Recommendations for organizing the workplace of a topometrist. Guidelines for organizing the workplace of a doctor and a nurse in a polyclinic

Approved

Head office

treatment and prophylactic

assistance of the Ministry of Health of the USSR

Agreed

Central Committee of the Trade Union

medical workers

ORGANIZING THE DOCTOR'S WORKPLACE

AND THE NURSE OF THE POLYCLINIC

Guidelines prepared by the staff of the department of NOT of employees of health care institutions of the All-Russian Research Institute of SG and OZ named after V.I. ON THE. Semashko (Yu.I. Zotov, G.I. Kutsenko, V.S. Vasyukova, D.K. Eremina, head of the department, Doctor of Medical Sciences V.F. Minakov) and the Council of Social Insurance of the Central Committee of the Trade Union of Medical Workers (V S. Shurupova, N.I. Kolesnik).

One of the important sections of the scientific organization of labor (SOT), aimed at creating favorable conditions for efficient and high-quality work, is the rational organization of the workplace and working conditions for medical personnel of outpatient clinics. However, to date, this issue has not been given due attention in the country's polyclinics. used in practical activities doctor and nurse due to the limited coverage area and the lack of devices for placing medical records, tools and office equipment, stationery tables are of little use for putting things in order in the workplace. Often in the workplace of a doctor you can find a mountain of medical records, various forms, referrals, glasses with spatulas and thermometers, which creates crampedness and confusion. Poor organization of the workplace leads to irrational costs of working time. It has been established that during a three-hour outpatient appointment, the local general practitioner has to search for lost objects four times on average. medical document, form, medical card. The time spent searching for each document ranges from 10 s to 3.5 m. In addition to the loss of working time, this circumstance causes additional psycho-emotional stress in the work of the doctor and nurse, creates an unfavorable atmosphere at the reception, and negatively affects the state of the medical and diagnostic process.

Specially conducted studies have shown that many elements of the work of a doctor during an outpatient appointment are performed in forced, non-physiological positions, which leads to a rapid increase in fatigue of various parts of the musculoskeletal system, the development of functional insufficiency and discomfort in them, and also negatively affects the quality of the diagnostic work, especially at the stage of physical examination of the patient. To a large extent, the forced working postures of medical workers at an outpatient appointment are associated with the irrational organization of workplaces: imperfect equipment, improper selection and placement of furniture, its inconsistency with the specifics of work, anthropometric data and physiological capabilities of workers.

Improving the organization and maintenance of workplaces in healthcare institutions should be aimed at creating optimal conditions that ensure a high level of efficiency of medical personnel, more complete use of the working time of a doctor and nurse for the main types of work.

Experience in the rational organization of labor of the leading institutions of the country: Polyclinic No. 22 in Kyiv, Polyclinic No. 1 in Novopolotsk, a number of outpatient clinics in the cities of Riga, Dushanbe, the polyclinic department of the Aluksenskaya Central District Hospital of the Latvian SSR, etc. and results scientific research performed by the department of NOT VNII SG and OZ them. ON THE. Semashko, made it possible to determine the main requirements and outline measures to improve the organization of the workplaces of a doctor and a nurse conducting an outpatient appointment.

General requirements for the organization of workplaces

The workplace should be understood as the area labor actions employee or group of employees, equipped and equipped with everything necessary to perform their duties. When organizing jobs for medical workers, first of all, the type of institution and the profile of a specialist are taken into account, that is, workplace should be specialized.

The rational organization of any workplace in a medical institution should provide for equipment, rational layout, organization of workplace maintenance, compliance with ergonomic, aesthetic and sanitary and hygienic requirements.

Equipping workplaces is one of the main conditions for the rational use of the labor of medical workers and involves providing each workplace with a set of furniture, special instruments and equipment, office equipment, standard forms, etc. When equipping, it is necessary to take into account the nature labor activity working.

Important in the organization of the workplace is the rational placement of medical furniture and equipment in the doctor's office. In accordance with ergonomic requirements (see below), as well as based on observations of the actions of the doctor and nurse, it is recommended to place the furniture and equipment of the doctor's office, guided by the following rules:

The desktop of the doctor and nurse should be in the most illuminated part of the office;

There must be space around the table to ensure the free movement of the doctor and nurse from the table to any object in the office;

The couch for examining the patient should be positioned so that the right half of the patient's body is on the doctor's side; the couch must be fenced off from front door screen and close to it to put a chair for the patient;

The location of each item must be thought out in order to minimize the cost of movement and ensure compliance with aesthetic requirements in the design of the office;

The door of the office must be visible so that the doctor can see the incoming patient.

Ergonomic requirements for the organization of workplaces determine the conformity of the design data and dimensions of work furniture, office equipment with the anthropometric, biomechanical and psychophysiological capabilities of the human body. Compliance with them allows providing a medical worker with a physiologically rational posture in the course of work that meets the criteria of functional comfort.

Hygienic requirements for the organization of workplaces in medical offices provide for the observance of basic sanitary and hygienic standards in them: sufficient space, cubic capacity, footage per worker, microclimate parameters, lighting, noise, etc.

Aesthetic requirements for the organization of workplaces provide for the implementation of a set of recommendations for the artistic design of working premises, office interiors, and the institution as a whole.

Ergonomic, hygienic and aesthetic requirements for the organization of workplaces are set out in the relevant regulatory and methodological materials.

Workplace services include the organization of document flow, the provision of medicines, standard forms and tools, the organization of a call for patients, the preparation of workplaces and cleaning of premises. In recent years, in many medical institutions, centralized provision of workplaces with everything necessary has become widespread.

In the rational organization of workplace services, an important place should be given to the use of standard referral forms for research and treatment. As observations have shown, the frequency of issuing referrals, for example, in the office of a local general practitioner is on average 23 times by a doctor and 46 times by a nurse per 100 visits, and in an ENT room - 21 and 31, respectively. An average of 1.4 m is spent on an extract from one direction. Taking into account the fact that the patient needs to be explained where and to which office he needs to appear, how to prepare for the study, unproductive costs of working time increase significantly. Therefore, the rationalization of this element of the work of medical personnel has a significant benefit in the work of polyclinic specialists. It is recommended to use standard referral forms for certain types of research (Appendix 2 - not provided). The front side of each form-direction consists of two sections. In the first section, the nurse enters the surname, initials, medical record number and address of the patient, as well as the doctor's surname and date of appointment. The second part is intended to fill in the results of the study of auxiliary diagnostic services. back side The form has a memo for the patient, including information about the rules for preparing for the study, the place and time of its conduct. The presence of such forms completely frees the doctor from writing directions, saves work time nurses. Direction forms must be placed in the table's blank library, only in this case it is convenient to use them.

Significantly saves the doctor's working time using pre-prepared prescriptions. It has been established that the frequency of their discharge is, for example, for an otolaryngologist an average of 100 - 150 per 100 visits, for a local general practitioner, respectively, 200 - 250. Special studies have shown that an otolaryngologist operates in his work about 100, and district doctor 140 - 160 prescriptions, most of which are used repeatedly during the working day and week. In view of the foregoing, the optimal volume of the prescription library should be designed for 40-60 prescriptions.

With a rational organization of the workplace, it is necessary to address the issues of reducing the time spent on maintaining an outpatient medical record, which occupy at least 25-30% of the working time at the reception in the work of doctors of the main specialties. For this purpose, it is currently recommended in clinics to use cliched inserts in the medical record (developed at the N.A. Semashko All-Russian Research Institute of SG and OZ), which allow, by emphasizing the signs listed in them and entering the missing ones in specially designated lines, to significantly reduce (by 15 - 20%) doctors' expenses for filling out a medical card. Samples of such inserts for the local general practitioner and otolaryngologist are given in Appendix 3 (not shown). Inserts can be printed in a typographical way or by making a rubber plate. In the latter case, they are printed as needed directly in the doctor's office.

Maintenance of functional connections of doctors at an outpatient appointment is ensured by equipping workplaces with means of communication with all the main divisions and services of the polyclinic: the registry, offices of specialist doctors, heads of departments, auxiliary treatment and diagnostic rooms.

To call the patient to the doctor's office, it is advisable to use a light or sound alarm. When using light signaling, a light board with the inscription "Do not enter" is installed at the door of the office, which is illuminated during the reception of the patient, and "Enter" when the doctor has received the patient and calls the next one. In this case, a light signal switch is equipped at the doctor's workplace. In the second option, any intercom communication device operating in a loud-speaking mode (for example, PU-1) is used.

Thus, the well-thought-out organization and maintenance of the workplace, its equipment and equipment, taking into account the requirements of ergonomics and aesthetics, the rational layout of the office should be aimed at creating conditions for the effective and high-quality work of the doctor and nurse conducting outpatient appointments.

Organization of the workplace of the local general practitioner

The doctor conducting an outpatient appointment has his desk as a workplace. At present, taking into account the shortcomings associated with the use of conventional stationery tables in the work of local general practitioners, a number of functional tables have been proposed.

The work table of an outpatient doctor, developed by P.E. Beilin, which is used in polyclinic N 22 in Kyiv. It consists of four rectangular boards, three of which are vertical, set in an H-shape, the fourth covers them horizontally. Devices: a tape recorder, a microphone, a Riva-Rocci apparatus, glasses with spatulas and thermometers are "drowned" in the table cover, and glasses with disinfectants for storing thermometers and spatulas are also placed. Medical supplies are placed on the table in specially designated working areas. The table is equipped with a portable recipe library for 24 cassettes mounted in the front drawer of the table. To organize the workplace of a nurse, a folding board is provided. The table can be recommended for use in clinics where the tape recorder method of keeping records of medical records has been introduced.

The Republican Center for NOT and the Health Department of the Ministry of Health of the Latvian SSR proposed a unified table for a local general practitioner, which is used in a number of polyclinics in Riga. On the horizontal plane of the table there is a recess for a tonometer fixed with a special bracket. In the drawers of the table top there are directions for examinations and treatment, items for individual use of a doctor and a nurse. The top drawer of the table base is intended for short-term placement of medical records of outpatients. Delivery of medical records to the doctor's office is carried out using containers that are completed in the registry in the order of priority for receiving patients by the doctor. As a container, desktop file cabinets for A-5 format cards, produced by the industry, are used. The bottom drawer of the support pedestal of this table is intended for personal belongings of the doctor and nurse. This table is recommended to be introduced into the work of a local general practitioner, whose work organization provides for the use of standard referrals for examinations and treatment, delivery of medical records in special containers.

Department of NOT workers of health care institutions VNII SG and OZ them. ON THE. Semashko, together with the All-Union Design and Technological Institute of Furniture, proposed a desktop for a doctor and a nurse, using cliched inserts for medical records, standard referral forms, and pre-made prescription prescriptions. The table has a slightly larger work surface (1280 x 940 mm) compared to a conventional stationery table. This allows you to organize the workplace of a doctor and a nurse at one table. Under the table cover on the middle line on both sides there are two flat boxes measuring 198 x 512 x 60 mm, designed to accommodate reference literature, a site passport, stationery. The surface of the table has two zones - for a doctor and a nurse, in addition to the table, a card file in the form of two bedside tables on wheels is attached. Drawers in bedside tables serve as containers for placing inserts of medical records, standard referrals, registration forms, temporary storage of medical records, placement of control cards for dispensary patients, etc. The drawers of the bedside tables are pulled out with the help of hanging hinges, which allow keeping the extended containers in a horizontal position for the entire length. The presence of a separate blank card file allows you to install it in a place convenient for the doctor and nurse. On the surface of the table there is a special device for mounting the tonometer.

Aesthetic and hygienic requirements for the design of the office of the local general practitioner are established in accordance with SNiP II-69-78 "Treatment and preventive institutions. Design standards", according to which the area of \u200b\u200bthe office should be 12 - 16 square meters. m (with a room width of at least 2.4 m and a depth of 4 - 6 m in conditions of one-sided lighting). The ratio of the depth of the room to its width should be no more than two.

The color of the walls can affect the perception of the color of pathological tissues, emphasizing or, conversely, masking their pallor, cyanosis, etc. In this regard, it is preferable to paint the walls of the room in neutral tones, for example, light gray. The ceiling is painted white, the floor is dark. It is advisable to have curtains on the windows in yellowish shades, and desk covers in green colors.

The optimum air temperature in the office according to GOST 12.1.005-76 "Working area air. General sanitary and hygienic requirements" in cold and transitional periods of the year should be within 20 - 23 ° C, in the warm period of the year - 20 - 25 ° C at relative humidity 60 - 40% and air speed not more than 0.2 m / s in all periods of the year. In order to avoid disturbance of thermal equilibrium and cooling of patients during physical examination, it is necessary that the difference in air temperature horizontally (from the outer walls to any point inside the room) and vertically (between the floor and a height of 1.5 - 2 m) does not exceed 1 - 2 ° C . The frequency of air exchange in the office at least 1 time per hour is provided by the use of natural ventilation.

According to GOST 12.1.003-76 "Noise. General requirements safety" the noise level in the offices should not exceed 30 dB, and in the premises for the reception of patients in noisy industries, noise levels should not exceed 50 dB.

The bacterial contamination of the air in working rooms should not exceed 4000 per cubic meter. m of bacteria and 50 colonies per cubic meter. m representatives of hemolytic microflora.

The hygienic regime of the premises provides for wet cleaning twice a day.

The nature of the work of GPs requires high levels of both natural and artificial lighting. At the same time, according to SNiP II-4-79 "Natural and artificial lighting. Design standards", the normalized values of the coefficient of natural lighting (KEO) are 1.5 - 2.0; artificial illumination at the level of the table surface should be at least 300 lux and is provided by general lighting. Given the high requirements for color discrimination in the work of a local general practitioner, fluorescent lamps with optimal color characteristics should be preferred as a light source. Luminaires such as LHE, LDTs can be used to illuminate classrooms.

In order to create the aesthetics of workplaces in the office of the local general practitioner, it is necessary to provide for landscaping, which also acts as a factor that improves the microclimate.

Organization of the workplace of an otolaryngologist

The office of an otolaryngologist according to SNiP II-69-78 is organized in a room of 18 square meters. m, having at least 6 m in length, which is necessary for the study of hearing in patients with whispered and colloquial speech. For the same purposes, when arranging an office, good sound insulation should be provided. The ENT room is recommended to be placed in two adjacent rooms, one of which is intended for receiving patients, the other for complex manipulations and outpatient operations. New projects of outpatient clinics for 750 or more visits per day provide for an operating room with a preoperative area of 22 square meters next to the otolaryngological room. m (14 sq. m + 8 sq. m).

The optimum air temperature in the ENT room is 18 - 20 °C, in the warm season - up to 25 °C. The air exchange rate is once per hour. If washing and drying of surgical instruments are carried out directly in the working room, the air exchange rate should be increased by three times the exhaust per hour. If there is a fume hood in the office, in which work with biologically active drugs is carried out, the optimal conditions of the air environment in the office can be provided with natural ventilation.

Other hygienic indicators of the air environment correspond to the normative ones for the offices of local general practitioners.

One of the unfavorable factors of the working conditions of otolaryngologists is a wide contact with the infection, which is confirmed by the high incidence of acute respiratory diseases in specialists of this professional group, identified in the course of a special study. Taking into account this circumstance, special attention should be paid to measures aimed at reducing bacterial contamination in working areas.

The surface of walls and ceilings must be smooth, allowing wet cleaning and disinfection. The floor should be covered with a waterproof material that is easy to clean and can be cleaned frequently.

Sanitation of air is more effective to carry out directly in the presence of people. For this purpose, the method of air disinfection with bactericidal lamps should be used. The domestic industry produces a wall-mounted bactericidal NBO irradiator, consisting of two lamps (BUV-30P): the upper (shielded) irradiates directly the upper zone of the room in the presence of people, then the disinfected air enters the breathing zone of personnel and patients by convection currents; lower ( open lamp) produces a short powerful exposure in the absence of people for 15 - 20 m. Irradiation of the premises after wet cleaning (before work and between shifts) ensures the death of pathogenic microflora, which plays an important role in the etiology of acute and chronic diseases of the upper respiratory tract. When using UV radiation for disinfection, the walls and ceiling of the room should be painted with yellowish oil paints that have an optimal reflection coefficient for ultraviolet rays.

When organizing the workplace of an ENT doctor and a nurse, the use of ergonomically sound furniture is of great importance. According to a special study, otolaryngologists at outpatient appointments under the prevailing working conditions spend more than half of their working time in forced positions. The non-physiological postures of otolaryngologists are primarily due to the specifics of the diagnostic and treatment process of persons in this specialty. The main elements of labor activity when examining patients and performing medical manipulations are carried out with non-fixed hands with the body tilted forward by 17 - 25 °. This causes tension in the muscles of the back, upper shoulder girdle and is a significant load on the anterior sections of the cervical and thoracic vertebrae. Large service spaces (reach area up to 1200 mm) force the doctor to make a significant number of forward and side bends (about 450 - 500) during one appointment. The situation is aggravated by the irrational organization of the workplace, which leads to rapid fatigue of various parts of the musculoskeletal system that carry the main load in these postures. This is confirmed by numerous complaints, as well as indicators of the state of the cardiovascular and muscular systems.

A feature of the work of persons in this specialty is the lack of motor activity: the dynamic component in the work of an otolaryngologist is only 4.7% of the working time. Under these conditions, much attention should be paid to the rational organization of the working posture of the doctor and nurse in the ENT room. To do this, the medical staff of the office must be provided with functional chairs. Since the otolaryngologist almost never leaves the workplace, the design of the working chair should provide conditions for short-term rest (maintaining the doctor’s body in a physiologically rational position while maintaining the natural curves of the spine, rest for the hands), for which the chair must be equipped with a backrest with armrests.

The otolaryngologist's chair should be movable in a horizontal plane with the possibility of automatically fixing it in the desired position. The rotation of the chair around the vertical axis of the supporting structure by 180° allows you to bring the dimensions of the reach zones closer to the optimal values. The mobility of the posture is also provided by a flat semi-soft seat, covered with a softened water-repellent, non-electric and airtight material. From working furniture produced by the domestic industry, in the most more The specified requirements are met by a chair designed by the Volgograd Medical Equipment Plant.

A rationally organized workplace for an otolaryngologist at an outpatient appointment includes a table for instruments (proposed by doctor A. Heeger) and a functional desktop. The instrument table is located to the left of the doctor. It provides the otolaryngologist with a comfortable posture during examination and treatment procedures. The area of the table, 1000 x 600 mm, allows you to rationally place all the necessary items and tools and install a work lamp at the right distance. The presence of another working area of the table, located below and parallel to the main one, allows you to timely release the working area from the used tools.

As a desktop of an otolaryngologist, it is advisable to use the functional table described in the previous section. The workplace of the nurse in this case is at the same table, opposite the doctor. At some distance from the workplace of the doctor and nurse, a table for instruments is placed. This allows the nurse to actively help the doctor in the implementation of diagnostic and treatment procedures, as well as perform a number of independent manipulations prescribed by the doctor. As a result, the efficiency and volume of work of the ENT-office increases.

The patient's chair should be rotatable with headrests, which allows fixing the head during manipulations and outpatient operations.

The specifics of the work of an otolaryngologist requires a certain degree of darkening of the office, which leads to the appearance of contrasts in the illumination of objects in the surrounding space. At the same time, during otoscopy, laryngoscopy, and surgical interventions, the doctor has to deal with the small size of the observed objects, which necessitates bright illumination of the field of view. The frequent re-adaptation of the organ of vision that occurs in these cases leads to a decrease in visual performance, rapid development fatigue, and with prolonged exposure - to pathological changes in the organ of vision. In view of the foregoing, special attention should be paid to rational lighting of the workplace. In order to provide favorable conditions for re-adaptation of the eye, the ratio of the brightness levels of the workplace and the surrounding background should not exceed 1:3. To comply with this requirement, the walls and floor of the ENT room should be painted in light colors with a high reflectivity. For more uniform illumination, to exclude the glare caused by the sun's rays, the orientation of the ENT-office is preferable to the north. To protect against direct and reflected sunlight, it is necessary to have sun protection devices on the windows (for example, blinds) that allow you to create the desired degree of darkening in the office.

The required levels of illumination in the ENT room are created using a combined lighting system. On the surface of the desk, the illumination should be at least 300 lux. The illumination of the viewing area during the examination of the patient is created by the light reflected from the working lamp, which is located at a distance of 10 - 15 cm from the patient and 60 - 70 cm from the doctor. As a light source in a working lamp, it is recommended to use 60 W incandescent lamps in a flask made of milky (frosted) glass, which does not have a pronounced blinding effect on the organ of vision. Incandescent lamps of this power provide an illumination level of 700 - 750 lux sufficient for examining ENT organs. It is convenient to use lamps attached with a bracket or mounted in a patient chair.

Important in the organization of the workplace of an otolaryngologist and a nurse should be given to the layout of the office with the rational placement of furniture, necessary items and means of labor for the medical personnel of the ENT office, taking into account ergonomic requirements, separation of the areas of activity of the doctor, nurse and traffic flows of visitors.

The rational organization of the workplaces of doctors and paramedical personnel of outpatient clinics is based on knowledge of the specifics of the labor process, as well as compliance with hygienic, psychophysiological and ergonomic requirements for working areas and working conditions of each specialist. The selection of functional furniture, the correct distribution of objects of labor, office equipment in the working space, the use of rational forms and methods of organizing work allows you to avoid clutter and disorder in the workplace, eliminates unproductive expenditure of working time, and reduces the increase in fatigue. Only the comprehensive implementation of all the described activities allows you to create the necessary conditions for the effective and high-quality work of medical personnel of medical institutions.

The Association assists in the provision of services in the sale of timber: at competitive prices for permanent basis. Timber products of excellent quality.

Approved

Head office

treatment and prophylactic

assistance of the Ministry of Health of the USSR

Agreed

Central Committee of the Trade Union

medical workers

ORGANIZING THE DOCTOR'S WORKPLACE

AND THE NURSE OF THE POLYCLINIC

The methodological recommendations were prepared by employees of the department of NOT of health care workers of the VNII SG and OZ named after V.I. ON THE. Semashko (Yu.I. Zotov, G.I. Kutsenko, V.S. Vasyukova, D.K. Eremina, head of the department, Doctor of Medical Sciences V.F. Minakov) and the Council of Social Insurance of the Central Committee of the Trade Union of Medical Workers (V S. Shurupova, N.I. Kolesnik).

One of the important sections of the scientific organization of labor (SOT), aimed at creating favorable conditions for efficient and high-quality work, is the rational organization of the workplace and working conditions for medical personnel of outpatient clinics. However, to date, this issue has not been given due attention in the country's polyclinics. Stationery tables used in the practice of a doctor and a nurse due to the limited coverage area and the lack of devices for placing medical documentation, tools and office equipment are of little use for putting things in order in the workplace. Often in the workplace of a doctor you can find a mountain of medical records, various forms, referrals, glasses with spatulas and thermometers, which creates crampedness and confusion. Poor organization of the workplace leads to irrational costs of working time. It has been established that during a three-hour outpatient appointment, a district general practitioner has to look for a lost medical document, form, medical card on average four times. The time spent searching for each document ranges from 10 s to 3.5 m. In addition to the loss of working time, this circumstance causes additional psycho-emotional stress in the work of the doctor and nurse, creates an unfavorable atmosphere at the reception, and negatively affects the state of the medical and diagnostic process.

Experience in the rational organization of labor of the leading institutions of the country: Polyclinic No. 22 in Kyiv, Polyclinic No. 1 in Novopolotsk, a number of outpatient clinics in the cities of Riga, Dushanbe, the polyclinic department of the Aluksenskaya Central District Hospital of the Latvian SSR, etc. and the results of scientific research carried out Department of NOT VNII SG and OZ them. ON THE. Semashko, made it possible to determine the main requirements and outline measures to improve the organization of doctor's workplacesand an outpatient nurse.

General requirements for the organization of workplaces

The workplace should be understood as the area of labor activities of an employee or a group of employees, equipped and equipped with everything necessary to perform their duties. When organizing workplaces for medical workers, first of all, the type of institution and the profile of a specialist are taken into account, that is, the workplace must be specialized.

Importancein the organization of the workplace has a rational placement of medical furniture and equipment in the doctor's office. In accordance with ergonomic requirements (see below), as well as based on observations of the actions of the doctor and nurse, the furniture and equipment of the doctor's office is recommended post according to the following rules:

The desktop of the doctor and nurse should be in the most illuminated part of the office;

There must be space around the table to ensure the free movement of the doctor and nurse from the table to any object in the office;

The couch for examining the patient should be positioned so that the right half of the patient's body is on the doctor's side; the couch must be fenced off from the front door with a screen and put a chair for the patient close to it;

The location of each item must be thought out in order to minimize the cost of movement and ensure compliance with aesthetic requirements in the design of the office;

The door of the office must be visible so that the doctor can see the incoming patient.

Ergonomic, hygienic and aesthetic requirements for the organization of workplaces are set out in the relevant regulatory and methodological materials.

Workplace services include the organization of workflow, the provision of medicines, standard forms and tools, the organization of a call for patients, the preparation of workplaces and cleaning of premises. In recent years, in many medical institutions, centralized provision of workplaces with everything necessary has become widespread.

In the rational organization of workplace services, an important place should be given to the use of standard referral forms for research and treatment. As observations have shown, the frequency of issuing referrals, for example, in the office of a local general practitioner is on average 23 times by a doctor and 46 times by a nurse per 100 visits, and in an ENT room - 21 and 31, respectively. An average of 1.4 m is spent on an extract from one direction. Taking into account the fact that the patient needs to be explained where and to which office he needs to appear, how to prepare for the study, unproductive costs of working time increase significantly. Therefore, the rationalization of this element of the work of medical personnel has a significant benefit in the work of polyclinic specialists. It is recommended to use standard referral forms for certain types of research (Appendix 2 - not provided). The front side of each form-direction consists of two sections. In the first section, the nurse enters the surname, initials, medical record number and address of the patient, as well as the doctor's surname and date of appointment. The second part is intended to fill in the results of the study of auxiliary diagnostic services. The reverse side of the form has a memo for the patient, including information about the rules for preparing for the study, the place and time of its conduct. The presence of such forms completely frees the doctor from writing directions, saves the nurse's working time. Direction forms must be placed in the table's blank library, only in this case it is convenient to use them.

Organization of the workplace of the local general practitioner

The work table of an outpatient doctor, developed by P.E. Beilin, which is used in polyclinic N 22 in Kyiv. It consists of four rectangular boards, three of which are vertical, set in an H-shape, the fourth covers them horizontally. Devices: a tape recorder, a microphone, a Riva-Rocci apparatus, glasses with spatulas and thermometers - "drowned" in the table cover, glasses with disinfectants for storing thermometers and spatulas are also placed. Medical supplies are placed on the table in specially designated working areas. The table is equipped with a portable recipe library for 24 cassettes mounted in the front drawer of the table. To organize the workplace of a nurse, a folding board is provided. The table can be recommended for use in clinics where the tape recorder method of keeping records of medical records has been introduced.

Department of NOT workers of health care institutions VNII SG and OZ them. ON THE. Semashko, together with the All-Union Design and Technological Institute of Furniture, proposed a desktop for a doctor and a nurse, using cliched inserts for medical records, standard referral forms, and pre-made prescription prescriptions. The table has a slightly larger work surface (1280 x 940 mm) compared to a conventional stationery table. This allows you to organize the workplace of a doctor and a nurse at one table. Under the table cover on the middle line on both sides there are two flat boxes measuring 198 x 512 x 60 mm, designed to accommodate reference literature, a site passport, stationery. The surface of the table has two zones - for a doctor and a nurse; Drawers in bedside tables serve as containers for placing inserts of medical records, standard referrals, registration forms, temporary storage of medical records, placement of control cards for dispensary patients, etc. The drawers of the bedside tables are pulled out with the help of hanging hinges, which allow keeping the extended containers in a horizontal position for the entire length. The presence of a separate blank file - file cabinet allows you to install it in a place convenient for the doctor and nurse. On the surface of the table there is a special device for mounting the tonometer.

The optimum air temperature in the office according to GOST 12.1.005-76 "Air of the working area. General sanitary and hygienic requirements" in the cold and transitional periods of the year should be within 20 - 23 ° C, in the warm period of the year - 20 - 25 ° C at relative humidity 60 - 40% and air speed not more than 0.2 m / s in all periods of the year. In order to avoid disturbance of thermal equilibrium and cooling of patients during physical examination, it is necessary that the difference in air temperature horizontally (from the outer walls to any point inside the room) and vertically (between the floor and a height of 1.5 - 2 m) does not exceed 1 - 2 ° C . The frequency of air exchange in the office at least 1 time per hour is provided by the use of natural ventilation.

According to GOST 12.1.003-76 "Noise. General safety requirements", the noise level in the offices should not exceed 30 dB, and in the rooms for receiving patients in noisy industries, noise levels should not exceed 50 dB.

The bacterial contamination of the air in working rooms should not exceed 4000 colonies per cubic meter. m of bacteria and 50 colonies per cubic meter. m representatives of hemolytic microflora.

The hygienic regime of the premises provides for wet cleaning twice a day.

Organization of the workplace of an otolaryngologist

The optimum air temperature in the ENT room is 18 - 20 ° C, in the warm season - up to 25 ° C. The air exchange rate is once per hour. If washing and drying of surgical instruments are carried out directly in the working room, the air exchange rate should be increased by three times the exhaust per hour. If there is a fume hood in the office, in which work with biologically active drugs is carried out, the optimal conditions of the air environment in the office can be provided with natural ventilation.

Other hygienic indicators of the air environment correspond to the normative ones for the offices of local general practitioners.

The surface of walls and ceilings must be smooth, allowing wet cleaning and disinfection. The floor should be covered with a waterproof material that is easy to clean and can be cleaned frequently.

Sanitation of air is more effective to carry out directly in the presence of people. For this purpose, the method of air disinfection with bactericidal lamps should be used. The domestic industry produces a wall-mounted bactericidal NBO irradiator, consisting of two lamps (BUV-30P): the upper (shielded) irradiates directly the upper zone of the room in the presence of people, then the disinfected air enters the breathing zone of personnel and patients by convection currents; the lower one (open lamp) produces a brief powerful exposure in the absence of people for 15 - 20 m. Irradiation of the premises after wet cleaning (before work and between shifts) ensures the death of pathogenic microflora, which plays an important role in the etiology of acute and chronic diseases of the upper respiratory tract. When using UV radiation for disinfection, the walls and ceiling of the room should be painted with yellowish oil paints that have an optimal reflection coefficient for ultraviolet rays.

When organizing the workplace of an ENT doctor and a nurse, the use of ergonomically sound furniture is of great importance. According to a special study, otolaryngologists at outpatient appointments under the prevailing working conditions spend more than half of their working time in forced positions. Non-physiological poses of otolaryngologists is primarily due to the specifics of the diagnostic and treatment process of persons in this specialty. The main elements of labor activity when examining patients and performing medical manipulations are carried out with non-fixed hands with the body tilted forward by 17 - 25 °. This causes tension in the muscles of the back, upper shoulder girdle and is a significant load on the anterior sections of the cervical and thoracic vertebrae. Large service spaces (reach area up to 1200 mm) force the doctor to make a significant number of forward and side bends (about 450 - 500) during one appointment. The situation is aggravated by the irrational organization of the workplace, which leads to rapid fatigue of various parts of the musculoskeletal system that carry the main load in these postures. This is confirmed by numerous complaints, as well as indicators of the state of the cardiovascular and muscular systems.

The otolaryngologist's chair should be movable in a horizontal plane with the possibility of automatically fixing it in the desired position. The rotation of the chair around the vertical axis of the supporting structure by 180° allows you to bring the dimensions of the reach zones closer to the optimal values. The mobility of the posture is also provided by a flat semi-soft seat covered with a softened water-repellent, non-electrifying and airtight material. Of the work furniture produced by the domestic industry, the chair designed by the Volgograd Medical Equipment Plant meets these requirements to the greatest extent.

The patient's chair should be rotatable with headrests, which allows fixing the head during manipulations and outpatient operations.

The specifics of the work of an otolaryngologist requires a certain degree of darkening of the office, which leads to the appearance of contrasts in the illumination of objects in the surrounding space. At the same time, during otoscopy, laryngoscopy, and surgical interventions, the doctor has to deal with the small size of the observed objects, which necessitates bright illumination of the field of view. The frequent re-adaptation of the organ of vision that occurs in these cases leads to a decrease in visual performance, the rapid development of fatigue, and, with prolonged exposure, to pathological changes in the organ of vision. In view of the foregoing, special attention should be paid to rational lighting of the workplace. In order to provide favorable conditions for re-adaptation of the eye, the ratio of the brightness levels of the workplace and the surrounding background should not exceed 1:3. To comply with this requirement, the walls and floor of the ENT room should be painted in light colors with a high reflectivity. For more uniform illumination, to exclude the glare caused by the sun's rays, the orientation of the ENT-office is preferable to the north. To protect against direct and reflected sunlight, it is necessary to have sun protection devices on the windows (for example, blinds) that allow you to create the desired degree of darkening in the office.

The rational organization of the workplaces of doctors and paramedical personnel of outpatient clinics is based on knowledge of the specifics of the labor process, as well as compliance with hygienic, psychophysiological and ergonomic requirements for working areas and working conditions of each specialist. The selection of functional furniture, the correct distribution of objects of labor, office equipment in the working space, the use of rational forms and methods of organizing labor allows you to avoid clutter and disorder in the workplace, eliminates unproductive costs of working time, reduces the increase in fatigue. Only the integrated implementation of all the described measures allows creating the necessary conditions for the effective and high-quality work of the medical personnel of medical institutions.

Rostov State Medical University

Department of General Surgery, Rostov State Medical University

INFORMATION MATERIAL

for first-year students of the medical and preventive faculty who are practicing as an "assistant to a junior ward nurse"

Compiled by:

Assoc. A.I.Maslov, Assoc. V.V.Skorlyakov, ass. S.Yu.Efanov, ass. O.V.Baev

Under the general editorship of Hon. activity science, prof. V.N. Chernova

Rostov-on-Don, 2012

1. Ethical and deontological principles of work and norms of medical personnel in the hospital. Legal responsibility of medical personnel

Medical deontology is the science of due, i.e. about how a medical worker is obliged to behave in various situations of communication with patients, relatives of the patient and colleagues in the profession.

The term "deontology" itself comes from the Greek words "deon", deontosis - due, proper, and "logos" - teaching.

This is a combination of such concepts as ethics, aesthetics, morality, law, mercy, adherence to principles. At the same time, education, literacy, professionalism play a huge role. The behavior of a medical worker, his words must necessarily lead to the creation of the best, optimal conditions for patients for treatment, regardless of the nature of the disease.

Basic deontological principles:

Responsibility;

Don't hurt;

Mercy;

Medical secrecy;

Behavior.

The physician must take responsibility for determining the prescription of this or that medicinal product one or another method of treatment. When determining the indications for surgery, the surgeon decides in the interests of the patient how much the outcome of the operation exceeds the risk of the disease itself.

Compliance with the principle "Do no harm!" is possible only if a medical worker has such a quality as the highest degree of self-criticism, the ability to correctly and soberly evaluate himself and his actions. Each surgeon, before deciding on an operation, must ask himself whether he would agree to perform such an operation on himself or his relatives in similar circumstances, and only if this issue is resolved positively, to operate.

Mercy is more of a quality that is brought up from childhood and adolescence on the example of surrounding adults, and during the period of thinking - on the basis of self-education. André Maurois wrote: "Charity is not an indispensable adornment of a physicist or a chemist, but it is a must for a general practitioner or surgeon."

If you see that the patient is groaning during dressing, and one of the students is looking out of the window abstractly, whispering, smiling, he clearly lacks such a quality as mercy for a medical worker.

Under the medical secret should be understood all the information received from the patient or identified during his medical examination or treatment, not subject to disclosure without the consent of the patient.

The behavior of medical personnel in the admissions department, wards, surgical dressing unit, in the lobby, etc. is an important factor influencing the psyche of patients and their confidence in the medical staff.

Much attention should be paid to wearing a gown, cap, change of shoes in the department, and a mask in the surgical department. A neat appearance, goodwill, balance, correctness create the best conditions for a patient in the treatment and prevention department.

It is noteworthy that for a long time the problem of the relationship of a doctor to a patient has been considered in terms of their cooperation and trust. So, the doctor and writer Abu-al-Faraj, who lived in the 13th century, formulated the following appeal to the sick person: “There are three of us - you, the disease and me; if you are sick, there will be two of you, I will stay - one - you will overcome me; if you are with me, there will be two of us, the disease will remain one - we will overcome it.

Medicine in modern world plays an exceptional role in human life and society. It is difficult to find a person who did not encounter her at all, meeting for the first time at birth and not parting until death. Therefore, the relationship between doctor and patient goes beyond the usual relationship between people. They require not only professional knowledge of a physician, compliance with moral and ethical standards, but also knowledge of the legal foundations for protecting the health of citizens. This is especially important in our time, when, contrary to the established traditions of the relationship between the doctor and patients, features are acquired that are characteristic of the relationship between the provider of services and their consumer, and when legal norms are their regulator.

In August 1993, the State Duma of the Russian Federation adopted the Basic Legislation of the Russian Federation on the protection of the health of citizens. This document, in the development of the Constitution, sets out the basic principles of protecting the health of citizens, organizing various health care systems, guaranteeing the implementation of medical and social assistance, the rights of citizens and certain groups of the population in the field of health protection.

2. Rules for personal hygiene of medical personnel.

A medical worker of any rank must observe the rules of personal hygiene and maintain his health. This is necessary both for himself and for the patients he serves. A medical worker should be an example of a high sanitary culture. No agitation gives such a result as a personal example. If a medical worker does not take care of his own health, how can he teach how to take care of the patient's health?

About meaning appearance Hippocrates, the great ancient Greek physician (460–377 BC), spoke of a medical worker. “The doctor is informed by authority,” said Hippocrates, “if he is of good color and well-fed, according to his nature, for those who themselves do not have a good appearance in their body are considered by the crowd to be unable to have the right care for others. Then, it is decent for him to keep himself clean, have good clothes and rub himself with fragrant ointments (having an unsuspicious smell), because all this is usually pleasant for patients.

Compliance with the daily routine is the basic rule of personal hygiene. You should always get up in the morning and go to bed, have breakfast, lunch and dinner at the same time. It is necessary to correctly distribute the hours of work and rest, alternating mental work with physical work.

Diet is an important element of personal hygiene. Eating at the same hours, rational selection of dishes, observing the diet in quantitative and qualitative terms are extremely important for health.

A medical worker should not have bad habits, and if he has acquired them, he should try to get rid of them. Bad habits that are incompatible with the medical profession include smoking, alcohol abuse, etc.

To maintain health and prevent diseases, it is necessary to engage in physical education and harden your body. Morning exercises followed by water procedures should become a habit.

A health worker must carefully monitor the cleanliness of his body. Face, neck should be washed 2 times a day. You should also wash the perineal area with warm water 1-2 times a day. Wash your feet daily, especially for those who sweat. It is recommended to wash in the morning with cold water up to the waist (after exercise) or take a cold shower, and at night wash, wash and wash your feet with warm water.

Hand care requires special attention. The health worker washes his hands not only before eating and after going to the toilet, but also before and after each medical procedure. Health care workers, especially those involved in surgery (operating nurses, midwives, etc.), should protect their hands from contamination. Dirty types of housework (washing the floor, cleaning the bathroom in the apartment, cleaning vegetables, etc.) should be done with gloves. Nails should be cut short and filed. The skin edge of the nail bed should not be trimmed, as this is a common cause of the formation of hangnails, and then abscesses. It is not recommended to paint nails with varnish. Hands should be washed with a brush. This is necessary, on the one hand, in order to clean the periungual and subungual spaces from dirt, and on the other hand, so that the skin in these areas becomes somewhat rougher.

Frequent washing of hands leads to dry skin, so it must be constantly nourished, lubricated daily at night and after work with some kind of cream, you can mix glycerin with ammonia (1/4 ammonia and 3/4 glycerin) and rub this mixture into the skin after hand washing.

You need to take good care of your hair. It is recommended to wash your hair no more than 1 time in 10-14 days. Hot water is used for washing oily hair, for dry hair you need to use warm water.

Hair should always be neatly combed, excessively lush hairstyles should be avoided, in which the hair during work can be knocked out from under a cap or scarf.

Oral care is also important, as neglect leads to tooth decay and bad breath. You should brush your teeth 2 times a day (at night and in the morning) and rinse your mouth after each meal. It is necessary to periodically show the dentist in order to carry out timely treatment if necessary. It is impossible to consider a cultured person who neglects the requirements of hygiene, carelessly treats the state of the oral cavity, turning it into a source of disease. Bad breath can be due to other reasons that should be found out in order to get rid of this disadvantage, which makes it difficult to communicate with people. Going to work, you should not eat strongly smelling substances (garlic, onions, etc.).

The medical worker is also obliged to observe the hygiene of clothing. Clothing should correspond to the season and climatic conditions, and its cut should be such that it does not impede the blood circulation of individual parts of the body and the functioning of organs.

When choosing a fabric for a work dress, consider the nature of the work being done. In most infectious diseases hospitals, in maternity hospitals, in a number of surgical departments for employees, there are individual cabinets designed to store not only overalls, but also work clothes and work shoes. In such cases, for wearing outside of working hours, you can purchase a dress made of any fabric, and for work, have a simple cotton dress that is easy to wash.

For work, it is most convenient to wear a skirt with a blouse.

Outerwear and woolen clothes should be brushed or vacuumed more often, and soiled areas should be cleaned with gasoline.

Underwear needs to be changed at least once a week. To sleep, you need to have a nightgown and in no case go to bed in the underwear that was on the body all day.

Shoes should be comfortable, not constraining the foot, with a small heel. It is better to refuse shoes with microporous or rubber soles, since on such shoes street dirt is brought into a medical institution or into the patient's apartment.

The overalls of the medical worker consist of a dressing gown, a headdress and footwear. In surgical departments, maternity hospitals, infectious diseases and some other departments, a dress and a mask are also referred to as overalls.

The form of a headgear for a doctor is a cap, for a nurse - a scarf or cap, for a nurse - a scarf. The fabric from which the headdress is made must be white, linen or cotton, easily washable. Any headgear must completely cover the hair. The dressing gown is sewn from white cotton or linen fabric, which is not destroyed by frequent washing, boiling and disinfection. The robe should cover the dress completely. For all medical workers, a gown with a fastener at the back is generally accepted, in some departments a double-breasted gown is acceptable. The dressing gown and headdress should be not just clean, but snow-white.

Medical staff working in a hospital are required to wear slippers. This is dictated by the convenience for the worker himself and the interests of the patients, since there is no noise when walking in slippers. Slippers should be worn with leather or rubber soles, but not felt or fur, as they absorb dirt well and are difficult to sanitize.

Medical ethics requires from a medical worker not only the observance of personal hygiene rules, but also decency. Clothes should be not only clean, but also comfortable for work. It should not irritate patients with excessive brightness or pretentious cut. Perfume or cologne should be used in moderation, and only those that do not have a strong smell. Modesty and moderation in the use of cosmetics and the wearing of various jewelry are dictated by the very nature of the work of a medical worker.

3. Requirements for the organization of the workplace of a nurse.

General requirements for the organization of workplaces

The desktop of the doctor and nurse should be in the most illuminated part of the office;

There must be space around the table to ensure the free movement of the doctor and nurse from the table to any object in the office;

The location of each item must be thought out in order to minimize the cost of movement and ensure compliance with aesthetic requirements in the design of the office;

The door of the office must be visible so that the doctor can see the incoming patient.

Hygienic requirements for the organization of workplaces in medical offices provide for compliance with the basic sanitary and hygienic standards in them: sufficient space, cubic capacity and footage per worker, microclimate parameters, lighting, noise, etc.

Ergonomic, hygienic and aesthetic requirements for the organization of workplaces are set out in the relevant regulatory and methodological materials.

In the rational organization of workplace services, an important place should be given to the use of standard referral forms for research and treatment. Taking into account the fact that the patient needs to be explained where and to which office it is necessary to appear, how to prepare for the study, unproductive costs of working time increase significantly. Therefore, the rationalization of this element of the work of medical personnel has a significant benefit in the work of healthcare professionals. Standard referral forms are recommended for certain types of research. The front side of each form-direction consists of two sections.

In the first section, the nurse enters the surname, initials, medical record number and address of the patient, as well as the doctor's surname and date of appointment. The second part is intended to fill in the results of the study of auxiliary diagnostic services. The reverse side of the form has a memo for the patient, including information about the rules for preparing for the study, the place and time of its conduct. The presence of such forms completely frees the doctor from writing directions, saves the nurse's working time. Direction forms must be placed in the table's blank library, only in this case it is convenient to use them.

With a rational organization of the workplace, it is necessary to address the issues of reducing the time spent on maintaining an outpatient medical record, which occupy at least 25–30% of the working time at the appointment in the work of doctors of the main specialties. For this purpose, it is currently recommended in clinics to use clichéd inserts in the medical record, which, by emphasizing the signs listed in them and entering the missing ones in specially designated lines, significantly reduce (by 15–20%) the costs of doctors filling out the medical record. Inserts can be printed in a typographical way or by making a rubber plate. In the latter case, they are printed as needed directly in the doctor's office.

Occupational safety in the healthcare system of the Russian Federation is one of the priorities. Its organization directly affects the provision medical care the population of the country. Medical workers are affected by the specifics and features professional activity. The work of medical personnel is very difficult to compare with any other types of work. The work of a doctor requires the utmost care, because every awkward step can result in the death of the patient. The doctor is the most responsible profession in the world.

They say that to become a doctor you need to have a heart of stone. Seeing the dedication of people in white coats, it is difficult to agree with this opinion. They pass all experiences, all tears and bitterness of patients through themselves. The failure of patients in the fight against diseases is their failure.

As their work activity, doctors have to contact with a large number of patients with a variety of diagnoses. At the same time, they must maintain high efficiency, have stress resistance 24 hours a day. Their work is almost always associated with extreme situations. What kind of psyche and dexterity is it necessary to have in order to suddenly, sometimes, “gather a person bit by bit” and breathe a second life into him? Seeing the complexity, difficulty and costs of the profession, it is necessary to properly organize working conditions at his workplace.

At a meeting of the Expert Council of the Federation Council Committee on social policy and health On June 9, 2011, issues of working conditions and safety of medical personnel were discussed. The main reason that brought together the meeting is the increased level of occupational diseases among healthcare workers. This indicator ranks fifth, ahead of workers chemical industry. The first place among the pathologies is occupied by infectious diseases, the second - by allergic, the third - by intoxication and diseases of the musculoskeletal system. Such a high level was caused, as it was concluded, by many factors, among which insufficient compliance with labor protection requirements stands out.

All medical institutions use microbiological diagnostics, which destroy viruses, infections, bacteria contained in the air and on work surfaces. It would seem that this is why the cause of infectious diseases should not exist at all. But work with the source of infections, patients, often occurs with the use of sharp, piercing and cutting instruments, which are direct carriers of infections in cuts, pricks and other injuries. The meeting participants saw the solution to this problem in the use of advanced production of safe medical devices. For example, the use of new safety hollow needles reduces accidental injections of workers by 90%. Often, infections are transmitted to medical personnel by airborne droplets. Cases are known when doctors of TB dispensaries become infected with TB through contact with patients. It is unusual to hear about the diseases of physicians. Taking care of people's health, they often forget about their own. The first reason, of course, is non-compliance with safety conditions.

Medicine is in dire need of a labor protection system. Without deep and thorough checks, the safety of both health workers and patients is reduced. The form of periodic control is (ARM, - ed.) - one of the effective subsystems of labor protection. AWP is carried out in accordance with. Certification is carried out for all jobs, ranging from doctors, nurses, paramedics and ending with technical staff. Let us dwell on the certification of the doctor's workplace in more detail.

The influence of external factors on this group of workers is quite large. Ultrasound rooms, X-ray departments, operating rooms, physiotherapy departments, etc. associated with the influence of harmful and dangerous factors. Let's remember our own fear when we have to do x-ray examinations every year. With each picture, it seems to us that the duration of our life is decreasing. But doctors reassure us, saying that the influence of the rays is established within reasonable limits. Ionizing radiation has a significant impact on the work of doctors. In accordance with sanitary regulations SP 2.6.1.758-99 the annual dose of medical exposure was set at 1 m3v/h. The standard can be exceeded only in extreme situations. This indicator must be kept under control, because radioactivity has a high penetrating power. The consequence may be malignant neoplasms, radiation burns, leukemia.

The severity and intensity of the work process also surpasses all indicators. Their working postures are standing and sitting postures. concrete example the first posture is the work of surgeons who tirelessly, for several hours, are in a tense state during operations. The working posture "sitting" is more common for dentists. They are forced to stay in it during the entire work shift.

The doctor's workplace should be organized in accordance with sanitary requirements. Sanitary and epidemiological requirements for the device, placement of equipment, preventive, anti-epidemic measures, working conditions of medical staff in medical institutions are given in SanPiN 2.1.3.2630-10.

In addition to identifying production factors doctors also determine the level of injury risk and availability of collective protective equipment (PPE, - ed.). As for injury risk, it is also present in medicine. It is characterized by work on complex medical equipment, with toxic drugs, as well as work with patients. There are many cases when ambulance doctors, at the request of patients, are attacked by completely inadequate people, drug addicts.

The main PPE for doctors, and for all employees of medical institutions, is a white coat. White symbolizes the color of purity and trust. True, today this color is gradually becoming a thing of the past. It is being replaced by more practical colors, such as violet, green, blue. Regardless of color, the doctor's clothing should be antistatic, bactericidal and blood-repellent. Mandatory PPE also includes: rubber gloves, masks, caps, preventive shoes, shoe covers.

If harmful and dangerous conditions work in the workplace,

The developed device is supposed to be operated in conjunction with the X-ray simulator SLS-9. When conducting research, the doctor will work with an X-ray simulator and a personal computer. Based on this, we can distinguish the following harmful factors that arise when using the device: exposure to ionizing radiation and factors caused by working with a personal computer. The levels of exposure to x-ray radiation are regulated by the document NRB - 96. And when working with a personal computer, the requirements specified in the regulatory document "Sanitary rules and regulations 2.2.2.542 - 96 Hygienic requirements for video display terminals, personal electronic computers and organization of work" must be met.

The most significant hazard is exposure to ionizing radiation. In accordance with the norms of NRB-96, the personnel working with the simulator can be classified as category B. Personnel belongs to category B, i.e. persons who permanently or temporarily work with sources ionizing radiation. As the main dose limits, depending on the group of critical organs for category A, the maximum allowable dose per year is established. For groups of critical organs 1,2, and 3, it is 5, 15, and 30 rem per year, respectively.

To protect personnel from ionizing radiation, special safety measures are provided. So, the room for research - treatment room is designed and equipped in a special way. The floor in the room is covered with special linoleum, the edges of which are raised to a height of 20 cm and carefully sealed. The walls are covered with barrite, a special material in the form of plaster, to protect against ionizing radiation. The doors to the treatment room are lined with sheet lead 1.5 mm thick. The viewing window from the control room to the treatment room is made of leaded glass, 20 mm thick. To control the absorbed dose, each researcher working with X-ray equipment has an individual dosimeter. The above, as well as a number of other technical, sanitary and hygienic and medical and preventive measures ensure the fulfillment of the requirements of NRB-96.

When conducting research, the interaction of the topometrist doctor with the hardware of the complex will consist only in turning on the device before starting work and turning it off after it is completed. Therefore, basically the doctor works with the software part using a personal computer. The above regulatory document defines the following requirements when working with a personal computer. Requirements for video display terminals and personal electronic computers, requirements for premises, requirements for the microclimate, the content of air ions and harmful chemicals in indoor air, noise and vibration requirements, lighting requirements, requirements for the organization and equipment of workplaces.

The computer used (including VDT) has a hygienic certificate, so all requirements and harmful factors (electromagnetic and electrostatic fields, surface electrostatic potential, VDT visual parameters) comply with regulatory documents.

Regulatory documents require that in premises where work on a VDT and a PC is auxiliary (namely, such work will be carried out by a topometrist doctor), noise levels at workplaces do not exceed the values established for these types of work by the Sanitary Standards for Permissible Noise Levels at Workers places" No. 3223-85. The vibration level should not exceed the allowable values in accordance with the "Sanitary Vibration Standards for Workplaces" No. 3044-84.

The temperature, relative humidity and air velocity in the workplace must not comply with the current regulations. sanitary standards microclimate industrial premises № 4088-86.

The levels of positive and negative air ions in the air of a room with a VDT and a PC must comply with the "Sanitary and Hygienic Standards for Permissible Levels of Air Ionization in Industrial and Public Premises" No. 2152-80.

The PC with which the topometrist is to work is installed in the hospital room. Therefore, the above regulatory requirements for the microclimate, the content of air ions and harmful chemicals, for noise and vibration, are met, because. requirements for this category of premises are much higher.

The room where the topometrist is supposed to work with a PC has natural and artificial lighting, which meets the requirements of SanPiN 2.2.2.542-96. The requirement was also met in terms of area and volume per one workplace - 6.0 sq.m. and 24.0 cubic meters. respectively (one PC is installed in a room with an area of 463).

Artificial lighting of the room is carried out by a system of general uniform lighting using fluorescent lamps of the LB type. Workplace lighting standards were met during the design of the lighting system. However, to ensure the normalized values of illumination in the room, it is necessary to clean the glass of window frames and lamps at least twice a year and timely replace burned-out lamps.

According to the standards, workplaces with VDT and PC in relation to the light openings should be located so that natural light fell sideways. Based on this, the following layout of the PC in the room is proposed, shown in Fig. 7.1.

Fig.7.1

conducting research.

1 - simulator, 2 - laboratory, 3 - equipment, 4 - simulator,
5 - control panel, 6 - desktop, 7 - work chair, 8 - monitor, 9 - keyboard.

Window openings of the room must be provided with light control devices, such as blinds or curtains.

The equipment and organization of the workplace must ensure that the design of all elements of the workplace and their relative position comply with ergonomic requirements, taking into account the nature of the activity performed, the complexity technical means, forms of work organization and the basic working position of the user. The design of the desktop should provide optimal placement on the working surface of the equipment used, taking into account its quantity and design features, the nature of the work performed. This allows the use of desktops. various designs meeting modern ergonomic requirements. According to regulatory requirements, the height of the desktop is supposed to be set equal to 285 mm. The work table shall have legroom at least 600mm high, at least 500mm wide, at least 450mm deep at knee height, and at least 650mm at extended leg height.

The design of the working chair (chair) should ensure the maintenance of a rational working posture when working with a PC, allow changing the posture in order to reduce the static tension of the muscles of the neck-shoulder region and back to prevent the development of fatigue. The work chair (armchair) must be lifting and swivel and adjustable in height and angle of inclination of the back and seat, as well as the distance of the back from the front edge of the seat, while the adjustment of each parameter must be independent, easy to carry out and have a secure fit. The surface of the seat, back and other elements of the chair (chair) should be semi-soft, with a non-slip, non-electrifying and breathable coating that provides easy cleaning from dirt. Its design should provide:

- seat surface with rounded front edge;
- the width and depth of the seat surface is at least 400 mm;
- adjustment of the height of the seat surface within 400-550 mm and forward tilt angles up to 15 degrees. and back to 5 degrees.
- the height of the supporting surface of the backrest is 300 mm, the width is not less than 380 mm and the radius of curvature of the horizontal plane is within 400 mm;
- the angle of inclination of the backrest in the vertical plane within 0 03 degrees;
- adjustment of the backrest distance from the front edge of the seat within 260 -400 mm;
- stationary or removable armrests with a length of at least 250 mm and a width of 50-70 mm;
- adjustment of the armrests in height above the seat within 230-30 mm and the internal distance between the armrests within 350-500 mm.

The screen of the video monitor should be located from the user's eyes at an optimal distance of 600-700 mm, but not closer than 500 mm, taking into account the size of alphanumeric characters and symbols.

The room should be cleaned daily. It is also desirable to ventilate it, which improves the quality of the air, including the air-ion mode. The room should be equipped with a first aid kit and carbon dioxide fire extinguishers.

The duration of work with a PC should not exceed 6 hours a day. To ensure optimal performance and maintain the health of the researcher, throughout work shift regulated breaks should be established, the total time of which for this work should be at least 30 minutes. Breaks should be set 2 hours after the start of the work shift and 2 hours after the lunch break of 15 minutes each. During regulated breaks, in order to reduce neuro-emotional stress, fatigue of the visual analyzer, eliminate the influence of physical inactivity and hypokinesia, and prevent the development of fatigue, it is advisable to perform sets of special exercises.

According to regulatory requirements, persons who do not have contraindications are allowed to directly work with VDT and PC. They must pass periodic inspections in the manner and within the time limits established by the Ministry of Health and Medical Industry of Russia and the State Committee for Sanitary and Epidemiological Supervision of Russia. It should be noted that pregnant and lactating women are not allowed to perform any type of work with VDT and PC.