With the development of modern medicine and the continuous improvement of medical technology, new chemicals and high-tech are widely used in clinic, various operations are widely carried out, and the number of AIDS cases attracting worldwide attention is increasing [1], which brings challenges to our clinic, the workload is obviously increased, and the work pace is accelerated, resulting in the operating room staff working in the environment of air pollution, ionizing radiation biological infection and psychological injury for a long time, and their health status will be different. This paper makes a preliminary discussion on this problem and puts forward some protective measures.
1 occupational hazards
1. 1 air pollution air pollution includes the volatilization of chemical disinfectants, the smell of high-frequency electrotome and the dispersion of general anesthesia drugs in the air. Formaldehyde, coal phenol soap, glutaraldehyde and ozone are all commonly used volatile chemical disinfectants in operating room [2]. Used for operating room disinfection, soaking samples, disinfection of instruments, etc. They are all irritating substances, which have stimulating effects on skin mucosa and upper respiratory tract. Formaldehyde also has sensitizing, mutagenizing and carcinogenic effects. Long-term exposure to low-dose formaldehyde solution can cause chronic respiratory diseases and chromosomal abnormalities. When the indoor carbon dioxide concentration reached 0. 1%, the air condition began to deteriorate and odor appeared. Enflurane is a new halogen-containing anesthetic, which has been widely used in clinic since 1980s. It contains vinyl, which is a potential mutagenic and carcinogenic substance. Its chemical properties are stable and non-irritating to respiratory tract [3]. Convulsion can be produced at high concentration and low Paco2 _ 2, and respiration and circulation can be inhibited during deep anesthesia, with only suspicious damage to liver and kidney. However, foreign cytogenetics has confirmed that SCE of operating room staff can be increased, and the relationship between them needs further study. With the wide application of disposable medical supplies, the disinfection of ethylene oxide gas is also increasing. Air pollution is minimal. They exist in the operating room for a long time at a low dose and enter the human body and other organisms through the skin and respiratory tract. Chemical pollutants are the most harmful to people's health. The harmful effect of air pollutants depends on their characteristics, chemical structure, concentration and the time of human contact, and many harmful substances are often mixed in the atmosphere. The most common phenomenon at this time is the toxic addition of harmful substances. Low-concentration pollutants will have a long-term chronic impact on people, which is often not easy to be noticed and difficult to identify. There is a special aspect of air pollution in operating room, which is related to anesthesia method, leak-proof quality of anesthesia machine, anesthesia duration, indoor ventilation equipment, use of surgical instruments and instruments, effective time and use method of disinfectant concentration. No matter what kind of pollutant, it is directly proportional to the pollution source, emission and pollution degree at the same time, and the comprehensive time limit for pollutants to pollute the environment in every corner of the operating room is also different. Anesthesiologists have more contact with the residual anesthetic gas exhaled by gasbags and patients, surgeons have more opportunities to use high-frequency electrotome, and when using high-frequency electrotome, they have more contact with the odor emitted by skin or tissues, and instrument nurses have more opportunities to contact formaldehyde and glutaraldehyde.
1.2 biological infection due to the special working environment of the operating room, the staff directly contact with the patient's blood, secretions, vomit, etc. And there are many opportunities for infection. For example, acupuncture injury is the most common occupational accident. Its harm is not limited to acupuncture injury itself, but also can spread diseases, and it is easy to be infected with viruses A, B and C, especially human immunodeficiency virus (HTV), tumor growth and septicemia.
1.3 ionizing radiation with the development of science and technology, with the continuous development of intraoperative radiography and direct vision surgery, operating room staff have more and more opportunities to be exposed to radiation. According to related literature, a small amount of repeated exposure to radiation can lead to cancer or fetal malformation due to accumulation.
1.4 physical fatigue and psychological injury The psychological injury of medical staff working in the operating room is mainly caused by mental stress and pressure. They have been in a heavy and ordinary working environment for a long time, with high concentration of thoughts, excessive mental pressure and irregular work. They often have to rescue some critically ill patients and work overtime. The nature of their work is a combination of meticulous mental work and physical work. Staff are prone to ulcer, heart disease, migraine, varicose veins of lower limbs, gastroptosis, chronic lumbago and leg pain, chronic hepatobiliary diseases, etc. At the same time, it will also produce bad psychological state, such as mental tension, anxiety, irritability and so on.
2 protective measures
2. 1 Strengthen indoor circulation, regularly open windows for ventilation, acquire air conditioning equipment, improve the sewage system, and take effective preventive measures for staff. For medical personnel exposed to anesthetics, inhaling anesthetics, such as enflurane, isoflurane, nitrous oxide, etc. , now used in combination. Long-term exposure can cause liver and kidney diseases. When patients undergo inhalation anesthesia, the liquid medicine will inevitably be released into the air of the operating room, inadvertently forming an air pollution. The amount of sprayed liquid medicine is directly proportional to the time of exposure to air and the tightness of anesthesia machine. When anesthetizing patients, it is necessary to check whether the anesthesia machine is turned off, so as to reduce the concentration of liquid medicine in the air and reduce pollution. The concentration of disinfectant should be prepared accurately, and it should be used now. The more dose, the better disinfection effect, so as to reduce unnecessary waste and harm to human body, reduce the chance of cross infection, wash your hands correctly before and after operation, and refuel strictly sterile. After the operation, the equipment, sewage and room shall be treated in strict accordance with the rules and regulations. For example, facilities such as a special pool for soaking dirty dressing are used for terminal disinfection to avoid polluting the surrounding environment.
2.2 In order to avoid biological infection, the patient's medical history must be known before operation, and liver function and the results of two-and-a-half examinations are very important preventive measures. For positive patients, preventive preparations should be made in advance to avoid unnecessary harm. If the gloves are damaged, replace the sterile gloves immediately to avoid direct contact with the patient's blood and secretions. If the skin is damaged, immediately disinfect it with 3% iodine and 75% alcohol, and immediately inject hepatitis B vaccine. Before operation, the roving nurse prepared 1000ml of 0.2% peracetic acid, put it in a special container and put it in the operating room, so that anesthesiologists and roving nurses can wash their hands at any time before and after the operation. A tablecloth soaked in 0.5% peracetic acid was laid at the entrance of the operating room to reduce the cross-infection caused by staff entering and leaving.
2.3 Try to avoid X-ray contact with ionizing radiation. When unavoidable, try to keep your body away from direct light. No exposure to x-rays during pregnancy.
2.4 to prevent physical fatigue, in addition to excellent professional quality requirements, staff should learn to adjust their emotions, correct general occupational stress, prevent the harm caused by standing and walking for too long, try to improve the mandatory posture of standing and walking, and pay attention to maintaining good operating posture and habits. Psychological research has proved that mental stress, anxiety and irritability have a great influence on the best level. Therefore, we should strengthen exercise and self-cultivation, so as to pay attention to strengthening the exercise of psychological quality and keep ourselves energetic, focused, happy and in the best psychological state, which plays an important role in giving full play to the best operational level.
References:
1. Occupational Hazards and Protection of Teachers Zhang Teaching Nurses. Journal of Nurse Training, 1994.9(8):8.
2. Xu Cuixia, improvement of disinfection and sterilization in operating room. Sichuan: New progress in clinical medicine. 1995.2 1 1
Liu Junjie, Modern Anesthesiology. Beijing: Published by People's Medical Publishing House, 1994+064.