Instructions on labor protection for personnel of departments, physiotherapy rooms

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Instructions on labor protection for personnel of departments, physiotherapy rooms

Occupational Safety and Health

Occupational Safety and Health / Standard instructions for labor protection

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Safe Operation

1. General safety requirements

1.1. Only persons with completed higher and secondary medical education, who have certificates of specialization in physiotherapy, who have been trained in labor safety in accordance with GOST 12.0.004-79, and who have 1 electrical safety group, are allowed to independently conduct physiotherapy procedures.

Instead of GOST 12.0.004-79, by the Decree of the USSR State Standard of November 5, 1990 No. 2797, GOST 12.0.004-90 was approved and put into effect.

Persons under 18 years of age are not allowed to work with electromedical equipment for UHF and microwave therapy, as well as in radon laboratories and radon clinics. In radon laboratories and radon clinics, women are not allowed to work during the entire period of pregnancy and breastfeeding.

1.2. The staff of the department, physiotherapy room must undergo a mandatory medical examination upon admission to work and periodic medical examinations at least once a year. Persons who do not have medical contraindications are allowed to work, in accordance with Order No. 700 of the USSR Ministry of Health of June 19, 1984 "On conducting mandatory preliminary upon admission to work and periodic medical examinations of workers exposed to harmful and adverse working conditions."

1.3. The staff of departments, physiotherapy rooms is obliged to:

comply with the internal labor regulations of institutions;
comply with labor protection instructions;
know how to provide first aid in case of electric shock, light and radioactive irradiation, poisoning or skin damage with chemicals;
immediately report to the immediate supervisor about any accident related to production or work.

1.4. The staff of departments, physiotherapy rooms should be provided with:

sanitary and hygienic clothing and footwear, overalls, special footwear and safety devices in accordance with the current standards approved by the USSR Ministry of Health;
soap, clean towels (electric towels) for washing hands in washrooms.

1.5. In departments, physiotherapy rooms, fire safety rules must be observed. Obstruction of aisles, littering the premises is not allowed.

Eating and smoking in the workplace is prohibited. For eating, it is necessary to equip special rooms.

1.6. Medical personnel are prohibited from:

leave the office during physiotherapy procedures and leave patients unattended;
allow procedures to be performed by junior medical personnel, as well as by the patient himself.

1.7. Solutions of drugs used for physiotherapeutic procedures should be stored in a specially designated place in dark glass bottles for no more than 10 days. Drugs that are not stable at room temperature should be refrigerated; medicines belonging to groups (strong) of the list A, B - to be stored in special cabinets under lock and key (the corresponding inscription "A", "B" should be on the cabinet).

1.8. Heating devices of the central heating system, pipes of the heating, gas, water and sewer systems located in the premises must be covered with wooden casings, painted with oil paint throughout and to a height inaccessible to the touch of patients and personnel during the procedures.

1.9. Metal cases and tripods of electric and light therapy devices, including portable ones, as well as heaters that may be energized due to insulation failure, are subject to protective grounding, regardless of the place of their installation and procedure.

1.10. The floors in departments, physiotherapy rooms should be smooth, non-slip, meet the hygienic and operational requirements of the room.

1.11. Supply and exhaust ventilation in departments, physiotherapy rooms should provide normal working conditions in accordance with the current building codes and rules "Medical institutions. Design standards" *.

1.12. Signs of radiation safety should be posted on the doors of rooms where people work with radioactive substances.

1.13. Persons who have failed to comply with or violate labor protection instructions are subject to disciplinary action in accordance with the internal labor regulations and, if necessary, an extraordinary examination of knowledge of labor protection issues and unscheduled briefing.

2. Safety requirements before starting work

2.1. Before starting work, you must:

put on sanitary and hygienic clothes, shoes, overalls and safety shoes, provided for by the standards approved by the USSR Ministry of Health;
check in the appropriate log for the elimination of previously recorded defects by the technician;
make sure that the devices, fences, interlocks, grounding devices are in good condition and, if defects are found, immediately report this to the head of the department, physiotherapy room, making an appropriate entry in a special log to mark the current repair of the equipment and its preventive examination;
all control and measuring devices of the apparatus are subjected to verification in accordance with the established procedure;
check the serviceability and efficiency of the supply and exhaust ventilation and turn on the ventilation;
remove dust from the devices with a dry cloth, wipe the mercury-quartz lamps with a damp cloth moistened with rectified alcohol;
check the condition of the wires. The wires used to connect the devices to the network must be made of a flexible cable, and in its absence - from flexible wires enclosed in a rubber tube. The wires extending from the devices to the patient must have high-quality insulation, the integrity of the wires must be checked before use.

2.2. In departments, physiotherapy rooms, it is prohibited:

carry out medical procedures on faulty devices until the defects are eliminated;
perform any manipulations inside the devices;
use wires with insulation that has defects;
use cylinders whose certification period has expired, without the established stamping, with faulty valves, damaged body, without proper coloring and inscription;
use cylinders without a reducer. The low side of the reducer must be adjusted to the pressure at which it is allowed to work on the apparatus for saturating water with carbon dioxide;
paint and clean cylinders and reducers.

2.3. Cylinders with carbon dioxide and oxygen should be protected from direct sunlight and placed at a distance of at least 1 m from a heating radiator and at least 5 m from stoves and other sources of heat with open fire. When installing protective screens that protect cylinders from local heating, this distance can be reduced to 1 m for stoves and other heat sources with open fire, and up to 10 cm for a radiator.

2.4. Cylinders with carbon dioxide and oxygen must be fastened with a metal bracket to the wall of the room or a special rack.

2.5. Spare cylinders filled with carbon dioxide should be stored in a dedicated room, and cylinders filled with oxygen should be stored in a dedicated building.

2.6. Delivery of cylinders with carbon dioxide and oxygen from their place of storage to the place of use should be carried out on special carts and stretchers.

2.7. All chemicals for the preparation of artificial hydrogen sulfide baths should be stored in a dry room under lock and key, and a strict record of their consumption should be kept.

2.8. The preparation of the solution and the bottling of hydrochloric acid for artificial hydrogen sulfide baths must be carried out in a laboratory in a fume hood, with strict observance of safety measures.

2.9. When preparing and pouring a concentrated radon solution, the following rules must be observed:

before starting work (10 - 15 minutes before) turn on the supply and exhaust ventilation. Ventilation should operate during the entire time of operation of the radon laboratory and turn off only after the personnel leave the laboratory;
a bubbler with a solution of radium salt (a radon generator) and a bottle with a concentrated solution of radon must be stored in a fume hood and boxes located in the laboratory;
when arranging equipment, use protection to the maximum so that, being at one workplace, the personnel are not exposed to radiation from a radiation source located in another place;
the time spent by personnel in close proximity to radiation sources should be minimal, necessary for carrying out the relevant work;
when starting work, check the tightness of the installation (the integrity of the rubber bands, the tightness of all connections, etc.);
when pouring it is necessary to avoid everything that can contribute to the release of radon into the air (spill of radon solution, rapid outflow of radon solution into burettes, etc.);
shake the bottles with a concentrated solution of radon using a shuttel apparatus;
during a long break in work with the bubbler, it is necessary to slightly open the side lower valve of the bubbler with a solution of radium once a month for a few seconds in order to eliminate the increased pressure in it. At the same time, measures should be taken to exclude the possibility of radon released from the bubbler getting into the indoor air (work in a fume hood, etc.);
it is prohibited to stay in the laboratory premises beyond the time required for the preparation and bottling of radon.

3. Safety requirements during work

3.1. In departments, physiotherapy rooms, it is prohibited:

be present to persons who are not related to work;
use radiation sources and equipment not for their intended purpose;
work on faulty devices, devices, devices with faulty devices, alarms, etc.;
leave unattended devices, devices, devices connected to the electrical network, electric heaters, keep cotton wool, alcohol and other flammable substances near them;
carry out physiotherapeutic procedures during a thunderstorm on devices powered by an overhead electrical network;
store radiopharmaceuticals (RP) with an activity exceeding that stipulated by the sanitary passport;
carry out technological operations with radiopharmaceuticals outside the workplace;
store radioactive waste at workplaces after work with radionuclides is completed;
store radioactive sources in quantities exceeding the value specified in the sanitary passport;
store and use drugs without labels, as well as in damaged packaging;
taste and smell the drugs used;
work with a disconnected water supply, sewerage and ventilation system;
work without the established overalls and safety devices;
store food products, home clothes and other items not related to work in offices, except for specially designated places.

3.2. In electrolight treatment rooms, medical personnel and patients are prohibited from:

touch any grounded metal objects during an electrotherapeutic procedure with contact switching of electrodes (diadynamic and amplipulse therapy, etc.);
carry out UHF therapy without careful adjustment of the therapeutic circuit in resonance with the generator, use one capacitor plate and a total air gap under both capacitor plates over 6 cm;
stay in the zone of direct influence of the energy of decimeter and centimeter waves when carrying out procedures using a remote method.

3.3. Devices for UHF therapy, UHF therapy, microwave therapy with a power of 100 or more watts must be operated in cabinets shielded with a fabric with a microwire (article B-14381 or similar in properties).

3.4. Boiling of electrode pads, cavity electrodes and instruments should be carried out in disinfection boilers or tanks only with a closed heater in a fume hood or under local ventilation.

3.5. Filling the four-chamber baths with water and removing water from them is possible only when the equipment is turned off.

3.6. When conducting electrotherapy procedures with contact application of electrodes (galvanization, diadynamic and amplipulse therapy, etc.) outside the electrotherapy room (ward, dressing room, operating room, at home, etc.), it is necessary to exclude the possibility of the patient coming into contact with metal parts (bed, dressing table). To do this, a metal bed or table should be covered with a woolen blanket, over it with 3-4 layers of rubberized fabric and sheets so that their edges hang from all sides of the bed or table.

If there is a conductive floor (stone, tile, etc.) in the ward, dressing room or operating room, then during the procedure at the location of the attendants, the floor must be covered with a dielectric mat, linoleum or rubber, tested for its dielectric properties, on an area of at least 1 m2.

3.7. When using ultraviolet irradiators, the eyes of patients and attendants must be protected by glasses (GOST 12.4.003-74 or GOST 12.4.013-75) with dark-colored glasses with side protection (leather or rubber frames). In the intervals between treatment procedures, the reflectors of the irradiators with lamps should be closed by the shutters on them, and in the absence of such shutters, by dense black with white lining fabric "skirts" 40 cm long, put on the edge of the irradiator reflector. A lamp that is turned on but not in use should be lowered to the level of the couch.

3.8. Lamps for infrared rays and solux must be equipped with fuses, wire mesh with a window of 4 - 5 mm, placed in the outlet of the reflectors; lamps should be placed at an angle with respect to the patient at a distance that excludes the possibility of falling fragments of broken lamps, ceramic parts, etc. on the patient's body. When irradiating the facial area with infrared rays, "glasses" made of thick cardboard or leather are put on the patient's eyes.

3.9. When conducting ultrasound procedures, the nurse must observe individual preventive measures: use cotton gloves, and when performing underwater procedures in special faience baths, wear rubber gloves over cotton ones.

When working with laser physiotherapy units, it is forbidden to look towards the primary or specularly reflected beam. When visually pointing the laser beam at the target, one should not look along the beam, as this increases the risk of injury from reflected light.

3.10. When working with laser physiotherapy units, the eyes of medical personnel must be protected by goggles in all cases where there is a possibility of damage to the eyes by direct, reflected or scattered laser radiation. When working with helium-neon lasers, the brand of glass in glasses must be SES-22. The number of points must match the number of workers on the longest shift with the same points reserve. Patients' eyes should be protected with opaque patches (masks). Work with laser systems should be carried out in rooms with bright general lighting. There should be no objects with mirror surfaces near the path of the laser beam (with the exception of those required by the conditions for the use of lasers). Medical instruments must have a matte surface.

The mirror surfaces of the equipment must be covered with non-reflective materials. The walls of the room should not give a mirror reflection. It is necessary to exclude the possibility of uncontrolled movements of the laser beam, as well as the possibility of accidental exposure of the direct or specularly reflected beam to personnel or patients outside the surgical field. From the outside of the premises where laser systems are installed, there should be a warning sign of laser danger "Caution. Laser radiation!" (GOST 12.4.026-76).

3.11. During the hydrogen sulfide procedures, the baths should be covered with a damp sheet on a wooden grate.

3.12. When carrying out radon baths, in order to prevent the release of radon from the water into the air of the room, it is necessary, when pouring a solution of radon into the bath, to ensure that it flows calmly into the water, through the siphon tube, to prevent air sloshing;

mix the water in the bath with a special spatula calmly and smoothly, avoiding shaking the water;
when pouring a radon solution into a bath, personnel should not immerse their hand in water;
prohibit patients when immersed in a bath, taking procedures and leaving the bath to make sudden movements;
when taking a bath by patients and especially when draining water from the bath, personnel should be as far away from the bath as possible.

Pearl baths, underwater massage should not be carried out with radon water. Radon baths with a radon content of more than 120 nCi/l (4,5 kBq/l) should be carried out using an onboard suction.

3.13. Paraffin and ozocerite should be heated in a water bath in a fume hood or under a hood with an exhaust hood. A vessel containing paraffin or ozocerite for heating may be opened only for temperature measurement and when taking its contents for procedures.

4. Safety requirements in emergency situations

4.1. In the event of an accident, personnel must:

disconnect the device from the mains;
in case of short circuit, breakage in power supply systems, turn off the main power switch in the room;
notify the head of the department, physiotherapy room.

4.2. In case of electric shock and other injuries to a person, act in accordance with the "Instructions for providing first aid to victims of electric current and other accidents" (agreed with the Main Directorate of Medical and Preventive Care of the USSR Ministry of Health dated December 18, 1985 letter No. 10-13 / 328-36).

4.3. In rooms where electric heaters are located, a sign should be posted indicating the nearest location of fire extinguishing equipment.

4.4. In the event of a fire, evacuate patients, call the fire brigade, and before it arrives, take all possible measures to extinguish the fire with the help of primary fire extinguishing equipment.

4.5. In case of other emergencies (breakdown of water supply, sewerage, heating, ventilation systems, etc.) that impede the performance of technological operations, stop work and inform the administration about this.

4.6. In the event of a radiation accident, the personnel must immediately notify the head of the unit.

4.7. If it is suspected that personnel exposure is higher than the values established by NRB-76, the head of the unit is obliged to organize an urgent check of the causes of overexposure, evaluate the dose received and, depending on its value, decide on the medical examination of the victim and his further work in the field of ionizing radiation*.

4.8. In case of radioactive contamination of personnel, it is necessary to determine the area and level of contamination, remove clothing and send it to the holding chamber, carry out the necessary decontamination of contaminated areas of the body, followed by dosimetric control. Permissible surface contamination should not exceed the values established by NRB-76 (up to 5 alpha decays per 1 cm2 of the surface of overalls for radium-226).

4.9. In case of radioactive contamination of production premises and equipment above the values established by NRB-76, it is necessary to organize cleaning by the staff of the department, clearly identify the place of emergency contamination, and in some cases organize the maintenance of equipment until the contamination reaches an acceptable level.

4.10. In radon laboratories:

in case of accidental spillage of a concentrated radon solution, work is stopped for 2–3 hours and they leave the laboratory, leaving the ventilation on; after the specified period, the solution is wiped from the surface in the usual way (with a rag, etc.);
in the event of a breakdown of the bubbler, it is necessary to eliminate, if possible, the penetration of radon from the bubbler into the laboratory room (by any means to close the opening of the bubbler), ensure continuous operation of forced exhaust ventilation.

4.11. In case of accidents accompanied by the pouring of a radium salt solution from the bubbler, it is necessary:

put on shoe covers, a plastic apron, plastic sleeves, rubber gloves, collect the spilled solution with cotton wool, which is held with tweezers;
wipe several times the place on which the radium salt solution has fallen with cotton wool moistened with 5% hydrochloric acid solution (the cotton wool is held with tweezers);
put the used cotton in a jar with a ground stopper;
control the quality of decontamination with a special counter (for example, RUP-1);
remove overalls;
place gloves and tweezers in a jar containing cotton wool with a solution of radium salt; wrap the rest of the overalls in thick paper and leave for subsequent dosimetric control and decontamination;
close the jar with a cork and place the container under the draft;
wash hands thoroughly with warm water and soap and carry out dosimetric control of hands and exposed parts of the body.

4.12. The container with waste after special preparation is subject to burial at a special burial ground.

4.13. When working with open radioactive sources, send radioactive waste to the holding chamber; conduct dosimetric self-control of clothing, body and hands.

4.14. The radiopharmaceutical custodian must send all unused radiopharmaceuticals to storage and seal it.

5. Safety requirements at the end of work

5.1. The staff of the department, cabinet is obliged to:

tidy up the workplace;
return the devices to their original position, turn them off or switch them to the mode specified in the operating instructions;
carry out wet cleaning of the premises;
check the power supply and water supply;
seal the cabinets in which the radiation sources are located;
in the department of open isotopes, turn off special ventilation in all rooms, except for the storage.

Notes:

clause 1.1. GOST 12.0.004-90 "SSBT. Organization of occupational safety exposure" is valid. General provisions.
clause 1.2. the Order of the Ministry of Health of the Russian Federation of March 14.03.96, 90 No. XNUMX "On the procedure for conducting preliminary and periodic examinations of workers and medical regulations for admission to the profession" is in force.
clause 1.4. the Order of the Ministry of Health of the USSR dated January 29, 1988 No. 65 "On the introduction of industry standards for the free issue of overalls, special footwear and other personal protective equipment, as well as sanatorium overalls and sanitary footwear" is in force.
clause 1.11. SNiP 2.08.02-89 is in force. "Public buildings" with changes and "Handbook for the design of health care institutions" to it, developed by Gipronizdrav, 1989
clause 4.7. the Radiation Safety Standards (NRB-96) are in force. Hygienic standards. GN 2.2.054-96 of the State Committee for Sanitary and Epidemiological Supervision of the Russian Federation dated April 19.04.96, 14, No. 72 and OSP-87/XNUMX.

Agreed by the Decree of the Presidium of the Central Committee of the Trade Union of Medical Workers of August 27.08.87, 8, Protocol No. XNUMX.

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