Vinnitsa National Pirogov Memorial Medical University

Department of Emergency and Military medicine

“Approved”

The head of the department Of Disaster

Medicine and Military Medicine

___________ass. prof. M.V. Matvichuk

“28” August 2020

THEME 9 for practical lessons of the discipline life safety for first-year students of the medical department:

LEGAL AND ORGANIZATIONAL ISSUES OF LIFE SAFETY AND LABOR PROTECTION OF MEDICAL AND PHARMACEUTICAL

WORKERS. OCCUPATIONAL HAZARDS IN THE PERFORMANCE OF PROFESSIONAL DUTIES OF MEDICAL AND

PHARMACEUTICAL WORKERS

Vinnitsa 2020

Occupational safety and health (OSH) is a multidisciplinary field concerned with the safety, health, and welfare of people at work. The goal of occupational safety and health programs is to foster a safe and healthy work environment. OSH may also protect co-workers, family members, employers, customers, and many others who might be affected by the workplace environment. In common-law jurisdictions, employers have a common law duty to take reasonable care of the safety of their employees. Statute law may in addition impose other general duties, introduce specific duties, and create government bodies with powers to regulate workplace safety issues: details of this vary from jurisdiction to jurisdiction.As defined by the World Health Organization (WHO) "occupational health deals with all aspects of health and safety in the workplace and has a strong focus on primary prevention of hazards." Health has been defined as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." Occupational health is a multidisciplinary field of healthcare concerned with enabling an individual to undertake their occupation, in the way that causes least harm to their health. It contrasts, for example, with the promotion of health and safety at work, which is concerned with preventing harm from any incidental hazards, arising in the workplace.Since 1950, the International Labour Organization (ILO) and the World Health Organization (WHO) have shared a common definition of occupational health. It was adopted by the Joint ILO/WHO Committee on Occupational Health at its first session in 1950 and revised at its twelfth session in 1995. The definition reads:"The main focus in occupational health is on three different objectives: (1) the maintenance and promotion of workers’ health and working capacity; (2) the improvement of working environment and work to become conducive to safety and health and (3) development of work organizations and working cultures in a direction which supports health and safety at work and in doing so also promotes a positive social climate and smooth operation and may enhance productivity of the undertakings. The concept of working culture is intended in this context to mean a reflection of the essential value systems adopted by the undertaking concerned. Such a culture is reflected in practice in the managerial systems, personnel policy, principles for participation, training policies and quality management of the undertaking."

— Joint ILO/WHO Committee on Occupational Health

"Occupational health should aim at: the promotion and maintenance of the highest degree of physical, mental and social well-being of workers in all occupations; the prevention amongst workers of departures from health caused by their working conditions; the protection of workers in their employment from risks resulting from factors adverse to health; the placing and maintenance of the worker in an occupational environment adapted to his physiological and psychological

capabilities; and, to summarize, the adaptation of work to man and of each man to his job.

The responsibility of the employers as a basic principleWith Framework Directive 89/391 EEC, the European legislator has established a fundamental law on occupational safety and health which defines common principles of prevention in the company and for the protection of the workers. It is essential to know that EU legislation does not mention the responsibility of management, but rather only the obligations and the responsibility of the employer with regard to safety and health at work: “The employer shall have the duty to ensure the safety and health of the workers in every aspect related to the work”.The employer is legally defined as “any natural or legal person who has an employment relationship with the worker and has responsibility for the undertaking or establishment”. This legal definition has to be interpreted in light of the European and national laws on corporate organization and companies. In forms of sole proprietorship or partnerships, shop owners are also the persons responsible in the sense of the “employer”. In corporate companies, the acting organ or managing board of the legal entity acts as employer in the sense of the European Framework Directive.Neither third persons entitled by the employer nor any obligation attributed to a worker have any influence on the basic principle of employers’ responsibility. This means that the employer can only delegate tasks that contribute to the fulfillment of the duties and obligations, but cannot delegate responsibility for safety and health at work in general. The delegation must be specific and precise and the employer is responsible for selection, instruction and supervision of any third person.

Obligations of the employerThe European legislative framework on occupational safety and health (OSH) is rather target oriented and therefore requires high standards from OSH management in the company in order to meet the aims and obligations set out by the different regulations. The basic principle of target orientation is set out in Art.6 Directive 89/391 EEC that obliges the employer to constantly guarantee a better level of protection of workers’ health and safety and aim at a permanent improvement of working conditions. In this context, the employers have to keep themselves informed about latest developments and state of the art technological improvements and work place design. They also have to develop a prevention policy that covers all aspects of safety and health at work.The Framework Directive defines a bundle of measures that the employer has to carry out in order to fulfill his legal responsibility for the safety and health of the workers. The most important ones are:

Carry out safety and health risk assessments at the workplaces in the company and provide documentation of the results. This includes the obligations of

implementing preventive measures based on the results of the risk assessment, in accordance to the principles of prevention as laid down in Art.6 of the Framework Directive and OSH risk assessment methodologies;

Inform the workers about safety and health risks as well as about adequate measures of protection and prevention (Art. 10);

Provide appropriate safety and health training measures and ensure that each worker can participate in accordance to the rules laid down in Art.12, which declares that training must take place on recruitment, in the event of a transfer or a change of job, in the event of the introduction of new work equipment or a change in equipment, in the event of the introduction of any new technology.

Take care of measures of emergency response (incl. evacuation procedures, fire fighting and medical services, Art. 8);

Consult workers and their representatives and allow them to participate in the decision making process concerning safety and health at work as foreseen in the EU-Directives;

Ensure the health surveillance of the workers in accordance with the national laws on occupational medical services (Art. 14).

In any case, the employer must ensure that the designated workers or service providers have the required capabilities, means, resources, expertise and information to successfully organize and carry out the designated prevention measures. If the employer does not comply with these provisions, it may be possible to accuse him/her of organizational negligence, a charge that could be substantiated with respect to personal responsibilities as per the national rules in penal or tort law.

Challenges of managing occupational safety and health complianceThe current European legislation on safety and health at work is influenced by the Scandinavian tradition of regulating occupational safety and health and by the definition of the working environment laid down in the international conventions of the International Labour Organization. The European legislation is based on a dynamic, holistic and preventive concept of safety and health at work, which obliges the employer to constantly improve for the benefit of the workers.The general prevention concept is primarily based on describing the aims and objectives rather than giving concrete prescriptions on thresholds, measurements or means. On the one hand, this gives the employer the opportunity to decide on the most adequate method to apply to the business. On the other hand, it requires a higher level of knowledge of how the goals can be reached in order to comply with legislation. In practice, this open approach has been discussed controversially because it seems to favour large organizations which dispose of a specialized management.

Models of OSH managementThe EU Directives on safety and health at work do not establish any strict regulatory framework on OSH management. It is up to the employers to decide on

how to organize their business. Traditional OSH management used to set the focus on the avoidance of punishment and experts’ knowledge. The main goal was establishing a regulatory compliance. In contrast, modern management aims to improve performance, activate workers and reach goals beyond legal prescriptions. Health and safety management is seen as a part of the general company’s management. Therefore, OSH experts strongly recommend some basic elements that should be taken into account:

Measurable objectives for safety and health should be set and be part of the company’s policy. Objectives and policy are transparent and supported by management and the workers;

Measures should be implemented following defined processes and responsibilities. Workers and their representatives should be involved;

Actions shall be based on a risk assessment and not only cover corrective, but also preventive measures;

Performance in safety and health at work should be checked on a regular basis with the of measurable performance indicators;

Lessons should be learned and be mainstreamed in an improvement cycle. Results of the lessons learned should be promoted in training sessions for management and workers.

At the current time, many companies use management systems to ensure that regulatory prescriptions are met. The big advantage of OSH management systems is that they provide a clear description of how processes concerning safety and health can be organized in the company. The International Labour Organization

defines an OSH management system as “a set of interrelated or interacting elements to establish OSH policy and objectives and to achieve those objectives”.The systems are usually based on industrial standards and can be implemented separately or as part of an integrated management approach together with quality management and/or environmental management systems. Some standards and guidelines are developed by International Organizations; national standards exist in various EU Member States. Some of them are industry specific or especially designed for use in small and medium enterprises. They are often promoted by labour inspectorates, accident insurance bodies, or other prevention services.Internationally established guidelines and standards of OSH management system are ILO-OSH 2001, a guideline for OSH management developed by the International Labour Organization and OHSAS 18001. The later one has also become a national standard in various European countries and can be certified worldwide. It is often combined with other management systems of the International Organization for Standardization. Additionally, there are various national standards for some of them, especially for small and medium enterprises or for certain industries which are promoted by national institutes or prevention services.OSH management systems usually based on the “Plan-do-check-act” (PDCA) model and aim to implement a continuous improvement process in the company which is integrated part of modern quality management (so-called “Deming Cycle”). So, generally speaking, management systems fit well to the aim of European OSH Directives for permanently improving the level of prevention in the company. However, one should keep in mind that the goals of improvement are in line with the enhancement of the prevention level in the company, which is the aim of the EU legislation.OSH management systems are designed for supporting the management in complying with legal requirements. The OHSAS 18001 standard for examples requires the employer to have an overview available, one that compiles all OSH legislative requirements relevant for the company. Such an overview should include all specific and detailed requirements, even from the EU legislation on machinery and on chemical substances. It can then be used to check where adequate measures are already in place, where plans for improvement (and compliance) are still necessary, and to develop a strategy for assuring compliance.However, when deciding to implement an OSH management system, one should remember that there is no homogeneous standard for OSH management systems and no common definition of scope and processes. Even though all OSH management systems serve for implementing the company’s OSH policy and for managing safety and health risks, the employer should always need to adapt it to the situation in the company. This means that each employer has to ensure that all relevant safety processes, working conditions and specific risks are covered in order to meet legal requirements.

Strategies for improving occupational safety and health management performance

Among the most common errors that occur is the inadequate response to new and emerging risks at the workplace. The most prominent example is the issue of psycho-social and organizational risks, despite the fact that they currently belong to the most important OSH risks factors. There are indicators that the management of psycho-social risks not only remains an uncovered issue in OSH management, but also in certification audits. Further frequent points of non-compliance with legal provisions are:

Focusing on accident prevention only instead of ill-health prevention in general Not including external service providers (e.g. maintenance workers or cleaners) Not including workplaces of temporary workers Not meeting “formalities” (e.g. documentation of risk assessments) Not involving workers or their representatives.In practice, the quality of OSH management is highly dependent on the prioritization of the topic in the management culture and to the management commitment for safety and health at work. In other words, OSH management can only be successful if it is handled with the same commitment as any other field of management in the company. This can be ensured by setting clear and measurable objectives that are followed with equal priority to other key data in the company, defining processes and responsibilities, ensuring monitoring and improving safety culture and awareness of workers and management representatives.For a more holistic approach that includes the promotion of the health of the workers, it is recommended that OSH management be combined with measures of work place health promotion or health management. Concepts exist that combine classical OSH aims like the reduction of sick leave costs with the promotion of productivity as well as with the promotion of individual resources.When the employer lacks expertise, it is advantageous to contact external specialists in order to improve OSH management performance. Such services do not have to be cost-intensive. In many EU Member States, governmental institutes, insurance bodies or sector organizations provide services for improving OSH management, in particular for small and medium enterprises.

Consequences of non-compliance and aspects of liabilityThe principle of being responsible for complying with the legislation on safety and health at work finds its expression in the rules of liability for the employer. These rules are established by national law and can include financial liability for workers’ compensations in the case of ailment, fines in cases of administrative offences, and also personal sanctions in criminal law.Financial compensation of workers

If the employer does not comply with the duties and obligations laid down in the European and national laws on safety and health at work, workers who become ill or get involved in accidents due to negligence can claim for indemnification and financial compensation for non-material damages. The procedure depends on the national systems for workers’ compensation and hence, on the company’s insurance status.If the company is insured by law (“statutory accident insurance”) or by private contract, the worker will usually receive compensation from the body of insurance. In an act of gross negligence by the employer, the body of insurance might have the right to reject the payment or to claim for regress. If the company does not dispose of any insurance coverage, the employer might be sentenced to compensate the worker from company resources.Personal criminal liability and tort lawSingle board members or management representatives might also be individually responsible in cases of gross negligence, depending on the national rules in criminal or tort law. This can be the case if they did not comply with the designated duties on safety and health at work or if they neglected duties of selection and supervision of a designated person.This personal responsibility can include convictions because of negligence, homicide or bodily harm. The personal criminal liability might be threatened with imprisonment depending to national legislation. The tort law might constitute personal financial compensation.Fines for non-complianceBelow criminal liability, the national rules might foresee fines for administrative offences. They include cases of not complying with OSH legislation. Even without any consequences for workers’ health employers can be fined by labour inspectorates. The fines depend on national legislation and the systems of labour inspection, which can vary from case to case. In some countries (like the Netherlands), fines can be substantially increased in cases of “non-compliance created economic benefits”. The economic benefit can then be added up to the normal fine. Labour inspectorates in some EU Member States take account of certified management systems when planning their inspection schemes in a way that sees them controlling them less frequently or only in re-active inspections (responding to complaints or accidents). This takes account of the fact that a certified OSH management probably contributes to the better organization of safety and health in the company. However, labour inspections can still control the fulfillment of the legal obligations and can impose fines for non-compliance. Poor OSH performance can also be fined by negative incentives or extra premiums: In this case, employers whose workers are frequently involved in work place accidents can be obliged by the insurance body to pay an extra premium for bad OSH performance.

Employers have the obligation to insure the safety and health of their employees by preventing the exposure to occupational risks, and thus avoiding the occurrence of occupational accidents and diseases, which are very expensive and have severe direct and indirect effects on the life of workers. To achieve such goal employers have to implement safety and health measures based on risk assessments and legislation. Within the European Community, this obligation was set by the Council Directive of 12 June 1989 on the introduction of measures to encourage improvements in the safety and health of workers at work (Framework Directive 89/391/EEC). Achieving this objective requires also the commitment of workers with occupational safety and health (OSH) principles.

Occupational disease- disease contracted as a result of an exposure over a period of time to risk factors (chemical, physical or biological agents) arising from work activity, that is any chronic ailment that occurs as a result of work or occupational activity. It is typically identified when it is shown that it is more prevalent in a given body of workers than in the general population, or in other worker populations. Examples include respiratory diseases (e.g. asbestosis or occupational asthma), skin diseases, musculoskeletal disorders (e.g. carpal tunnel syndrome) and occupational cancer.

Hazard - source, situation, or act with a potential for harm in terms of human injury or ill health, or a combination of these, i.e. anything present in the workplace that has the potential to cause an injury to workers, either a work accident or an occupational disease.

The meaning of the word hazard can be confusing. Often dictionaries do not give specific definitions or combine it with the term "risk". For example, one dictionary defines hazard as "a danger or risk" which helps explain why many people use the terms interchangeably.

There are many definitions for hazard but the more common definition when talking about workplace health and safety is:

A hazard is any source of potential damage, harm or adverse health effects on something or someone under certain conditions at work.

Basically, a hazard can cause harm or adverse effects (to individuals as health effects or to organizations as property or equipment losses).

Sometimes a hazard is referred to as being the actual harm or the health effect it caused rather than the hazard. For example, the disease tuberculosis (TB) might be called a hazard by some but in general the TB-causing bacteria would be considered the "hazard" or "hazardous biological agent".

A common way to classify hazards is by category: biological - bacteria, viruses, insects, plants, birds, animals, and

humans, etc., chemical - depends on the physical, chemical and toxic properties of

the chemical. ergonomic - repetitive movements, improper set up of workstation,

etc.,

physical - radiation, magnetic fields, pressure extremes (high pressure or vacuum), noise, etc,

psychosocial - stress, violence, etc., safety - slipping/tripping hazards, inappropriate machine guarding,

equipment malfunctions or breakdowns

Risk is the chance or probability that a person will be harmed or experience an adverse health effect if exposed to a hazard. It may also apply to situations with property or equipment loss.

For example: The risk of developing cancer from smoking cigarettes could be expressed as "cigarette smokers are 12 times (for example) more likely to die of lung cancer than non-smokers". Another way of reporting risk is "a certain number, "Y", of smokers per 100,000 smokers will likely develop lung cancer" (depending on their age and how many years they have been smoking). These risks are expressed as a probability or likelihood of developing a disease or getting injured, whereas hazards refer to the possible consequences (e.g., lung cancer, emphysema and heart disease from cigarette smoking).

Factors that influence the degree of risk include: how much a person is exposed to a hazardous thing or condition, how the person is exposed (e.g., breathing in a vapour, skin contact), and how severe are the effects under the conditions of exposure.Risk assessment is the process where you:

identify hazards, analyze or evaluate the risk associated with that hazard, and determine

appropriate ways to eliminate or control the hazard.

Principles of prevention and controlPrevention means the act or practice of stopping something bad from

happening. It means the avoidance of the risk or hazard at work. In contrast to prevention, control is the term to describe mitigation activities where the risk cannot be prevented. The general principles are:

avoiding risks; evaluating the risks which cannot be avoided; combating the risks at source; adapting the work to the individual, especially as regards the design of

work places, the choice of work equipment and the choice of working and production methods, with a view, in particular, to alleviating monotonous work and work at a predetermined work rate and to reducing their effect on health;

adapting to technical progress; replacing the dangerous by the non-dangerous or the less dangerous; developing a coherent overall prevention policy which covers

technology, organization of work, working conditions, social relationships and the influence of factors related to the working environment;

giving collective protective measures priority over individual protective measures;

giving appropriate instructions to the workers.

Dangerous and hazard industrial factors

Physical factors, among which most frequent is unfavorable microclimate. Surgeons undergo the action of this factor during their work for a long time in the operating room, as well as district therapeutics and pediatricians, doctors of ambulance. Radiologists, radiologists, surgeons, traumatic surgeons, therapeutics, undergo the action of ionizing radiation during radiological examinations of patients. Surgeons undergo the action of higher atmospheric pressure during carrying out operations on the heart, large vessels and other operations, connected with high risk in the bar operating rooms. Pressure in bar operating room is about 2-3 atmospheres. Surgeons work in atmosphere, which contains pure oxygen.

Noise connected with work of different apparatus and machines (for example, apparatus of mechanical lung ventilation) is a factor of doctors' labor. Sometimes noise reaches 60-70 dB. Physiatrists undergo the action of ultra-violet radiation. Laser-radiation is widely used in surgery, ophthalmology and other branches of medicine. Electro-magnetic fields influence surgeons, physiatrists during their work.

Chemical factors influence the doctors' organism. Air of hospital rooms is polluted by chemical substances (ozone, nitrogen oxides, antibiotics, narcotic substances). Sixty per cent of all professional diseases of doctors are connected with chemical substances. Chemical substances can cause allergic diseases, bronchial asthma, rhinitis, bronchitis, allergic myocarditis, dermatitis, etc. Surgeons, anesthesiologists, physiatrists, dentists are very frequently exposed to the action of chemical factors.

Behind a method of penetration into an organism: through respiratory ways, through digestive system, through a leather(skin) (chemical burns);

By the level of toxic :very high (MPC at air < 0,1 mg/m3), highly toxic (MPC 0,1 - 1,0mg/m3), average high (MPC 1,0- 10,0 mg /m3), hardly toxic (MPC > 10,0 mg / m3).

Biological factors. Infectious danger is peculiar to all doctors, especially infectionists, phthisiatricians, pediatricians. Diseases of doctors connected with biological factors make up 30 %from total number of diseases; the other diseases make up 10%.The influence of negative factors causes a specific picture of doctors' morbidity. Very often doctors have diseases of respiratory system, circulatory system, alimentary canal, urogenital system, etc.

The group of psychophysiological factors:Physical overstrain: static (keeping of the big cargoes); dynamic (a raising

and moving of the big cargoes) hypodinamic, forced position of a body, overstraining organs of body. Nervous -psychological over stain: mind overstrain, an overstrain of attention, intensive change work processes, monotony of work, emotional pressure.

Occupational and work-related diseases

An “occupational disease” is any disease contracted primarily as a result of an exposure to risk factors arising from work activity. “Work-related diseases” have multiple causes, where factors in the work environment may play a role, together with other risk factors, in the development of such diseases.

Classifications of occupational diseases have been developed mainly for two purposes: (1) notification for labour safety and health surveillance and (2) compensation. The absence of unified diagnostic criteria, coding systems and classifications reduce the compatibility and comparability of national statistics on occupational diseases.

An occupational disease is not characterised merely by the disease itself, but by a combination of a disease and an exposure, as well as an association between these two. Classifications of occupational diseases have been developed mainly for two purposes: (A) surveillance and notification for labour inspection purposes and (B) social security (compensation) purposes.

The majority of the classification systems have the following hierarchy:1. Diseases caused by agents

1.1Diseases caused by chemical agents1.2Diseases caused by physical agents1.3Diseases caused by biological agents

2. Diseases by target organ2.1Occupational respiratory diseases2.2Occupational skin diseases2.3Occupational musculoskeletal diseases

3. Occupational cancer4. OthersThe classifications contain both categories defined by the causative agent

and categories defined by the medical diagnosis. Cases of a given disease may therefore fall into several categories. The absence of unified diagnostic criteria, coding system and classification reduce the compatibility and comparability of national statistics on occupational diseases. Even for classical occupational diseases like asbestosis, there is heterogeneity in the national statistics and clinical practice in what kind of conditions are codedunder the general heading of asbestosis.

Separate sharp and chronic professional diseasesSharp professional disease (intoxication) occurs suddenly, after disposable

influence concerning high concentration of chemical substances, which is in the air of working zones.

Chronic diseases arise in consequence of long but low influence (not more than MPC, MPL, MPD) concentration, levels, dozes harmful industrial - professional factors.

In daily professional work of the doctor his organism can undergoes the influence of professional harmful factors of different direction actions:

Physical nature:

- microclimatic conditions,- illumination,- noise, - ultrasound,- different kinds electromagnet radiation - ultra-violet, infra-red, ionizing

kinds

Chemical nature:

- medicine of a chemical origin,- disinfectants,- solvents and others.

Biological nature:

- microorganisms,- medicine of a biological origin.

The psychological nature:

- The high level of responsibility for consequences of your professional activity,

- Constant contact to the patient and others .

Сharacteristics of occupational hazards for different medical personnel

The occupational exercise load and hazards of the surgical specialties doctors include:

1.the number of surgical interventions is up to 150 per year in general surgery, 170 – in otorhinolaryngology, 370 – in obstetrics and gynecology. The number and complexity of the operations increase with the raising level of the surgeon’s skill;

2.the forced body position with the trunk frontal bending and the prolonged static tension of muscles of the shoulder girdle, back and stretched forward arms;

3.the hot microclimate of the operating room with high streams of the radioactive heat from the artificial lighting sources (shadow less lamp);

4.the ionizing radiation during the X-ray examinations, especially in traumatology, vascular surgery, neurosurgery;

5.the toxic effect of the narcosis agents (nitrogen, halothane, chloroform, diethyl ether) and anesthetics;

6.high mental and nervous-emotional exertion, connected with the complexity and duration of the surgical intervention, possible post-operative complications and responsibility for patient’s life.

Among the diseases afflicting the surgical specialties doctors with temporary disability the diseases of nervous system, cardio-vascular system, digestive system and acute respiratory diseases are the most widespread.

Among chronic diseases of these specialists such diseases, as the diseases of cardio-vascular system, connected with high psycho-emotional and physical load should be mentioned. They are: angina pectoris, hypertension, vegeto-vascular dystonia.

There are frequent diseases due to the prolonged standing at the surgical table: radiculitis, osteochondrosis, dyskinesia, varix dilatation of the lower extremities.

Surgeons’ disabilty or necessity to change their occupation in 60 – 80 % cases can be explained by chronic intoxication with narcotic agents and anesthetics, in 11 – 20 % cases - by the infectious diseases, 9 – 10 % cases - by physical and nervous overexertion.

Hygienic peculiarities of labour conditions and health status of the therapeutic doctors depend on the patient service forms. In case of polyclinic, district service, the leading role belongs to the excess physical load, which depends on the year season (amount of calls), the size of the doctor’s district and the type of the buildings (detached houses or many-storied buildings, elevator’s presence or absence). These specialists may also suffer from psycho-emotional exertion and different physical factors’ unfavorable effect – X-ray, ultrasound, laser and other diagnostic and physiotherapeutic measures, chemical harmful substances – the pharmacological preparations, from which nurses suffer more frequently.

Occupational diseases of therapeutic doctors, first of all of the phthisiatricians, infectiologists, dermatologists, helminthologists, the laboratory assistants at the bacteriological, virological, helminthological laboratories include the corresponding infections; phthisiatricians, X-Ray doctors, radiologists suffer from dermatitis, exzemas, toxicodermia, melanomas, leucosis, skin cancer, radiation sickness; psychiatrists from psychoneurosis.

One of the main occupational hazards for dental doctors is their forced standing with the bending and turning trunk position which leads to the prolonged static tension of the corresponding muscles groups; noise and vibration due to drilling machines, sight exertion, blinding effect of the photopolymer lamp, penetration of mercury from the mercury amalgam into the respiratory organs, fumes of the polymer materials solvents, danger of infection from the patient with the upper respiratory tract diseases during the incubation or convalescence stage, while performing the manipulations connected with the patient’s mucosal membrane or blood contact.

Abovementioned hazards can result in bearing disorder (34 – 45%), varix dilatation of the lower extremities (19 – 49%), signs of the vibration diseases (paresthesia, loss of hands’ temperature sensibility and perceptibility, Dupuytren's contracture).

The visual analyzer exertion can lead to the accommodation spasm, so-called false myopia,and sore eye.

NotificationIn addition to the diagnosis of occupational disease, additional information

should be included in the notification.

ILO has defined the minimum information to be included:1. enterprise, establishment and employer

name and address of the employer name and address of the enterprise name and address of the establishment economic activity of the establishment number of workers (size of the establishment)

2. person affected by the occupational disease name, address, sex and date of birth employment status occupation at the time when the disease was diagnosed length of service with the present employer

3. occupational disease name and nature of the occupational disease harmful agents, processes or exposure to which the occupational disease is

attributable description of work which gave rise to the condition length of exposure to harmful agents and processes date of diagnosis of the occupational disease

Occupational safety objectives are primarily addressed through the National Occupational Research Agenda (NORA). NORA was established by the Centers for Disease Control and Prevention (CDC) National Institute for Occupational Safety and Health (NIOSH) and its partners to stimulate research and improve

workplace practices. NORA focuses on occupational safety and health in 10 sectors:

Agriculture, Forestry, and Fishing Construction Health Care and Social Assistance Manufacturing Mining Oil and Gas Extraction Public Safety Services Transportation, Warehousing, and Utilities Wholesale and Retail Trade

Maintenance of radiating safety of the personnel at radiological researches

Radiological researches as an additional method of diagnostics are widely used in medical practice. Decrease(reductions) in the beam loading received by the personnel at radiological researches, can be achieved by the rational antiradiation protection. It is organized by system, which base on the following principles.

Principle of correctness:The irradiation should be proved and be appointed exclusively by the doctor for achievement diagnostic and therapeutic effect which cannot be received by other methods of diagnostics and treatment.

Principle of optimization:Collective dozes which are received with the population at carrying out of radiological and radiological procedures, should be so low as far as it is possible with taking into account economical and social factors.

Principle of not excess:Sizes of dozes of an irradiation should be established only by the doctor for

each patient individually proceeding from the prevention(warning) of occurrence effects which determine in healthy fabrics and an organism as a whole.

Norms of radiating safety establish such categories of people which can give in to antirradiation:

• category А(Personnel) people who work with sources of ionizing radiation constant or temporarily

• category B (personnel) - People which don’t work with sources of ionizing radiation but location of their working places in premises(rooms) and on industrial

platforms of objects with radiation-nuclear technologies can receive additional radiation.

• category C- all population.

Radiating safety of the personnel of radiological departments

As well as in X-Ray room, a source of harmful factors of radiological branches is ionizing radiation. As against operating conditions of doctors - radiologists ionizing radiation in radiological branches can create not only the closed sources of ionizing radiation but also open.

«Closed» Such sources, which radioactive substance does not get into an environment (X-ray, scale cobalt guns, B - thrones). Principles of radiating protection of the personnel are based on actions of protection against external radiation.

«Open» such sources, which radioactive substance get into an environment (using of radioactive iodine - 131). Principles radiation protection of the personnel are based on actions of protection against internal and external radiation.

According to use of a source of ionizing radiation exist features of radiation protection

Kind of a source

«Closed» sources (external radiation)

«Open» sources (internal and externalradiation)

Principles of radiating protection of the personnel

1. Protection by the screen.2. Protection by the distance.3. Protection by time.4. Protection by doze.

1. Use radiating aseptic. 2. Protection by the screen.3. Protection by the distance.4. Protection by time.5. Protection by doze.

Principles of antiradiative protection of the personnel against an internal irradiation first of all include measures for prevention of hit of radio isotopes in an organism of the personnel any of possible way - through respiratory ways, through a gastro enteric tract, through mucous membranes, through skin.

To be protected from the ionizing and non-ionizing electromagnetic radiation, methods based on physical laws of radiation decay, which are stated in the legislative and organization direction are used. They include the protection by means of the radiation sources capacity limitation, distance, time, and shielding.

Thus, the legislation implies limit doses of the ionizing radiation, maximum allowable concentrations of radionuclides in the air of working zone (Norms of radiation safety of Ukraine(NRSU)-97), their maximal allowable activities at the working place and other.

In order to keep health of medical personnel with harmful labour conditions, the legislation establishes the half day are:

- 4-hour-day – for medical workers directly connected with the open sources of radionuclides;

- 5-hour-day – for personnel connected with closed sources of the ionizing radiation(gamma-, X-ray), also for morbid anatomists, prosectors, forensic medical experts, anatomists;

- 5.5-hour-day – for doctors of the tuberculosis, psycho-neurological centers, physiotherapeutists, dentists;

- 6-hour-day – at the infectious, tuberculosis, psychiatric, narcological, balneal, radon, laboratory departments.

Inadmissible influence of ultrasound and maintenance of protection of the doctor of ultrasonic diagnostics

At the present stage of development of medicine ultrasonic diagnostics are widely used in various in the direction: in therapy, neurology, urology, obstetrics, stomatology. But the ultrasounds not absolutely safe for the person, therefore its professional using demands methods of protection of the personnel from its harmful influence.

Ultrasound is the sound fluctuations from 20000 up to 109 Hz. Ultrasound is absorbed fabrics of a human body with allocation thermal energy. Can cause by damage the central nervous system, defeat of ears, the vestibular organs.

Protection against negative influence of ultrasonic fluctuations passes by hermetic sealing sources, using absorbed materials, reduction of contact of the personnel with ultrasound.

Key concepts in OSH are: 1. Hazard –- source, situation, or act with a potential for harm in terms of human injury or ill health, or a combination of these, i.e. anything present in the

workplace that has the potential to cause an injury to workers, either a work accident or an occupational disease.2. Risk – combination of the likelihood of an occurrence of a hazardous event or exposure and the severity of injury or ill health that can be caused by the event or exposure.3. Risk assessment– is the process of evaluating risks to workers’ safety and health from workplace hazards. It is a systematic examination of all aspects of work that considers: o what could cause injury or harmo whether the hazards could be eliminated and, if not,o what preventive or protective measures are, or should be, in place to control the risks.4. Safety – it is very difficult to define. Safety is the state of being "safe" i.e. free from harm or risk, but in practice this state is never obtained. Therefore safety must be seen as a value judgment regarding the level of risk of being injured which is considered to be acceptable. 5. Health – in relation to work, indicates not merely the absence of disease or infirmity; it also includes the physical and mental elements affecting health which are directly related to safety and hygiene at work. 6. Occupational disease – disease contracted as a result of an exposure over a period of time to risk factors (chemical, physical or biological agents) arising from work activity, that is any chronic ailment that occurs as a result of work or occupational activity. It is typically identified when it is shown that it is more prevalent in a given body of workers than in the general population, or in other worker populations. Examples include respiratory diseases (e.g. asbestosis or occupational asthma), skin diseases, musculoskeletal disorders (e.g. carpal tunnel syndrome) and occupational cancer.7. Work accident – is a discrete occurrence in the course of work (even if the accident happens off the company’s premises, or if it is caused by third parties), which leads to physical or mental harm.8. Prevention – all the steps or measures taken or planned at all stages of work in the undertaking to prevent or reduce occupational risks.