Occupational diseases of health workers. Occupational allergic diseases of medical workers

Preventive measures for dermatitis are aimed at prolonging the period of remission. There are 4 types of this disease: contact, atopic, seborrheic and allergic dermatitis. Each of them requires compliance with specific rules.

For contact dermatitis it is necessary to exclude interaction with the trigger of inflammation: avoid jewelry made from allergen metal, latex products, use protective gloves when cleaning, etc. If the allergen does get on the skin, you must immediately rinse it in running cool water.

Cases atopic dermatitis often associated with diseases gastrointestinal tract, endocrine and neurological systems, etc. In this case, the prevention of atopic dermatitis is associated with the prevention of the underlying disease. If rashes and itching are associated with food allergies, you must follow a special diet that excludes citrus fruits, fish, seafood, nuts, chocolate, sausage, sausages, eggs, meat broths, spices, vegetables, red fruits and berries, and sweets.

Allergic dermatitis usually accompanies seasonal allergies or reactions to fluff, feathers, dust, animal hair, etc. During the flowering season, patients with allergic dermatitis are recommended to take a course of antihistamines. It is also necessary to carry out wet cleaning as often as possible to prevent dust accumulation and avoid contact with animals. Blankets, pillows and mattresses should be made of synthetic material.

Cause seborrheic dermatitis– fungus Malassezia furfur. This microorganism lives in the mouths of the sebaceous glands of many people, but causes cases of skin disease. The main preventive measures are strengthening the immune system (in a weakened body, the fungus begins to actively multiply), as well as adjusting the functioning of the sebaceous glands using creams and shampoos with birch tar, naphthalan oil, and salicylic acid.

Wear light-colored clothing made from smooth, natural fabrics that do not irritate the skin. Clothing made from cotton or linen provides ventilation, prevents excessive sweating, and the light color hides flaking skin.
For water procedures use warm water. Hot water injures the skin and provokes the appearance of microtraumas. After hygiene procedures, do not rub, but gently blot the skin with a towel.
Use special hygiene products designed for irritated problem skin. For example, shampoo and gel “Losterin” contain naphthalan oil, extracts of medicinal herbs and a complex of vegetable oils, which means they can be used to prevent dermatitis.
Monitor your condition in stressful situations. Before and during important events, it is recommended to take mild sedatives.
The diet should include foods with vitamins A and E(fish, seafood, nuts, vegetable oils), unless you are allergic to them. If this food causes an allergic reaction, you must take vitamin capsules.
Russian dermatological balneological resorts have a wealth of experience and modern equipment. They are located in Altai, in the Caucasian Mineral Waters region, in the Urals and in the Black Sea region. The treatment course usually includes taking mineral waters, therapeutic baths, mineral mud applications, physical exercise, diet therapy, herbal drinks, thalassotherapy, sun and air baths, as well as physiotherapy. Therapy is aimed not only at eliminating the external manifestations of dermatitis, but also at strengthening the immune system and normalizing metabolism.
Dermatitis is a disorder of metabolic processes in the skin, including water balance. Even during remission, the skin of a patient with dermatitis is subject to dryness and peeling. It is necessary to use moisturizing creams daily. Losterin cream contains a complex of nourishing and moisturizing agents: D-panthenol, almond oil and Japanese Sophora extract. The components promote active skin regeneration and create an imperceptible film on the surface of the epidermis that prevents moisture evaporation.

The work of doctors is one of the most complex and responsible types of human activity. It is characterized by significant intellectual load, and in some cases, great physical activity and endurance. Medical workers are subject to increased demands, including the volume of operational and long-term memory, attention, and high ability to work in extreme conditions.

The result of the activities of medical workers - the health of patients - is largely determined by the working conditions and health of employees. By occupation, a doctor (as well as a nursing and junior medical worker, a pharmacist and a pharmacist) is affected by a complex of factors of a physical, chemical, and biological nature. Doctors experience high neuro-emotional stress. Moreover, in the process professional activity a medical worker is exposed to functional overstrain of individual organs and systems of the body (from functional overstrain of the musculoskeletal system to overstrain of the visual organ).

The results of studying medical histories of medical workers made it possible to identify the following etiological structure of occupational diseases:

Impact biological factors- 63.6% of patients;

Allergoses (due to exposure to antibiotics, enzymes, vitamins, formaldehyde, chloramine, latex, detergents) - 22.6%;

Diseases of toxic-chemical etiology - 10%;

Overstrain of individual organs and systems of the body - 3%;

Impact physical factors(noise, ultrasound, x-ray radiation) - 0.5%;

Neoplasms - 0.25%.

Allergoses. Allergic reactions to natural latex dust are high among medical workers. The prevalence of latex allergy is 22.61%. Clinically, latex allergy in medical workers in 32.5% of cases occurs as an immediate type of hypersensitivity and is manifested by bronchial asthma, allergic rhinitis, urticaria, including in 6% of cases - acute allergic reactions (Quincke's edema, anaphylactic shock), requiring providing emergency medical care. In 67.5% of cases, allergic reactions upon contact with natural latex occur as delayed-type hypersensitivity and manifest themselves as contact dermatitis.

The most severe and prognostically unfavorable allergic disease among medical workers is anaphylactic shock - an immediate allergic reaction. It is characterized by rapidly developing predominantly general manifestations: decreased blood pressure, body temperature, central nervous system disorder, increased vascular permeability and smooth muscle spasm. Anaphylactic shock develops in response to repeated administration of an allergen, regardless of the route of entry and the dose of the allergen (it may be minimal).

For example, there is a known case of anaphylactic shock as a reaction to traces of penicillin in a syringe that remained in it after it had been processed, washed and boiled. An immediate allergic reaction is characterized by rapid development, violent manifestations, extreme severity of the course and consequences. The type of allergen does not affect the severity of anaphylactic shock. His clinical picture diverse. The less time has passed since the allergen entered the body, the more severe the clinical picture. Anaphylactic shock causes the greatest percentage of deaths when it develops 3-10 minutes after the allergen enters the body.

Occupational bronchial asthma (OBA) is one of the common allergic diseases of medical workers. PBA is defined as a disease caused by exposure to allergens on the respiratory tract in the workplace of a medical worker or pharmacist. The leading etiological factors causing PBA are latex, disinfectants (sulfathiazole, chloramine, formaldehyde), antibiotics, herbal medicinal raw materials, and chemical components of diagnostic kits. Many occupational factors with which medical and pharmaceutical workers come into contact have a strong irritant effect on the nasal mucosa and lung tissue. The main symptoms of the disease are itching and irritation of the nasal cavity, sneezing and rhinorrhea, often accompanied by nasal congestion.

The research results confirmed that viral hepatitis is the leader among all occupational diseases of medical workers - 39.5% of patients. Based on etiology, three groups of diseases were identified: chronic hepatitis B, chronic hepatitis C and mixed hepatitis B + C, B + C + D, with hepatitis C predominant. The relative regression of hepatitis B is apparently associated with the immunization of medical workers, as well as their greater attention to their health, more regulated use of personal protective equipment.

The risk group includes not only people who have direct contact with the blood of patients (surgeons, resuscitators, operating room and procedural nurses, etc.), but also medical doctors of therapeutic specialties who periodically perform parenteral procedures and who have virtually no anti-epidemic alertness.

Potentially hazardous body fluids include cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, and seminal fluid. Their contact with skin that has microdamages and mucous membranes can cause infection of a medical worker.

Features of viral hepatitis in medical workers are:

Frequent development of mixed (mixed) forms of hepatitis (B + C), which complicates the clinical picture of the disease and its prognosis;

The development of viral hepatitis against the background of previous toxic-allergic liver damage (drug, chemical, toxic-allergic hepatitis);

The presence of varying degrees of resistance to drug therapy; more frequent development of complications of hepatitis: liver failure, cirrhosis, liver cancer.

Infection of tuberculosis among medical workers is possible both in anti-tuberculosis institutions. and in general medical institutions - departments of thoracic surgery, pathological-anatomical and forensic bureaus, i.e. where contact with tuberculosis patients is possible - bacilli excretors or contaminated material (employees of bacteriological laboratories).

The clinical picture of tuberculosis skin lesions comes down to the development of characteristic elements, the professional nature of which is confirmed by the localization typical for warty skin tuberculosis (at the site of microtraumas of the skin during work, mainly on the fingers). In some cases, occupational tuberculosis of the skin can be diagnosed by pathologists on the skin of the fingers and dorsum of the hands (“cadaveric tubercle”). For medical workers, influenza and childhood infectious diseases (measles, diphtheria, mumps) are also very important in terms of infection.

In epidemiological, etiological and clinical terms, these diseases are united by such features as transmission by airborne droplets or airborne dust, a high level of morbidity that periodically takes on the character of an epidemic, the involvement of large contingents of medical workers in serving patients (for example, during influenza epidemics), often having no experience working in difficult epidemiological conditions, lack of natural or insufficient effectiveness of artificial immunity to influenza and childhood infectious diseases. At the same time, the diagnosis of a chronic occupational disease is possible only in persons with persistent residual effects after an infection.

It is possible for a medical worker to become infected with HIV through contact with blood and other biological fluids of AIDS patients and HIV-infected patients.

Occupational diseases of toxic-chemical etiology. In most cases, toxic and toxic-allergic hepatitis develops in medical workers due to exposure to anesthetics and antibacterial drugs. When studying the microclimate of operating rooms, it was discovered that even with a normally functioning ventilation system, the concentration of the most widely used anesthetic, ether, in the breathing zone of the anesthesiologist exceeds the maximum permissible concentration by 10-11 times, in the breathing zone of the surgeon - by 3 times. This leads to diffuse lesions of the liver parenchyma, disorders of pigment metabolism, and the development of toxic-allergic hepatitis.

Damage to the upper respiratory tract by irritating chemicals was typical for junior medical personnel and laboratory workers and manifested itself in the form of nonspecific catarrh of the mucous membrane. In workers with extensive work experience, the outcome of catarrhal rhinitis was chronic atrophic rhinitis.

Occupational diseases from overstrain of individual organs and systems of the body. Staying in an irrational position leads to a fairly rapid development of functional insufficiency of the musculoskeletal system, which manifests itself in fatigue and pain. The first signs of fatigue (for example, in the arm muscles of otolaryngologists) appear after 1.5-2 years of work and are associated with arm fatigue. With otorhinolaryngologists, surgeons, dentists and other specialists constantly in a forced working position, the disorders become persistent, leading to the formation of individual diseases of the musculoskeletal system, nervous and vascular systems. In practice, varicose veins were more common lower limbs and cervicobrachial radiculopathy among healthcare workers.

Patients complain of pain in the veins throughout the lower limb, which, unlike obliterating endarteritis or atherosclerosis of the arteries, is associated with prolonged standing, and not with walking. Walking, especially at the beginning of the disease, even brings relief. Upon examination, convolutions and tangles of dilated veins are determined on the inner or posteroexternal surfaces of the leg and thigh. The skin at the beginning of the disease is not changed.

With an advanced process, pigmentation (hemosiderosis) of the skin on the lower leg, atrophic and eczematous changes, swelling, scars, and ulcers are noted. Acute infectious complications (thrombophlebitis, lymphangitis) are manifested by areas of inflammatory hyperemia, often in the form of stripes. A varicose ulcer is localized, as a rule, on the lower leg, its shape is round, less often scalloped, the edges are slightly undermined. The ulcer is a flaccid, often bluish granulation, surrounded by a flat pigmented scar.

Prevention of professional varicose veins on the legs of medical workers consists of the following areas:

Qualified professional selection for work involving long periods of standing (surgeons, operating room nurses, etc.). Persons with chronic peripheral diseases are not allowed to work. nervous system, obliterating diseases of the arteries, severe enteroptosis, hernias, abnormalities in the position of the female genital organs. When providing career guidance to future specialists, it is necessary to exclude constitutional weakness of connective tissue, for example, flat feet;

Qualified periodic medical examinations, the purpose of which is to diagnose the compensated stage of varicose veins and the corresponding timely employment of patients without reducing qualifications. Possible retraining taking into account the main profession, active medical rehabilitation;

Rational organization of the work regime, if possible excluding prolonged standing (rationally organized operating days, comfortable microclimate, rooms for physical and psychological relaxation, etc.), physical therapy.

The development of dyskinesia is based on a violation functional state CNS. More often, coordination neuroses develop as a result of prolonged monotonous work against a background of emotional stress.

Premorbid features also contribute to the development of dyskinesia:

Inferiority of the musculoskeletal system (insufficient development of the muscles of the shoulder girdle, scoliosis of the thoracic spine);

Personal characteristics;

Age-related changes and others additional factors, negatively affecting the functional state of the nervous system (mental trauma, infections, etc.).

The most favorable effect in the treatment of professional hand dyskinesia is observed with complex treatment: a combination of acupuncture with electrosleep, autogenic training, hydrotherapy, and therapeutic exercises. In addition, patients are prescribed salt-pine or pearl baths, depending on the nature of the functional disorders, sedatives and minor tranquilizers.

A worker whose eyes cannot cope with these conditions quickly experiences visual and general fatigue. There are complaints of a feeling of weakness, rapid fatigue when reading and working at close range, cutting and aching pain in the eyes, forehead, crown of the head, deterioration of vision, the appearance of periodic double vision of objects, etc. A complex of visual functional disorders develops, which is commonly called asthenopia.

To prevent the development of asthenopia and myopia, careful professional selection is necessary when hiring for jobs related to performing precision operations. The ophthalmologist, in addition to identifying diseases of the organ of vision, must examine the refraction of the eyes, color perception, the state of convergence, stereoscopic vision, and muscle balance.

When refractive errors are detected, the correct selection of corrective glasses is recommended. Correction of refractive errors - necessary condition in the fight against rapid eye fatigue during visual work. Corrective glasses must be selected taking into account the distance from the working surface to the eyes.

Preventive measures include physical exercises, eye exercises, balanced diet with the addition of calcium, vitamin D, hardening of the body.

Occupational diseases caused by physical factors. Among the harmful production factors of physical nature (vibration, noise, different kinds radiation) the causes of the development of occupational diseases in medical workers are primarily various types of ionizing and non-ionizing radiation (radiation, ultrasound, laser radiation, microwave radiation), which can cause radiation sickness, local radiation injuries, vegetative-vascular dystonia, asthenic, asthenovegetative, hypothalamic syndromes, local tissue damage by laser radiation, autonomic-sensory polyneuropathy of the hands, cataracts, neoplasms, skin tumors, leukemia.

The most exposed to radiation are medical personnel serving X-ray rooms, radiological laboratories, as well as some categories of surgeons (X-ray surgical teams), and employees of scientific institutions. If procedures are frequently performed, in which X-ray monitoring is related to the nature of the surgical intervention, radiation doses may exceed permissible limits. The radiation dose to medical workers should not exceed 0.02 Sv (Sv (Sievert) is a dose of any type of ionizing radiation producing the same biological effect as a dose of X-ray or gamma radiation equal to 1 Gray (1 Gy = 1 J/kg)) in year.

Diseases associated with exposure to laser radiation and ultrasound occupy a large place among the occupational morbidity of medical workers. Laser systems generate electromagnetic radiation that is monochromatic, coherent, and high energy density. The energy of laser radiation in biological tissues is transformed into heat and can potentiate photochemical processes and have a damaging effect.

Maximum absorption of laser radiation energy occurs in pigmented tissues, which is why the organ of vision is often damaged. In mild cases of eye damage, transient functional disorders are usually noted - disturbances in dark adaptation, changes in corneal sensitivity, and transient blindness. With more severe eye diseases, scotoma occurs (loss of part of the visual field) without any pain. Systemic effects on the nervous system are also characteristic - vegetative-vascular dystonia, asthenic, astheno-vegetative, hypothalamic syndromes.

The development of occupational pathology in those working with medical lasers, along with direct exposure to the beam, is facilitated by:

Diffuse-reflected and scattered laser radiation;

Insufficient illumination of objects of influence, manipulation technologies that require increased visual load;

Stable and impulse noise accompanying the operation of laser systems;

Significant neuro-emotional stress due to the great responsibility of medical personnel.

Among health care workers, dentists are the most susceptible to noise (and vibration). High-pitched sounds generated during the operation of dental equipment lead to unfavorable changes not only in the hearing organ, but also in the nervous system. Treatment is aimed at improving the functional state of the labyrinth receptors.

Quite rarely, dentists encounter vibration disease, the most typical of which are angiodystonic, angiospastic, vegetative-sensory and other clinical syndromes. The disease develops slowly, after 5-15 years from the start of work associated with vibration, with continued work the disease increases, after cessation a slow (within 3-10 years), sometimes incomplete recovery is noted. Patients complain of pain and paresthesia in the arms, chilliness of the fingers, they are concerned about diffuse pain and paresthesia in the arms, less often in the legs, decreased pain, temperature, tactile sensitivity of the polyneuritic type.

Diseases of the nervous system. Neuroses are psychogenic functional disorders of mental (mainly emotional-volitional) and neurovegetative functions while the patient retains a sufficiently correct understanding and critical assessment of the symptoms of himself and others with a mild violation of social adaptation. Professional neuroses can develop during long-term direct service to mentally ill people.

Increased excitability is noted on the part of all analyzers: ordinary noise is annoying, light is blinding, conversation is tiring. Increased excitability is manifested by impatience, haste, and fussiness. There are frequent complaints about a painful feeling of emptiness in the head. Remembering names, numbers, dates presents insurmountable difficulties. As neurasthenia develops, patients become more and more lethargic, lazy, weak-willed, and apathetic. Mood swings with a tinge of melancholy increase, hypochondriacal symptoms arise, and extreme concentration on one’s painful sensations.

The so-called exhaustion depression may develop; when the neurosis lasts for more than 2 years, a restructuring of the personality structure occurs in the form of new stereotypes in behavior and emotional defensive reactions, changes in attitudes, hierarchy of motives and values. The patient’s lifestyle and reactions to everyday and work circumstances acquire a stereotypical neurotic character, the painful state turns into a habitual way of existence (neurotic personality development according to the asthenic, hysterical, hypochondriacal type).

With appropriate psychocorrection, rational organization of work, excluding (or reducing) the possibility of mental trauma, patients remain able to work

Occupational diseases from exposure to biological factors HepatitisHIV infection Tuberculosis Infectious diseases Occupational diseases of toxic-chemical etiology Toxic and toxic-allergic hepatitis Catarrhal rhinitis and chronic atrophic rhinitis. Contact non-allergic dermatitis

Occupational diseases from overstrain of individual organs and systems of the body Diseases of the musculoskeletal system Varicose veins Dyskinesia of the hands (coordinating neuroses) Deterioration of vision (asthenopia, myopia) Occupational diseases from the action of physical factors Radiation sickness, occupational leukemia, skin cancer from exposure to x-rays Diseases, associated with exposure to laser radiation and ultrasound.

Occupational diseases of the hands in the form of angioneurosis, polyneuropathy (vegetative-sensitive and sensorimotor forms of polyneuritis) Vibration disease Diseases of the nervous system Neuroses Rules for examination and principles of treatment of occupational diseases of medical workers Literature

The work of doctors is one of the most complex and responsible types of human activity. By occupation, a doctor (as well as a nursing and junior medical worker, a pharmacist and a pharmacist) is affected by a complex of factors of a physical, chemical, and biological nature. Doctors experience high neuro-emotional stress. In addition, in the process of professional activity, a medical worker is exposed to functional overstrain of individual organs and systems of the body (from functional overstrain of the musculoskeletal system to overstrain of the visual organ).

Allergic reactions to natural latex dust are high among medical workers. Clinically, latex allergy in medical workers occurs as an immediate type of hypersensitivity (about 1/3 of cases) and is manifested by bronchial asthma, allergic rhinitis, urticaria, including acute allergic reactions (Quincke's edema, anaphylactic shock), requiring emergency medical care help. In 2/3 cases, allergic reactions upon contact with natural latex occur as delayed-type hypersensitivity and manifest themselves as contact dermatitis.

Occupational bronchial asthma (OBA) is one of the common allergic diseases of medical workers. PBA is defined as a disease caused by exposure to allergens on the respiratory tract in the workplace of a medical worker or pharmacist. PBA is predominantly diagnosed in nurses, especially procedural nurses, which is associated with prolonged contact of this category of medical workers with a wide range of substances that have an allergenic effect. The leading etiological factors causing PBA are latex, disinfectants (sulfathiazole, chloramine, formaldehyde), antibiotics, herbal medicinal raw materials, and chemical components of diagnostic kits.

One of the reliable methods for the specific diagnosis of PBA is a provocative inhalation test with minimal concentrations aqueous solutions allergens. Early recognition of the disease (peak flowmetry at the workplace and at home), cessation of further contact with the allergen and timely initiation of treatment are important. To confirm the occupational origin of bronchial asthma, it is necessary to determine the serum level of total IgE and allergen-specific IgE (skin testing, enzyme-linked immunosorbent assay, radioallergosorbent test) for household, pollen, fungal, and occupational allergens.

Allergic rhinitis Many occupational factors with which medical and pharmaceutical workers come into contact have a strong irritant effect on the nasal mucosa and lung tissue. The main symptoms of the disease are itching and irritation of the nasal cavity, sneezing and rhinorrhea, often accompanied by nasal congestion.

Viral hepatitis The risk group includes not only people who have direct contact with the blood of patients (surgeons, resuscitators, operating room and procedural nurses, etc.), but also physicians of therapeutic specialties who periodically perform parenteral procedures, who have practically no anti-epidemic alertness. Potentially hazardous body fluids include cerebrospinal fluid, synovial fluid, pleural fluid, pericardial fluid, peritoneal fluid, amniotic fluid, and seminal fluid. Their contact with skin that has microdamages and mucous membranes can cause infection of a medical worker.

Features of viral hepatitis in medical workers are: - frequent development of mixed (mixed) forms of hepatitis (B + C), which aggravates the clinical picture of the disease and its prognosis; - - development of viral hepatitis against the background of previous toxic-allergic liver damage (drug, chemical, toxic-allergic hepatitis); - the presence of varying degrees of resistance to drug therapy; more frequent development of complications of hepatitis: liver failure, cirrhosis, liver cancer

Infection of tuberculosis among medical workers is possible both in anti-tuberculosis institutions (they are often infected with strains resistant to the main anti-tuberculosis chemotherapy drugs), and in general medical institutions - thoracic surgery departments, pathological anatomical and forensic bureaus, i.e. where contact is possible with tuberculosis patients who shed bacilli or contaminated material (employees of bacteriological laboratories). Analysis of the clinical course showed that tuberculosis in medical workers occurs in the form of small forms: focal, infiltrative, tuberculoma of the upper lobes of the lungs, pleurisy.

Occupational diseases of toxic-chemical etiology In most cases, toxic and toxic-allergic hepatitis develops in medical workers due to exposure to anesthetics and antibacterial drugs. When studying the microclimate of operating rooms, it was discovered that even with a normally functioning ventilation system, the concentration of the most widely used anesthetic, ether, in the breathing zone of the anesthesiologist exceeds the maximum permissible concentration by 10–11 times, in the breathing zone of the surgeon - by 3 times. This leads to diffuse lesions of the liver parenchyma, disorders of pigment metabolism, and the development of toxic-allergic hepatitis.

Staying in an irrational position leads to a fairly rapid development of functional insufficiency of the musculoskeletal system, which manifests itself in fatigue and pain. The first signs of fatigue (for example, in the arm muscles of otolaryngologists) appear after 1.5–2 years of work and are associated with arm fatigue. With otorhinolaryngologists, surgeons, dentists and other specialists constantly in a forced working position, disorders become persistent, even leading to the formation of individual diseases musculoskeletal apparatus, nervous and vascular systems. In practice, varicose veins of the lower extremities and cervicobrachial radiculopathy were more common among medical workers.

Chronic venous insufficiency of the lower extremities is one of the most common diseases. Among the professional factors influencing its development, physical overexertion and prolonged static load of persons performing standing work, such as surgeons, are important. Of great importance in establishing the professional nature of the disease, in addition to taking into account the sanitary and hygienic working conditions of the health worker, is the exclusion of other (non-professional) causes of varicose veins, especially pregnancy. In addition, according to the List of Occupational Diseases (Order of the Ministry of Health and Medical Industry dated On the procedure for conducting preliminary and periodic medical examinations workers and medical regulations for admission to the profession).

Varicose veins of the lower extremities, which are complicated by inflammatory (thrombophlebitis) or trophic disorders, are recognized as professional. Professionally recognized are varicose veins of the lower extremities, which are complicated by inflammatory (thrombophlebitis) or trophic disorders. Prevention: - qualified professional selection; persons with chronic diseases of the peripheral nervous system, obliterating arterial diseases, severe enteroptosis, hernias, and abnormalities in the position of the female genital organs are not allowed to work. - qualified periodic medical examinations, the purpose of which is to diagnose the compensated stage of varicose veins. - rational organization of the work regime, if possible excluding prolonged standing, physical therapy.

Coordinator neuroses are an occupational disease of the hands. The most typical symptom of professional hand dyskinesia is the specific handwriting of medical workers whose work involves constantly filling out medical documentation. The development of dyskinesia is based on a violation of the functional state of the central nervous system. More often, coordination neuroses develop as a result of prolonged monotonous work against a background of emotional stress. The development of dyskinesia is also facilitated by premorbid features: inferiority of the musculoskeletal system (insufficient development of the muscles of the shoulder girdle, scoliosis of the thoracic spine); personal characteristics; age-related changes and other additional factors that negatively affect the functional state of the nervous system

The work of certain categories of medical specialists is characterized by visual strain - when working with laboratory, operating microscopes, computers, in microsurgery, dentistry, otorhinolaryngology (small size objects of discrimination) and leads to a deterioration in visual functions, which is manifested by a disorder of accommodation. To prevent the development of asthenopia and myopia, careful professional selection is required when hiring. The ophthalmologist, in addition to identifying diseases of the organ of vision, must examine the refraction of the eyes, color perception, the state of convergence, stereoscopic vision, and muscle balance. When refractive errors are detected, the correct selection of corrective glasses is recommended. Correction of refractive errors is a necessary condition in the fight against rapid eye fatigue during visual work.

The most common factor leading to the development of leukemia is considered to be ionizing radiation, exposure to which is possible if safety rules in the workplace are not followed. According to statistics, among radiologists at the age of 2539 years, leukemia occurs 7 times more often, and at 4070 years, 23 times more often than among the rest of the population. The connection between emerging leukemia and exposure to an occupational factor is evident in cases where hematological symptoms are observed for several years preceding leukemia. This is characterized by varying degrees of severity of cytopenic blood parameters. They are often small, but they are characterized by a rather long presence (from 2 to 10 years). If leukemia occurs several years after the cessation of contact with the leukemic factor, then this does not contradict its professional etiology.

Contact with sources that generate ultrasound can lead to occupational diseases of the hands in the form of angioneurosis, polyneuropathy (vegetative-sensitive and sensorimotor forms of polyneuritis), often accompanied by a functional disorder of the nervous system (neurasthenia syndrome, vegetative-vascular dystonia). Cerebral microorganic symptoms are possible. The basis for preventing the adverse effects of ultrasound on persons servicing ultrasonic installations is hygienic regulation. Medical contraindications for working in contact with ultrasound are: chronic diseases of the peripheral nervous system; obliterating endarteritis, Raynaud's disease, vasospasm of peripheral vessels.

Vibration disease Among medical professionals, dentists are the most susceptible to noise (and vibration). High-pitched sounds generated during the operation of dental equipment lead to unfavorable changes not only in the hearing organ, but also in the nervous system. Treatment is aimed at improving the functional state of the labyrinth receptors. Quite rarely, dentists encounter vibration disease, the most typical of which are angiodystonic, angiospastic, vegetative-sensory and other clinical syndromes. The disease develops slowly, after 5–15 years from the start of vibration-related work; as work continues, the disease increases; after cessation, a slow (within 3–10 years), sometimes incomplete recovery is noted.

Diseases of the nervous system Neuroses are psychogenic functional disorders of mental (mainly emotional-volitional) and neurovegetative functions while the patient retains a sufficiently correct understanding and critical assessment of the symptoms of himself and others with a mild violation of social adaptation. Professional neuroses can develop during long-term direct service to mentally ill people. With appropriate psychocorrection and rational organization of work, eliminating (or reducing) the possibility of mental trauma, patients remain able to work.

Rules for examination and principles of treatment of occupational diseases of medical workers If an occupational disease is suspected, medical workers are sent to regional (regional) centers of occupational pathology, research institutes of occupational pathology or departments of occupational diseases of medical universities, since only these structures have the right to establish a diagnosis of an occupational disease. The diagnosis is made based on generally accepted rules for diagnosing occupational pathology during an outpatient or inpatient examination.

RECOMMENDED READING - Kosarev V.V., “Occupational diseases of medical workers”, Monograph, Samara, “Perspective”, 1998, 200 pages (reissue 2009). - Guide to occupational diseases (edited by Academician Izmerov N.F., 1996 - Order of the Ministry of Health and Medical Industry from “On the procedure for conducting preliminary and periodic medical examinations of workers and medical regulations for admission to the profession”

Among almost 40 thousand currently existing professions, more than 4 million medical workers occupy a special social niche. The work of doctors is one of the most complex and responsible types of human activity.

It is characterized by significant intellectual stress, and in some cases – great physical activity and endurance. Medical workers are subject to increased demands, including the volume of operational and long-term memory, attention, and high ability to work in extreme conditions.

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That is why it remains in focus today.

The result of the activities of medical workers - the health of patients - is largely determined by the working conditions and health status of employees. By occupation, a doctor (as well as a nursing and junior medical worker, a pharmacist and a pharmacist) is affected by a complex of factors of a physical, chemical, and biological nature.

Doctors experience high neuro-emotional stress. In addition, in the process of professional activity, individual organs and systems of the body are subject to functional overstrain (from functional overstrain of the musculoskeletal system to overstrain of the organ of vision).

Prevention of occupational diseases among health workers

The works of academician are devoted to the analysis of the health status of medical workers. RAMS N.F. Izmerova, V.G. Artamonova, N.A. Mukhina, first in Russian Federation monograph by Honored Scientist of the Russian Federation, Professor V.V. Kosarev “Occupational diseases of medical workers” (1998).

The results of a study of medical histories of medical workers who applied to the clinical expert commission of the Samara Regional Center for Occupational Pathology over the past 15 years (397 people: doctors, nurses, laboratory assistants, nurses), made it possible to identify the following etiological structure of occupational diseases:

Structure and full list occupational diseases of medical workers are enshrined in the order of the Ministry of Health and Medical Industry of Russia dated March 14, 1996 No. 90 “On the procedure for conducting preliminary and periodic medical examinations of workers and “.

Prevention of occupational diseases: allergies

Allergic reactions to natural latex dust are high among medical workers. According to E.V. Makova (2003), the prevalence of latex allergy is 22.61%.

Clinically, latex allergy in medical workers in 32.5% of cases occurs as an immediate type of hypersensitivity and is manifested by bronchial asthma, allergic rhinitis, urticaria, including in 6% of cases - acute allergic reactions (Quincke's edema, anaphylactic shock), requiring providing emergency medical care.

In 67.5% of cases, allergic reactions upon contact with natural latex occur as delayed-type hypersensitivity and manifest themselves as contact dermatitis.

The most severe and prognostically unfavorable is anaphylactic shock - an immediate allergic reaction.

It is characterized by rapidly developing predominantly general manifestations: decreased blood pressure, body temperature, central nervous system disorder, increased vascular permeability and smooth muscle spasm.

Anaphylactic shock develops in response to repeated administration of an allergen, regardless of the route of entry and the dose of the allergen (it may be minimal). For example, there is a known case of anaphylactic shock as a reaction to traces of penicillin in a syringe that remained in it after it had been processed, washed and boiled.

An immediate allergic reaction is characterized by rapid development, violent manifestations, extreme severity of the course and consequences.

The type of allergen does not affect the severity of anaphylactic shock. Its clinical picture is varied. The less time has passed since the allergen entered the body, the more severe the clinical picture. Anaphylactic shock causes the greatest percentage of deaths when it develops 3–10 minutes after the allergen enters the body.

Not determined during examination arterial pressure, or it is very low, the pulse is frequent, thread-like; heart sounds are quiet, in some cases they are almost not audible, an accent of the second tone may appear above pulmonary artery. In the lungs, upon auscultation, hard breathing and dry scattered wheezing are heard. Due to ischemia of the central nervous system and swelling of the serous membranes of the brain, tonic and clonic convulsions, paresis, and paralysis can be observed.

Bronchial asthma

(PBA) is one of the most common allergic diseases of medical workers and occupies a leading place in the prevention of occupational diseases. PBA is defined as a disease caused by exposure to allergens on the respiratory tract in the workplace of a medical worker or pharmacist.

Some epidemiological studies have shown that up to 14% of all asthma patients suffer from PBA.

Thus, among those examined in Samara regional center Occupational pathology of medical workers PBA accounted for 62.2% of all identified allergic diseases (for comparison: allergic urticaria amounted to 18.9%, allergic rhinitis - 8.9, allergic dermatitis - 10.5%). PBA is predominantly diagnosed in nurses, especially procedural nurses, which is associated with prolonged contact of this category of medical workers with a wide range of substances that have an allergenic effect.

The leading etiological factors causing PBA are latex, disinfectants (sulfathiazole, chloramine, formaldehyde), antibiotics, herbal medicinal raw materials, and chemical components of diagnostic kits.

One of the reliable methods for the specific diagnosis of PBA is a provocative inhalation test with minimal concentrations of aqueous solutions of allergens.

Early recognition of the disease (peak flowmetry at the workplace and at home), cessation of further contact with the allergen and timely initiation of treatment are important. To confirm the occupational origin of bronchial asthma, it is necessary to determine the serum level of total IgE and allergen-specific IgE (skin testing, enzyme-linked immunosorbent assay, radioallergosorbent test) for household, pollen, fungal, and occupational allergens.

Allergic rhinitis

Prevention of occupational diseases includes early diagnosis allergic rhinitis in order to prevent its occurrence.

Many occupational factors with which medical and pharmaceutical workers come into contact have a strong irritant effect on the nasal mucosa and lung tissue. The main symptoms of the disease are itching and irritation of the nasal cavity, sneezing and rhinorrhea, often accompanied by nasal congestion.

Occupational diseases from exposure to biological factors

Dysbacteriosis, candidomycosis of the skin and mucous membranes, visceral candidiasis develop through contact with infectious patients or infected materials, producing fungi, antibiotics (work in outpatient and inpatient medical institutions, pharmacies, bacteriological laboratories, microbiological medical industry enterprises, etc.).

When determining the degree of loss of professional ability for a medical worker in each specific case, the severity of dysfunction of the body, the degree of compensation, the patient’s ability to perform work in their main profession to varying degrees, including in ordinary or specially created conditions, as well as measures are taken into account on rehabilitation, including professional education and retraining.

To reduce the level of occupational morbidity among medical workers, immunization and antiviral therapy are effective; doctors and paramedical workers require greater attention to their health and the use of personal protective equipment.