From Big Medical Encyclopedia

ACCIDENT PREVENTION - system of the organizational actions and technical means allocated for prevention of influence on the working dangerous production factors which are the reason of injuries or sudden sharp deterioration in health. T. is a part labor protection (see) also includes such actions as training and instructing working on safety issues of work, maintenance in technically safe condition of buildings and constructions, equipment of the newly created and operated production equipment as protection and safety devices, development of means of collective and individual protection of the dangerous and harmful production factors working from influence, and also the organization of providing with these means of workers and employees.

Actions for T. are based on requirements of the normative documentation developed and approved in development of the relevant articles of «Bases of the legislation of USSR and federal republics about work».

The main normative documents regulating safety of work are the state and industry standards of a security system of work (see. Standardization ).

At each enterprise, in institution and the organization there is a system of training, instructing and certification working on safety issues of work, offices on labor protection will be organized. The integral component of this work — promotion of questions of labor protection with use of posters, radio, movies, lectures and conversations with working.

Technical safety of the production equipment shall be ensured as at stages of its development and production, and during operation. The equipment all developed, produced in lots and operated shall meet the requirements of occupational safety standards system and other specifications and technical documentation for safety of work. Special value has creation and implementation in production of completely safe cars and processing equipment excluding use of additional resources of T. at their operation. Similarly safety of technological processes shall be ensured.

In system of actions for T. an important role is played by means of collective and individual protection. These means shall be rather reliable and effective in prevention of influence on the working dangerous and harmful production factors. Special attention is paid on efficiency of ventilating installations and means of radiation protection (see. Radiation safety , X-ray apparatus ), on safety of electroinstallations and illumination of jobs, on quality of overalls (see. Clothes special ), special footwear (see. Footwear ), safety spectacles (see) and other safeguards.

The accident prevention during the work with the medical equipment

Depending on types and a design of the medical equipment, ways of its use and service, types of rooms where she is exploited, various harmful and dangerous production effects on service personnel are possible. Defeats by electric current, the increased levels of the ionizing, electromagnetic, ultraviolet, infrared, ultrasonic, reflected and scattered laser radiations in working zones, the high or low temperature of surfaces of the medical equipment, vzryvo-and fire danger, the increased noise level and vibrations in a workplace, danger of bruises, harmful chemical and biol concern to them. influences, etc.

Basis of T. during the work with the medical equipment its constant maintenance in serviceable technical condition, observance of rules of use, the device of electroinstallations for power supply of the elektrome-ditspneky equipment, and also the general and industry service regulations of devices and devices is.

Broad use in healthcare institutions of the equipment and electric equipment creates danger of defeat by electric current (see. Electric trauma ). The result of defeat by electric current depends on a look and the size of current, a way of current through a body of the person, time of action and its frequency, on humidity, temperature and pressure of an ambient air. The main reasons for defeat by electric current of the persons servicing the medical equipment medical and technicians are accidental touches without protective agents to the current carrying parts which are energized or hiting at to the metal parts which appeared under mains voltage owing to damage of isolation, protection and blocking devices and also violation of the rules of technical operation of electroinstallations and rules T. Measures of constructive, technical and organizational character are taken for elimination of it. Constructive measures: unavailability to service personnel of current carrying parts, existence of blocking to disconnection of the device from power supply at its opening, the alarm system testimonial of the fact that the device is switched on, protective grounding of available metal parts of the products of the medical equipment having only the main isolation, the double or strengthened isolation of the network chain excluding emergence of tension of network, dangerous to the person, on exposed metal parts of the device. Also development of products is provided (endoscopes, ophtalmoscopes, etc.), food to-rykh is carried out from the isolated source of alternating current no more than 24 in or a direct current of 50 in, not having other chains with more high tension.

For ensuring electrical safety carry out periodic control and survey of technical condition of the electromedical equipment, check wiring, electrical insulation and means of protection. During periodic and postrepair control check integrity of all casings, protective covers, the isolation of a network cord and wires connected to the patient, the main technical characteristics of the device, fastening of wires and details of the device measure currents of leak, resistance of isolation of a network chain from the case and from a chain of the patient, resistance of a chain of protective grounding. In use the equipment pollution of ways of leakage of current and air gaps is possible, to-rye it is necessary to clear periodically.

At adjustment of the elektromoditsinsky equipment which is under the network or more high tension it is necessary to use tools with the isolated handles, to work, standing on a dielectric rubber rug, in dielectric gloves, in clothes with long sleeves, etc. In rooms where the electromedical equipment is operated and at its setup energized metal pipes of a water supply system, heating, a pipe, on the Crimea the gases used in medicine move, and other grounded carrying-out designs shall be unavailable to a touch, napr, are protected by wooden boards. In rooms where medical personnel and patients can directly contact to the electromedical equipment fed from network, napr, in operating rooms, chambers of an intensive care, the system of alignment of potentials of metal designs shall be applied: cases of the electromedical equipment, metal pipelines, operating and tool tables shall be connected to the protective grounding isolated by copper conductors with a section not less than 4 mm2.

Marginal sizes of intensity of the electromagnetic field in a working zone of the personnel servicing devices for microwave therapy at radiation during all working day — no more than 0,01 MW/cm2; at radiation to 2 hours for the working day — no more than 0,1 MW/cm2; at radiation up to 20 min. a day — no more than 1 MW/cm2 on condition of use of safety spectacles. Stay of personnel in a zone of radiation of the devices generating centimetric and decimeter waves is forbidden. Operation of such devices with a remote arrangement of radiators is allowed only in specially allocated rooms or in the shielding cabins.

Reflectors of quartz-mercury and bactericidal lamps in intervals between to lay down. procedures shall be closed by the gates or dense «skirts» made of cloth which are put on edges of a reflector of an irradiator available on them (see. Physiotherapeutic office ).

The service personnel shall use behind the covered safety spectacles with light filters (see Points, safety spectacles; Ultraviolet radiation ).

For protection of hands against harmful effects ultrasound (see) during the holding underwater ultrasonic procedures the nurse shall work in gloves made of cloth, atop to-rykh rubber gloves are put on. At placement and operation of laser medical machines actions for decrease in power illumination in workplaces to tolerance levels and on prevention of defeat of personnel are provided by a direct laser beam. It is forbidden to look towards to primary or specularly reflected beam, and also along a beam at visual aiming of a beam at a target. It is necessary to use safety spectacles when there is a probability of damage of eyes to straight lines, the reflected or scattered laser radiation (see. Laser ).

The explosion hazard and the fire can arise at operation of the sterilizing equipment (see Sterilizers) working iod with pressure (autoclaves, cylinders with oxygen and other gases), pressures chamber (see. Hyperbaric oxygenation ), devices for an inhalation anesthesia (see) and nek-ry types of the laboratory equipment at disturbance by personnel of special safety requirements. Steam sterilizers (autoclaves) shall be subjected to periodic surveys and hydraulic tests by the supertension specified in technical documentation and also after repair using welding or the soldering and in other cases when destruction of joint welds is possible. At installation and use of cylinders with oxygen or other gases it is necessary to be guided by Rules for the Construction and Safe Operation of the vessels working under pressure. For prevention of explosions and the fires in operating rooms during the use of the gaseous anesthetics forming easily flammable mixes with air and oxygen it is necessary to exclude sources of ignition: sparks are electric, electrostatic and a shock origin, naked flame, thermal manifestations of chemical reactions (decomposition of ether under the influence of sunshine), hit of fats and oils on the way passing under pressure of oxygen. Use in operating rooms of the isolated system of electric food with constant control of its isolation, the device of antistatic floors and effective ventilation (tenfold exchange of air in an hour), grounding of the electromedical equipment allow to increase the level of explosion safety. The fire in to a pressure chamber (see) can result from ignition of oxygen from sources of ignition (electrostatic discharge, sparking owing to bad contacts in an electrical wiring, etc.). For prevention of the fire it is necessary to eliminate sources of ignition, to maintain relative humidity of a gaseous fluid in a pressure chamber not lower than 65%, to ground the patient in a pressure chamber, the operating console and the case of a pressure chamber. Rooms where pressures chamber are placed, shall be equipped with furniture from non-combustible materials; in them use of naked flame and smoking is forbidden.

System of organizational actions for T. during the work with the electromedical equipment includes: timely instructing and training medical and technicians to safe working methods, the correct organization of a workplace and mode of work, use of protective agents, supervision in operating time, the admission to independent work of only specially trained personnel is not younger than 18 years, suitable for health reasons and qualifications (certified) to implementation of operation, installation, maintenance and repair of the medical equipment, appointment responsible for the accident prevention, development of the program of periodic surveys and technical tests of the electromedical equipment and electrical units, use of precautionary texts and signs.

Bibliogr: Cromwell L., etc. The medical electronic package for health care, the lane with English, M., 1981; L and in e N with about A. R. Elektrobezopasnost's N of medical equipment, M., 1981, bibliogr.; Bases of the legislation of USSR and federal republics, page 209, M., 1982; Safety regulationss at installation, maintenance and repair of products of medical equipment, M., 1983.

A. P. Kupchin; A. N. Grishin, O. K. Shchepotyev (the accident prevention during the work with the medical equipment).