. Specific preventive interventions At present, no vaccine is available against HIV infection. Post-exposure prophylaxis is recommended after high risk occupational exposure. It involves administration of an association of antiretroviral drugs. Such prophylaxis should start immediately, possibly within 1 to 4 hours after exposure (never after 24 hours) and continue for at least 4 weeks.

    26. Chemical risks - Chemotherapeutic drugs Drugs employed in chemotherapy represent an heterogeneous group of substances that inhibit the proliferation of malignant cells with different mechanisms, mainly genotoxic. These do not spare normal highly proliferating tissues (piliferous bulb, intestinal epithelium, bone marrow). The main groups of chemotherapic drugs include: - alkylation agents (cyclophosphamide, cisplatinum, carboplatinum, ect.); - antimetabolites (azathioprine, fluorouracil, methotrexate, etc.); - antimitotics (vincristine, vinblastine); - antibiotics (actinomycin, bleomycin, daunomycin); - enzymes (L-asparaginase).

    27. Most of these substances have been proved to be mutagenic, carcinogenic and teratogenic in experimental systems. Antineoplastic drugs usually irritate skin and mucous membranes. Furthermore, they can provoke local toxic effects (phlebitis, allergies, tissue necrosis) and systemic toxic effects (allergies, organ toxicity).

    28. Among the most serious side effects of these drugs there are both mutation induction and carcinogenic effects. According to IARC (International Agency for Research on Cancer) many antitumoural drugs can provoke tumours. In fact, cases of second tumours in patients treated with antiblastic drugs have been reported (especially acute non lymphoblastic leukemia). Antitumoural drugs taken into account by IARC are reported in the following table:

    29. Group 1: carcinogenic to humans 1,4-Butanediol dimethanesulfonate (Myleran), Cyclophosphamide, Chlorambucil, 1(2-Chloroethyl)-3(4-Methylcyclohexyl)-1-Nitrosourea Estrogens, Melphalan, MOPP, Treosulfan Group 2: probably carcinogenic to humans sufficient evidence: Adriamycin, Bischloroethyl nitrosourea (BCNU), Cisplatin, 1-(2-Chloroethyl)-3-Cyclohexyl-1-Nitrosourea (CCNU), Procarbazine hydrochloride, Thiotepa limited evidence: Bleomycin, Dacarbazine, Daunomycin

    30. As far as the potential exposure of the health workers is concerned, the enormous difference between therapeutical doses and doses resulting from professional exposure must be emphasized. Up to the present day reliable carcinogenic effects have been found only in the treated patients and not in health workers. Cytogenetic effects, such as an increase in chromosomic aberrations and exchange of sister chromatids have been shown in groups of nurses and pharmacy personnel that had been handling the drugs without taking the recommended precautions, whereas they have not been observed in the groups that complied with the required hygienic measures. As far as the potential effects of professional exposure to these drugs on the outcome of the first three months of pregnancy are concerned, some case-control studies have shown a double risk of miscarriages and malformations on the offspring, whereas other more recent studies have shown negative results.

    31. Ethylene oxide Ethylene oxide is a gas widely used in the hospital environment for the sterilization of medical and surgical equipment, such as catheters, tubes and, all materials that cannot be sterilized in the autoclave. After the sterilization has taken place, before the material can be used again it must undergo an appropriate degasifying period. This varies between some hours and some days depending on the material and on the used method (natural ventilation, forced ventilation, ect.). Ethylene oxide can be responsible for irritating and allergic manifestations and for neurotoxic and haemolytic effects. It is classified by the International Agency for Research on Cancer (IARC) amongst substances of "sufficient evidence" of carcinogenic effect for animals and of "limited evidence" for humans.

    32. Formaldehyde Formaldehyde is a substance widely employed in the hospital environment as a sterilizing agent and as disinfectant both of medical material and bed linen and of environments. Furthermore it is employed as a fixing and conserving agent in histopathology and in the haemodialysis wards. It is a gas with a strong irritating smell (its olfactory threshold is in fact very low, being 0.13 ppm). Formaldehyde can be absorbed through the respiratory system and in very small quantities also through the skin. It can cause irritations of mucous membranes, contact dermatitis (both irritating and allergic) and bronchial asthma. Furthermore formaldehyde has mutagen and carcinogenic power (it is classified by the International Agency for Research on Cancer amongst substances of "sufficient evidence" of carcinogenic effect for animals and of "limited evidence" for humans).

    33. Allergy-inducing agents Many agents able to cause immunoallergic manifestations can be found in the hospital environment: skin iritation and contact dermatitis respiratory system with asthmatic manifestations appearance of generalised forms such as urticaria and shock (anaphylaxis) Allergic risk factors : Chemical substances : Vegetable and animal products: detergents disinfectants laboratory animal products drugs house dust mites synthetic rubber gloves latex

    34. Disinfectants: gluteraldehyde, ammonium salts, formaldehyde and T chlorammine strong allergy-inducing agents largely used for skin and environments disinfection and in the sterilization of surgical and dentistry tools, endoscopes and catheters. These disinfectants, and also some detergents, may cause both irritating and allergic contact dermatitis, more frequently localized on the hands, around the wrists and on the forearms; Some disinfectants may be held responsible for some forms of professional asthma. The higher exposure takes place in: nursing staff, operating-theatre staff and endoscopy staff.

    35. Drugs: some antibiotics, such as betalactamide, chloramphenicol or neomycin, synthetic rubber and plastic gloves (thiurams and carbamates remaining after the vulcanisation of rubber) may induce contact dermatitis. Latex sensitization are extremely varied and may be characterized by local manifestations as contact dermatitis or by generalized manifestations involving: - skin and mucous membranes * generalized urticaria, * angioneurotic edema of the face or of other areas, * edema of the glottis with consequent severe respiratory difficulties,

    36. - the respiratory system (asthma and rhinitis), - the eyes (conjunctivitis), - shock (anaphylaxis). Products Containing Latex Emergency Equipment Blood pressure cuffs Stethoscopes Disposable gloves Oral and nasal airways Endotracheal tubes Tourniquets Intravenous tubing Syringes Electrode pads At risk of latex are even the persons who, though not wearing the gloves, works in confined spaces where such gloves are extensively used. cuff - manžetacuff - manžeta

    37. Personal Protective Equipment Gloves Surgical masks Goggles Respirators Rubber aprons Office Supplies Rubber bands Erasers Hospital Supplies Anesthesia masks Catheters Wound drains Injection ports Rubber tops of multidose vials Dental dams Prevention of allergic risk : The employment of detergents-antiseptics with non-physiological pH and an irritating action must be avoided, as skin irritation favours sensitization phenomena. Furthermore, excessive washing and rubbing of the hands and forearms should be avoided, as such manoeuvres harm the cutaneous hydrolipidic layer that is an essential barrier against the passing of allergens to deeper layers.

    38. Secondary prevention: identification of the subjects at highest risk of sensitization, such as the atopic subjects and those affected by allergic dermatitis of a different nature. extra-working measures ought to be adopted by the worker to avoid contact with the allergen. Hospital workers at higher risk of latex sensitization must avoid food with cross reactivity with latex, such as bananas, chestnuts, hazelnuts, avocados and kiwi. Derivatives of laboratory animals (such as urine and dandruff of cavies, mice, rats and rabbits) cases of occupational asthma

    39. Stress In dealing with problems of physiology and psychology at work, the physician is faced with a complex system, where three components interact with each other: man, work and the environment. Any stressing agent interacting with man can cause two kinds of reaction: a positive regenerative reaction (eustress) and a negative reaction (distress) that may lead to psychical psychosomatic pathologies, depending on whether the subject is able to find the personal resources to cope with the emergency situation. Stress is, basically, the answer to a situation in which the subject is aware of the discrepancy between the external demands and his/her subjective and objective characteristics. Therefore, stress can be seen as the consequence of the judgement regarding the need to employ greater energy than usual. Any condition disturbing the equilibrium of the man-work-environment system can be seen as a stress factor and the alterations that follow are described by the term strain.

    40. Schematically, the relationship stress-strain can be represented by the combination of a weight and a spring, where the weight represents the load stress and the stretching represents the deformation undergone by the spring (strain). If the weight overcomes the springiness or the breaking load of the spring, then the deformation is irreversible. The stress syndrome may present itself in different clinical variants that have the following characteristics in common: The physiopathological response is non-specific, therefore different stimuli can lead to similar clinical pictures; The course of the disease is uniform and is characterized by the succession of an alarm phase, a resistance phase and, finally, a burn-out and/or adaptation phase; The mediators of the stress-strain reactions are represented by the endocrine system, the vegetative nervous system and the immune system; An essential characteristic of the strain manifestations is represented by the twofold valence of the answer to environmental factors, which is both somatic and behavioural. Therefore, it is possible to alternatively observe psychological reactions, somatization phenomena, integrated psychosomatic reactions.

    41. Individual reactions vary depending on the subject's psychology, however, as far as the health personnel is concerned, it is possible to describe three main types of reaction: behavioural disorders, psychophysiological disorders, burn out syndrome. Behavioural disorders include alcohol abuse, tabagism and an increased number of alimentary disorders (hypo or hyper alimentation). The psychophysiological disorders include an increase in sleep disturbances, an increase in cardiovascular symptoms associated with anxiety (palpitations, hypertension, dyspnoea, hiperhidrosis), a generalized muscular tension linked with psychomotor restlessness and incapacity to relax.

    42. Burn out syndrome is an emotional exhaustion syndrome characterized by: feelings of dissatisfaction and professional incompetence, apathetic attitudes and depersonalization. The subject feels deprived of the emotional and personal resources that had led him/her towards the professional choice and he/she is pervaded with the feeling of not having anything more to give. Prevention The first prevention against stress is represented by the immediate opening to one's own problems as soon as they arise, taking advantage also of the counselling services. The prevention and correction of work-related stress is based on the constant renovation with regards both to the technical professional aspects and to the organizational laws in force, as well as on the systematic confrontation between health workers. These measures will favour the improvement of the emotional and professional wellbeing of those who, working in the hospital environment, are constantly stressed by environmental, continuously evolving, demands

    43. Manual weight lifting The link between manual weight lifting and risks of trauma and musculo-skeletal disorders, particularly of the lumbar vertebral column, has been widely reported in the literature. In fact, low back pain is the first cause of disability in the population under 45 years of age. As much as 20% of accidents at work involve the lumbar vertebral column as a result of heavy objects lifting carried out incautiously. Such pathologies hold the second place among the ten most important health problems at work, as reported by NIOSH (National Institute of Occupational Safety and Health). Every year, in Great Britain, as much as 4% of workers need to change job due to vertebral column disorders.

    44. In the Scandinavian countries, the average of working days lost every 100 workers due to low back pain problems is 36. In the US it has been calculated that the total cost for all cases of low back pain ranges between 10 and 60 billion dollars a year. This knowledge has urged the European Union to issue specific rule to regulate the employment of manual force in weight lifting, in order to keep it within acceptable limits. In Italy this directive has been implemented in the law 626/94 (title V). Musculo-skeletal disorders are very common in the hospital environment; in fact, hospital work usually involves both the maintenance of prolonged fixed postures and the lifting and carrying of weights. During such operations, in relation to the worker's posture, the weight and dimensions of the object, the distance to be covered, compression forces affect the anatomical constituents of the lumbar spine and can lead to microlesions and lesions of such structures. Among the different causes that can lead to disorders of the spine, both the structure and organization of the hospital and the training of the health personnel play an important role.

    45. In fact, as far as the structure is concerned, an erroneous planning of the rooms and of the fittings could impede a correct manual lifting of the patients or could prevent the employment of hoists should they be available. Furthermore, the hoists could be underemployed because of insufficient information or training or because of the tendency, especially of the senior personnel, to avoid new machinery or because of the precariousness of such machinery. On the basis of the workers' perception of strain, the situations at highest risk are as follows: shifting the patient from the bed to a wheelchair, turning the patient in bed, lifting the patient on the pillow, lifting up the back of the bed, all operations that might become particularly difficult if the patient cannot cooperate, as it is often the case in some of the wards, such as the rehabilitation ward, the intensive care unit, the Accidents and Emergencies department, the surgical wards and the orthopaedics ward. Disorders of the vertebral column affect the lumbar, dorsal and cervical tracts and consist of arthrosis and disc herniation. Symptoms include pain and functional inability.

    46. Primary prevention of postural risks at work must be carried out during the planning of the plants and fittings of the workplace, taking into account in the first place the physical and psychological characteristics of the workers rather than the economic and productive ones. For example, appropriate clear spaces should be available to easily transfer patients. The employment of adjustable beds is recommended and, generally, the employment of low beds (less than 50 cm high) should be avoided, because it forces the personnel to bend awkwardly. Specific hoists should be made available to perform the different operations on patients. Health personnel should be appropriately trained on the correct way to perform the different manoeuvres of lifting and moving patients and on the employment of hoists. Furthermore, personnel should be adequately informed about the possible risks that such manoeuvres entail for the musculoskeletal system. A useful indication is that of performing all lifting operations with one's legs wide apart in order to make the support base as wide as possible to improve the equilibrium of the position. When rearranging the bed, the best custom would be to lean one knee on the bed in order to avoid awkward stress to the vertebral column.

    47. When turning a non-cooperating patient in bed, the operator should keep one foot forward and the other backward with bent knees and grasp the patient at the pelvis or scapula level. Should a patient be moved (for example onto a wheel-chair), the operator needs to make the support base as wide as possible and bend the knees, then the operator should make his/her arm pass underneath the patient's and firmly grasp the patient's folded arms. This manoeuvre is best performed by two operators, one on each side. Should the patient be able to cooperate even to a small extent, it is useful to train him/her to perform adequate matching endeavours. If the patient is not able to second the stress, it is useful to make a strong length of material pass underneath the patient's body and lift him/her up together with other operators to divide the stress. Alternatively, a first operator could grasp the patient underneath the shoulder, a second operator at the pelvis and a third one at the knees. A stretcher can be employed to make the transfer easier. It should be positioned crosswise with respect to the bed in order to allow freedom of movement to the operators. Alternatively, a board could be employed. It should be positioned in parallel to the patient's body which is then dragged onto it.

    48. The general principles that can be taught to workers in order to prevent harm and injuries during the moving and lifting stress include: -it is necessary to make sure that the route is clear of obstacles and, if the ground is not flat, it is necessary to make sure to be able to brake; -it is necessary to employ footwear with a firm grip on the ground; -when moving heavy objects, it is better to push them than to pull them. Furthermore, to start the movement it is better to face backwards, pushing one foot firmly to the ground, and begin the movement applying the strength with the back. Preventive measures consist in the assessment of the musculoskeletal strain during the working activity. This is done by employing both systems to analyse posture and biomechanical models to measure the exposure to the load of physical work, giving an indirect analysis of the stress borne by the vertebral column and the main joints.

    49. Furthermore, during health surveillance an accurate clinical-functional examination of the vertebral column must be performed and, if necessary, radiological examinations can be required to establish whether the health operator is fit to perform tasks that involve moving and lifting patients or other loads. Furthermore, the personnel must be periodically examined both to allow the early diagnosis of alterations linked to the job and to prevent further deterioration of the worker's condition, as well as to allow an appropriate motory recovery.

More Related