Introduction

IN Russian Federation about 180,000 people die every year for reasons that are more or less related to the impact of harmful and dangerous production factors. Every year more than 200 thousand people are injured at work, about 10 thousand cases of occupational diseases are registered, more than 14 thousand people become disabled due to work injury and occupational disease [ 4 , 5 , 6 ]. Annual economic losses caused by unfavorable working conditions are estimated at 1 billion rubles (more than 4% of GDP). Due to diseases, on average, up to 10 working days are lost (in the EU countries - 7.9 days) per worker. Taking into account the total number of workers employed in the economy, the loss of working time due to expert opinion are about 700 million working days [ 4 ].

Due to significant social and economic losses caused by injuries and occupational diseases at work, the importance of in-depth research, analysis, evaluation and development of new, more advanced management mechanisms and methods of influencing working conditions and occupational risks is sharply increasing. The situation is aggravated by the loss of labor potential, the increasing cost of labor resources in the context of the use of market methods of management, including in the social and labor sphere.

Without a detailed scientific study and the creation of a fundamentally new comprehensive toolkit for assessing the degree of manifestation of hazardous and (or) harmful factors of the labor process and the production environment, determining occupational risks and the consequences of their impact on the body of various categories of workers, it is impossible to change the situation for the better.

Purpose of the study . To study the degree of influence of the main factors of the production process on health indicators and the performance of specialists of pharmaceutical organizations with an extended and round-the-clock work schedule to justify a system of measures for the prevention of professionally caused morbidity.

Research methods . Documentary, marketing and mathematical-statistical analysis, sociological research methods, comparative and system analysis.

Research objects:

• - statistical material (data on general, occupational morbidity of pharmaceutical workers);
• - documents of pharmaceutical organizations on labor protection;
• - Questionnaires of employees of pharmacy organizations with an extended working hours.

Results and discussion

Among the almost 40,000 currently existing professions, a special social niche is occupied by more than 4 million pharmaceutical workers, whose work belongs to the number of complex and responsible types of human activity, is characterized by a significant intellectual load, and in some cases - large physical activity. Pharmaceutical specialists are subject to increased requirements, including the volume of operational and long-term memory, attention, high working capacity in various conditions.

By type of activity, a pharmacist or pharmacist is affected by a complex of factors of a physical, chemical, biological nature. These professionals experience high neuro-emotional stress. In addition, in the process professional activity they are subjected to functional overstrain of individual organs and systems of the body (from functional overstrain of the musculoskeletal system to overstrain of the organ of vision).

Occupational diseases arise as a result of exposure to the body of adverse factors of the production environment. But only some occupational diseases are characterized by a special symptom complex, due to peculiar radiological, functional, hematological and biochemical changes. Clinical manifestations often do not have specific symptoms and, only information about the working conditions of the sick person, make it possible to establish that the identified pathology belongs to the category of professionally caused diseases.

There is a growing interest in organizations of all kinds to achieve and demonstrate good health and safety (OH&S) performance through OH&S risk management consistent with their policies and objectives. This is also a requirement from the side of legislation to improve economic policy [2 ], introducing OH&S best practices, and responding to growing stakeholder concerns about OH&S.

Over the last period of time, a number of documents have been developed to assess activities in the field of occupational health and safety, first of all, they include the standards ISO 9001:2000, ISO 14001:2004 and OHSAS 18001:2007. OHSAS 18001 has been developed to be compatible with ISO 9001:2000 (for quality management systems) and ISO 14001:2004 (for environmental management systems) to help organizations integrate quality management systems, environmental management, health and safety management labor. OHSAS 18001 - the basis for national standards for the management system of health and safety at work [ 7 ].

The management of each organization should develop and implement an OH&S policy and ensure that, within the established scope of its OH&S management system, that policy:

• 1. is appropriate to the nature and extent of the organization's OH&S risks;
• 2. included a commitment to prevent injury and ill health, and to continually improve OH&S management and OH&S performance;
• 3. included a commitment, as a minimum, to comply with applicable statutory and regulatory requirements, and with other requirements to which the organization agrees, relating to its OH&S hazards.

The main task of the modern labor protection management system is the transition from responding to insured events "post factum" to managing the risks of damage to the health of workers.

This goal can be achieved by creating a comprehensive, end-to-end occupational risk management system, which should become the basis for managing the system for preserving the life and health of workers in the course of work, covering all jobs, regardless of the size and form of ownership of the enterprise, involving the main parties in managing these risks. social partnership - employers and employees [ 1 ].

The occupational risk management system should develop, first of all, through the introduction of progressive methods of organizing labor protection in the workplace, for which it is necessary to significantly increase common culture labor protection [ 9 ].

The actual state of working conditions in terms of the degree of harmfulness and danger is determined in accordance with the Hygienic criteria for assessing working conditions in terms of harmfulness and danger of factors in the production sector, the severity and intensity of the labor process by comparing the results of measuring all hazardous and harmful factors of the working environment with the hygienic standards established for them. On the basis of such comparisons, a class of working conditions is determined for each workplace.

The results of the assessment of the actual state of working conditions at the workplace are entered in the certification card of workplaces for working conditions. Each card must be signed by the commission and the employee of a particular workplace. If at the workplace the actual value of at least one of the harmful factors of the working environment and the labor process exceeds the existing hygienic standards, and the requirements for injury prevention and the provision of workers with PPE do not meet existing standards, the working conditions at such a workplace are considered harmful or dangerous [ 3 ].

For 10 years, the Department of Organization and Economics of Pharmacy has been conducting research to study the working conditions of pharmaceutical specialists. The results of sociological studies in pharmacies with a normal operating mode showed enough high level Satisfaction of specialists with working conditions (including the state of the microclimate - 82%, the level of illumination of the workplace - 78%, the degree of comfort of the working regime - 92%).

In order to identify the opinions of specialists in assessing the need for preventive and therapeutic measures to maintain and restore health, a sociological study was conducted in pharmacies with an extended opening hours. Research tools were developed - a questionnaire that included three blocks of questions: general information about the respondent (age, education, position, work experience); special issues related to working conditions, as well as the employee's subjective assessment of his health indicators in the absence of an objective medical opinion; recommendations and wishes for employers.

The participants of the survey are specialists of pharmacies with an extended and round-the-clock operation of the city of Khabarovsk. All respondents were females, of which 54% were under the age of 30, 36% were from 30 to 50 years old, and 10% were over 50 years old. More than 70% of respondents have experience in such pharmacies for up to five years, but there are also specialists who have been working for more than 10 years (20%).

An analysis of the answers to questions on the organization of workplaces and the regime of regulated rest showed that the length of the lunch break established by the labor regulations is up to 30 minutes, 6% of respondents have, from 30 minutes to 1 hour - 68% of respondents and 26% of respondents do not have a break respondents. Consequently, for 32% of respondents, the break time does not comply with the norms of the Labor Code of the Russian Federation. disease pharmacist health professional

According to the current standard, which determines the composition of the premises of pharmacy organizations, it is required to allocate premises for staff. But even in pharmacies with round-the-clock and extended opening hours, only 48% of respondents noted that they have a recreation area (room, corner) in their organization, 52% do not.

The workplaces of all respondents are computerized and equipped with modern office equipment. The study of internal local documents on labor protection revealed the absence of additional regulated breaks provided for PC operators. These observations are also confirmed by the results of the survey: only 20% of respondents during the work shift have regulated breaks in accordance with the requirements of SanPiN - 2.2.2.542-96 for organizing the working time of PC operators [ 8 ].

Thus, the analysis of the data obtained made it possible to reveal the discrepancy between the provisions of internal local regulatory documents that determine the work and rest regimes for specialists in pharmacies with an extended working period, and sanitary and hygienic standards.

To identify the causes of occupational morbidity, the data of the second block of questions of the questionnaire were analyzed, concerning the employee's subjective assessment of his health indicators in the absence of an objective medical report.

To date, the basis for admission to professional activities in terms of health is a very short list of studies and medical reports, i.e. preventive examination results. Therefore, despite the fact that 32% of respondents note the presence of chronic diseases before entering the pharmacy, this is not taken into account by the employer when determining the possibility of a specialist to work in an extended or round-the-clock mode, that is, with an increased load on all physiological systems of the body.

Two-thirds of respondents (68%) believe that they did not have chronic diseases before joining this pharmacy. As a result of exposure to the body of unfavorable factors of the working environment, 74% of workers consider occupationally caused diseases acquired during work in an extended mode as acquired.

The period of work from 8:00 pm to 8:00 am affects the decrease in working capacity, which was noted by 80% of respondents, and the decrease in concentration - 74%. Decreased visual acuity and discomfort in the eyes when working on a computer by the end of working hours occurs in 90% of specialists, but only 34% of respondents perform sets of exercises for the eyes recommended by SanPiN - 2.2.2.542-96 [ 8 ].

Working conditions determine the assessment of the impact on the worker's body of production factors and often lead to disruption of the functions of some of its systems. Thus, 90% of pharmaceutical specialists observe pain in the lumbar and cervical spine during work. 78% of respondents report feeling of heaviness in the legs, cramps of the calf muscles, swelling of the legs in the evening or at night, 22% do not have such symptoms

An analysis of the results of sociological studies revealed a lack of awareness of specialists about the causes and consequences of occupational morbidity and showed the need to develop recommendations for employers on optimizing working conditions for a timely solution to this problem.

At the next stage of the study, a list of medications and non-pharmacological means used by pharmaceutical specialists for the prevention and treatment of deviations in the state of their health.

Among the non-pharmacological agents used for the prevention and treatment of work-related diseases of certain physiological systems, the respondents noted the following:

• 1. violation of the musculoskeletal system: posture corrector, posture corset, massage, fitness, exercise, shaping;
• 2. disease of the veins of the lower extremities: prophylactic exercises, compression underwear (tights, stockings, stockings), elastic bandages;
• 3. reduced visual acuity: eye exercises, corrective, relaxing, anti-glare glasses.

The list of drugs and dietary supplements for the prevention and treatment of certain production-related diseases of pharmaceutical specialists includes:

• Metabolic changes in cerebral circulation: Gingko biloba (Bilobil), Glycine, Cavinton, Lucetam, (Piracetam), Mildronate, Pantogam, Picamilon, Phenotropil, Picomilon, Phenotropil.
• Violation, including for the elimination of pain, of the musculoskeletal system: Alflutop, Artra, Artrofoon, Dolgit (Diclofenac), Calcium D3 Nycomed, Ketonal, Mydocalm, Milgamma, Nimesil, Fastum gel, Milgamma, Nimesil, Fastum gel.
• Diseases of the veins of the lower extremities: 911 with horse chestnut, Antistax, Askorutin, Venitan, Venolife, Venolgon, Gelenven, Hepatrombin, Detralex, Kapilar, Sophia with leeches, Trental, Troxevasin, Troxerutin, Trombless, Aescusan, Phlebodia.
• Reduced visual acuity: Vidisk, Vizin, Vizualon, Vitrum Vision, Irifrin, Lutein (BAA), Midriacil, Okuvayt lutein (BAA), Oculist (BAA), Oftagel, Sistane, Strix, Blueberry Forte (BAA).

conclusions

• 1. The problem of production-related morbidity in the field of pharmaceutical activity and modern approaches to its solution have been studied.
• 2. Analysis of the competitive advantage of round-the-clock operation structural divisions pharmacy chains of the city of Khabarovsk revealed the high efficiency of this form of work, but at the same time showed that the health protection system and optimization of working conditions in them require significant improvement (52% of respondents indicated that they did not have rest rooms when working in extended hours).
• 3. Results sociological research on assessing the need for preventive and therapeutic measures to maintain and restore the health of specialists in pharmacies with extended hours of operation allowed us to evaluate:
• 1. Working conditions of pharmaceutical specialists for compliance with the norms of the current regulations. Thus, 32% of respondents are limited in the right granted by the Labor Code to the minimum duration of a lunch break - 30 minutes. 80% of respondents do not have regulated breaks provided for PC operators;
• 2. decrease in working capacity and concentration of attention during the period of work from 20:00 to 08:00 was noted by more than 70% of employees;
• 3. the impact on the body of adverse factors of the production environment causes professional morbidity. Thus, 74% of respondents consider acquired in the process of working in an extended mode chronic diseases recently diagnosed with them.

In the structure of professionally caused diseases, the groups of diseases of the musculoskeletal system (90%), organs of vision (90%) and veins of the lower extremities (78% of respondents) predominate.

• 1. The range of drugs and dietary supplements that help maintain vigorous activity during work has been studied, a ranked list of drugs and medical supplies for the prevention and treatment of metabolic changes in cerebral circulation, disorders of the musculoskeletal system, diseases of the veins of the lower extremities and organs of vision has been compiled.
• 4. Recommendations have been developed for the heads of pharmaceutical organizations to improve the health status of working professionals in the evening and at night, presented for implementation in the work of pharmacy chains, on the basis of which research was carried out.

When defining strategic objectives and planning work on labor protection and health improvement of working personnel, it is necessary to include in the program of measures the monitoring of a number of additional indicators at all stages of personnel movement: from selection to dismissal.

It is imperative to take into account the health status of the applicant for the position more fully. When concluding a collective agreement, developing a provision on labor protection, at the initiative of the employer or collective, an additional agreement is concluded with a medical institution or with an insurance company on an extended list of diagnostic examinations of employees whose working regime differs from the usual one. It is necessary to draw up a list of names of persons subject to periodic medical examinations (examinations) and send it 2 months before the start of the examination to a medical organization with which an agreement has been concluded for conducting periodic medical examinations (examinations).

When developing SSBT in a pharmaceutical organization, organizational and technical measures are planned, including the following:

• 1. when equipping the workplace, it should be taken into account that the furniture (tables and chairs) should be so comfortable that it does not cause disturbances associated with the wrong position of the body, and, as a result, ensure high labor productivity. The monitor screen and PC keyboard should be installed at an optimal distance from the user's eyes; monitor screens are recommended to have an antistatic coating;
• 2. it is necessary to provide in the local regulatory document that defines the rules of the labor schedule for additional regulated breaks for production charging;
• 3. introduce regulated lunch breaks, lasting no less than 30 minutes and no more than 2 hours. Provide for regulated breaks in accordance with the requirements of SanPiN for organizing the working time of PC operators - during continuous work with a computer, the duration should not exceed 2 hours;
• 4. in the staff rest room or in the dining room, it is necessary to provide for the presence of tonic and vitamin-containing drinks (drugs and dietary supplements containing ginseng, lemongrass, aralia, eleutherococcus, B and C vitamins), as well as wet wipes for treating the face and hands with a cooling effect. When forming a first aid kit for employees of the organization, provide for the presence of painkillers, including external dosage forms with a venotonic effect (Antistax, Venitan, Venolife, Gepatrombin, Sofya with leeches, Troxevasin, Troxerutin, etc.);
• 5. when designing a rest room, it is required to take into account the principles of videoecology to ensure a relaxing effect during regulated main and additional breaks;
• 6. in case of progression of symptoms of tension in the veins of the lower extremities, it is necessary to provide the worker compression underwear, as well as corrective insoles for removable shoes;
• 7. When developing a regulation on the dismissal of specialists from pharmaceutical organizations with an extended work schedule, it is necessary to conduct an interview to identify the reasons for dismissal, which may directly depend on changes in health indicators.

Bibliography

• 1. Decree of the Government of the Russian Federation No. 761 "On ensuring the harmonization of Russian sanitary and epidemiological requirements, veterinary - sanitary and phytosanitary measures with international standards" dated September 28, 2009
• 2. Order of the Ministry of Health and Social Development of the Russian Federation No. 586 "On Approval of the Program of Action to Improve Labor Conditions and Safety" dated October 23, 2008
• 3. Geyts I.V. Occupational Safety and Health. - M.: Business and Service, 2008. - 288 p.
• 4. Report on All-Russian Congress specialists in labor protection "State policy in the field of labor protection in the light of the Concept of demographic policy in the Russian Federation", Moscow. - 2008. - 21 p.
• 5. Zanina M.Ya. Hygienic characteristics of the organization and working conditions// Modern high technologies. - M.: Academy, 2008. - S.19 - 21.
• 6. Kononenko G.A., Occupational safety and health of medical workers// Handbook of a specialist in labor protection. - 2006. - No. 12. - S. 32-41.
• 7. Nizyaeva I.V., Stepanov S.A. Medico-social and economic aspects of protecting the health of the working population of Russia//Materials of the V All-Russian Congress "Profession and Health". - Moscow, 2006. S. 610-621.
• 8. Sanitary rules and norms SanPin - 2.2.2.542-96 "Hygienic requirements for video display terminals, personal electronic computers and organization of work" (approved by the Decree of the State Committee for Sanitary and Epidemiological Supervision of the Russian Federation of July 14, 1996 N 14) // ATP "Consultant Plus ".
• 9. Stepanov S.A. On occupational morbidity in Russia// Labor protection and social insurance. - 2007. - No. 2. - S. 4-10.

TOPIC 15. HYGIENIC REQUIREMENTS FOR WORKING CONDITIONS OF PHARMACY WORKERS

TOPIC 15. HYGIENIC REQUIREMENTS FOR WORKING CONDITIONS OF PHARMACY WORKERS

Purpose of the lesson:development by students of hygienic requirements for the working conditions of pharmacy workers.

In preparation for class, students should work on the following: theory questions.

1. Working conditions of pharmacy workers and harmful production factors in pharmacy organizations (pharmacy).

2. The state of health and morbidity of pharmacy workers.

3. Sanitary and hygienic requirements for the personnel of pharmacy organizations (pharmacies).

After mastering the topic the student must know:

determination of the levels of influence of various factors of the working environment in pharmacy organizations (pharmacies) on pharmacists and pharmacists;

be able to use:

Optimal and affordable ways to assess the working conditions of pharmacy workers;

The main regulatory documents and information sources of a reference nature for creating favorable and healthy working conditions for the personnel of pharmacy organizations (pharmacies) under the influence of various factors of the working environment.

Training material for the assignment

Industrial hazards and occupational diseases of pharmacy workers

The work of pharmacists and pharmacists in pharmacy organizations is one of the peculiar, complex and intense types of work. Pharmacy workers are exposed to unfavorable microclimatic conditions, environmental factors, low labor intensity with great neuropsychic tension.

The physical component of the labor activity of pharmacy workers does not go beyond the limits of moderate severity, however, visual strain, neuro-emotional stress due to the need to solve non-stereotypical tasks (preparation of medicines according to individual, non-standard prescriptions, great moral responsibility for the quality of manufactured drugs, contact with patients and etc.) require great attention to this profession.

The work of the main production groups of personnel in a pharmacy is associated with a significant tension of individual organs. The most significant stress is experienced organ of vision since pharmacy workers perform a large amount of technological operations related to distinguishing between small objects, the color of medicinal raw materials and finished medicinal products, the turbidity of mixtures with the determination of the uniformity of mixtures, powders, reading prescriptions, inscriptions, etc. Therefore, there is a need to ensure the most favorable lighting in the production premises of the pharmacy that meets hygienic standards.

Examinations of pharmacy personnel showed that when working in conditions of insufficient illumination, there is an overstrain of vision. There is irritability, weakening of attention, impaired coordination of movements, myopia develops; more often than other professional groups, it threatens pharmacists-technologists, technologists-analysts, and pharmacists. Myopia can occur as a result of the fact that with insufficient light intensity it is necessary to examine the object, bringing it very close to the eyes. Frequent changes in the position of the eyes from one level of brightness to another also causes severe eye fatigue. Such a phenomenon can occur in a pharmacist-technologist and pharmacist when moving their eyes from a brightly lit burette turntable to other objects, when weighing on an analytical balance, examining small suspensions in solutions, counting divisions on pipettes. This can gradually lead to asthenopia - fast-onset eye fatigue. This condition is characterized by symptoms such as eye pain, blurred vision, general fatigue and headache. In this regard, the pharmacy should create such conditions for natural and artificial lighting that would take into account the nature of the work performed and provide the opportunity to see small details without eye strain. The uniformity of illumination is of great importance.

Strict observance of hygienic requirements for the illumination of pharmacy premises is necessary to maintain the health and increase the productivity of pharmacy workers.

Pharmacy staff often work with forced position of the body. So, in a forced standing position, the development of flat feet is possible, pain in the legs, cramps of the calf muscles, varicose veins, thrombophlebitis can be noted. It is necessary to alternate standing and sitting postures. Sitting work causes curvature of the spine, increased intra-abdominal pressure, congestion in the pelvis (female genital dysfunction, hemorrhoids). It is very important to change the working position, alternate types of work, use a swivel chair. In the assistant's office, in the process of work, overstrain of the small muscles of the hands and fingers occurs when performing monotonous and small movements (hanging, packing powders, measuring liquid from a burette or pipette), hence the development of such diseases as myositis, convulsions, coordinating neuroses.

To prevent the impact of these factors, it is necessary, first of all, to take measures aimed at properly equipping workplaces, providing technological and organizational equipment with integrated and small-scale mechanization. All the necessary equipment, auxiliary material and substances from which medicinal products are made should be as close as possible to the workers in such a way that they can easily, without effort and unnecessary movements, perform their work. Workplaces should be so comfortable that they do not cause disturbances associated with incorrect body position and ensure high labor productivity.

The design of tables and chairs should correspond to the characteristics of the body of workers and be comfortable during work (mobile, rotating devices, etc.).

It is advisable to change activities and types of work. It is necessary to reduce and, if possible, completely eliminate the use of manual labor in the packaging of powders, capping vials, packaging solutions and other operations.

Much attention should be paid to industrial gymnastics, mini-pauses, changes in body position, and the introduction of elements of the scientific organization of labor. An important role is played by the preliminary

regular and periodic medical examinations to identify the initial stages of eye diseases, disorders of the musculoskeletal system and other health disorders both when entering a job and during work in a pharmacy.

For a group of administrative and economic workers, the leading unfavorable factors are the moral responsibility for all types of work in the pharmacy. They are characterized by the frequency of cardiovascular diseases, such as coronary heart disease, hypertension, neurasthenia.

The issue of the relationship between pharmacy employees and visitors, especially behavior in conflict situations, is extremely important. Pharmacy employees must master the methods of positive impact on visitors - benevolence, empathy, suggestion, persuasion.

Exposure to drugs and harmful chemicals. The unfavorable factors of the working environment in a pharmacy include the direct impact of drugs in the process of their manufacture. In case of violation of the sanitary-hygienic regime of the technological process and non-compliance with the rules of personal hygiene, drugs in the form of dust or aerosols can enter the body of workers through the air through the lungs, skin and mucous membranes.

The most unfavorable are those technological operations in which medicinal dust is released into the air, which is a biologically and physiologically active substance.

Characterizing medicinal dust from this point of view, it should be noted that most of its types are highly dispersed aerosols. For 96-98% they consist of dust particles smaller than 5 microns in size. As a result, almost all drug aerosols are highly stable in air and can penetrate deeply into the lungs.

penetrating the skin, mucous membranes, respiratory system, an aerosol can have a specific adverse effect: toxic, irritating, allergic, etc. A number of medicinal substances can simultaneously have both toxic and irritating or some other effect. For example, many broad-spectrum antibiotics have toxic, allergenic

properties and cause dysbacteriosis. In pharmacy workers, the effect of medicinal dust can cause severe forms of the disease, since during the working day they can receive a dose that is significantly higher than the daily therapeutic dose during treatment. Pharmacists-technologists, pharmacists, packers, pharmacists-analysts have the longest contact with medicinal substances, and in particular with their dust. Higher concentrations of medicinal dust are found in pantries (material) during intra-pharmacy packaging of medicines, medicinal semi-finished products, medicinal herbs; in the assistant - in the direct manufacture of drugs and especially complex medicinal mixtures.

To prevent the adverse effects of toxic substances and drug dust on the body of pharmacy workers, it is necessary to take a number of preventive measures.

An important role in improving the working conditions of pharmacy workers is played by sanitary facilities: air conditioning systems, sufficient lighting, timely supply of cold and hot water, a rational ventilation system that allows timely removal of gaseous impurities and dust from the air of industrial premises, as well as not polluting the air of administrative and household rooms.

Rational layout of premises. Their mutual arrangement should provide for the impossibility of the penetration of polluted air from one room to another. So, the aseptic unit should be away from the washing, assistant, packaging; administrative and amenity premises should be isolated from production.

The use of small-scale mechanization of such heavy and labor-intensive processes as the packaging of liquids from large containers to small ones, filtering, sifting, grinding, etc. This reduces the ingress of drug dust on the skin, mucous membranes and respiratory tract.

Mandatory is the use of personal protective equipment for respiratory organs, skin.

Compliance with the rules of personal hygiene - thorough hand washing after working with toxic substances. It is forbidden to eat on workplaces, especially in the assistant's and storerooms.

Noise impact. The noise regime in pharmacies is due to both external noise penetrating from the street and internal. The main source of external noise is urban transport. Indoor noise is mainly generated by the operation of ventilation systems, plumbing and sewerage devices, electric vacuum pumps, motor installations and washing machines. This equipment generates at the level of 40-49 dB. When studying the working capacity of pharmacy workers, it was found that its sharp decrease is already observed at a noise intensity of 45 dB. For pharmacy premises, it is recommended to set the noise level to no more than 30 dB, since more intense noise contributes to an increase in the number of errors in the manufacture of drugs. In order to combat noise in pharmacies, it is necessary to use the principle of isolation, that is, equip all units and devices with noise screens and place them in separate rooms.

Impact of the microclimatic factor. If the sanitary regime is violated in pharmacies, unfavorable microclimatic conditions can be created. The impact of this harmful factor is experienced primarily by those working in the washing, distillation-sterilization and trading floors.

In the washing room, high humidity and elevated air temperature are noted, which has a negative effect on the human body: there is a violation of thermoregulation processes and it is difficult to release heat by evaporation, which leads to overheating. In the sterilization-distillation and sterilization rooms, the increase in air temperature is due to the heating of various devices - drying cabinets, sterilizers, distillation devices, etc. To create optimal microclimatic conditions in these rooms, it is necessary to install an efficient general exchange supply and exhaust ventilation.

The trading floor and the basement belong to the premises with a cooling microclimate. In the sales area, especially during the cold season, the air can be significantly cooled, which is associated with the constant movement of visitors and the opening of the outer door. In this regard, unfavorable conditions are created for the work of pharmacists, pharmacists and cashiers. To eliminate this factor in the pharmacy, it is necessary to have an insulated vestibule with an air thermal curtain.

The low temperature and high humidity in the basement are explained by the direct contact of the walls with the soil. Therefore, during the construction of a building, in order to avoid dampness and moistening of the walls, the level of groundwater standing (at least 1.5 m) is taken into account. Basement premises of pharmacies should be equipped with supply and exhaust general ventilation.

Sanitary and hygienic requirements for pharmacy staff

Employees of pharmacy organizations involved in the manufacture, control, packaging of medicines and processing of pharmacy utensils, as well as those in contact with finished products, undergo a medical examination upon admission to work, and then a preventive examination in accordance with the current orders of the Ministry of Health of the Russian Federation. The results of the examinations are recorded in the sanitary book.

Each employee must notify the management staff of any deviations in the state of health. Employees with infectious diseases, damage to the skin are not allowed to work. Identified patients are sent for treatment and sanitation. Admission to work is carried out only if there is a certificate from the health facility on recovery.

Personnel are obliged to follow the rules of personal hygiene and industrial sanitation, wear technological clothing appropriate to the operations performed.

Sanitary clothing and sanitary footwear are issued to pharmacy employees in accordance with applicable standards, taking into account the production operations performed. Sanitary clothing should be changed at least 2 times a week, towels for personal use - daily. A set of special clothing for personnel working in aseptic conditions must be sterile before starting work. It is advisable to provide distinctive signs in the sanitary clothing of personnel, for example, overalls or its parts of a different color than white, in order to more easily recognize violations of the order of movement of personnel in the aseptic area, between rooms or outside the aseptic unit, in other production areas.

Particular attention should be paid to the selection and training of production personnel for work in aseptic conditions. The personnel of the aseptic unit must have, in addition to special

Zakharochkina Elena Revovna

Associate Professor of the Department of UEF FPP OP MMA named after. THEM. Sechenov, Ph.D.

Continued, beginning in MA No 05/06

Establishment of compensation for hard work and work with harmful and (or) dangerous working conditions that cannot be eliminated with the current technical level of production and labor organization is an important component in the labor protection of pharmaceutical workers.

A harmful production factor is a production factor, the impact of which on an employee can lead to his illness.

A hazardous production factor is a production factor, the impact of which on an employee can lead to his injury.

Social and labor protection of persons employed in hazardous industries is carried out in several main areas:

Reducing working hours;

Establishment of additional paid leave (for pharmaceutical workers 12 working days);

Salary supplements;

Free distribution of milk or other equivalent products;

Preferential pension provision for old age (age);

Free issuance of overalls, footwear, personal protective equipment;

Conducting mandatory periodic medical examinations of employees;

Payment preventive treatment, incl. the cost of vouchers for preventive sanatorium treatment of employees.

In pharmacies, the free distribution of milk or other equivalent products to employees employed in work with harmful working conditions is regulated by the following documents:

Labor Code of the Russian Federation, Art. 222;

Decree of the Government of the Russian Federation of November 29, 2002 No 849 “On the procedure for approving the norms and conditions for the free distribution of milk or other equivalent food products, as well as therapeutic and preventive nutrition to workers employed in work with harmful working conditions”;

Decree of the Ministry of Labor and Social Development of the Russian Federation of March 31, 2003 No 13 “On approval of the norms and conditions for the free distribution of milk or other equivalent food products to workers employed in jobs with harmful working conditions”;

Order of the Ministry of Health of the Russian Federation dated 28.03.03. No 126 “On Approval of the List of Hazardous Production Factors, under the influence of which, for preventive purposes, it is recommended to consume milk or other equivalent food products.”

In accordance with Article 222 of the Labor Code of the Russian Federation at work with harmful working conditions, employees are given milk or other equivalent food products free of charge in accordance with established standards.

According to Decree of the Government of the Russian Federation of November 29, 2002 No. 849, workers employed in jobs with harmful working conditions are provided with free milk or other equivalent food products in accordance with the List of harmful production factors, under the influence of which, for preventive purposes, it is recommended to use milk or other equivalent food products. products. Free distribution of therapeutic and preventive nutrition is carried out in accordance with the List of industries, professions and positions, work in which gives the right to receive free therapeutic and preventive nutrition in connection with especially harmful working conditions, rations for therapeutic and preventive nutrition, rules for the free distribution of therapeutic and preventive nutrition and norms of free distribution of vitamin preparations.

The rate of free delivery of milk is 0.5 liters per shift, regardless of its duration.

Free distribution of milk or other equivalent food products is made to employees on the days of actual employment at work related to the presence at the workplace of production factors provided for by the List of harmful production factors, under the influence of which, for preventive purposes, it is recommended to use milk or other equivalent food products, approved by the Ministry of Health RF. Harmful production factors include the following groups:

Chemical factors (total 956 chemical compounds);

biological factors;

physical factors.

Some groups of chemical compounds related to harmful production factors are listed below (in accordance with the Order of the Ministry of Health of the Russian Federation of March 28, 2003. No 126):

1. Inorganic Compounds:
1. Metals and their compounds (Barium borate, Barium hydrogen phosphate, Iron sulfate hydrate, Potassium bromide, Potassium iodide, Potassium chloride, Magnesium carbonate, Magnesium sulfate, Manganese carbonate, Manganese nitrate hexahydrate, Manganese oxides, Manganese sulfate, Copper sulfate, Sodium bromide, Sodium hydrosulfite, Mercury and its compounds, Zinc sulfide, Caustic alkalis, etc.);
2. Non-metals and their compounds (Nitric acid, Ammonium chloride (ammonia), Bismuth and its inorganic compounds, Hydrosulfide, Hydrochloride (hydrochloric acid), Iodine, Perhydrol, Sulfur, Sulphuric acid, Chlorine, etc.);

2. Organic compounds:

2.1. Aliphatic saturated and unsaturated organic compounds (Halogenated hydrocarbons of the methane series, Aliphatic acids ( Vitamin C, Aspartic acid, Glutamic acid, Isovaleric acid, Formic acid, Acetic acid), Aldehydes and aliphatic ketones and their halogen derivatives (Formaldehyde), etc.);

2.2. Carbocyclic organic compounds and their derivatives (Aromatic hydrocarbons (Benzene), Phenol and its derivatives, Aromatic acids and anhydrides

(benzoic acid), etc.);

2.3. Heterocyclic hydrocarbons and their derivatives (Piperazine, etc.);

2.4. Other organic compounds and materials

The issuance and consumption of milk should be carried out in buffets, canteens or in rooms specially equipped in accordance with sanitary and hygienic requirements.

It is not allowed to replace milk with monetary compensation and replace it with other products, except for equivalent products. For equivalent foodstuffs that can be given to employees instead of milk, free distribution norms are provided. (Table).

The replacement of milk with the indicated equivalent food products is allowed with the consent of the workers, taking into account the opinion of the elected trade union body or other body authorized by the workers of this organization, when for one reason or another it is impossible to issue milk to the workers.

Replacing milk with therapeutic and prophylactic drinks, vitamin preparations and bifid-containing fermented milk products is allowed only with a positive conclusion of the Ministry of Health of Russia for their use.

Workers in contact with inorganic lead compounds, in addition to milk, should receive 2 g of pectin in the form of fortified canned plant foods, drinks, jellies, jams, marmalades, fruit and fruit juices and canned food (the actual pectin content is specified by the manufacturer). It is allowed to replace these products with natural fruit juices with pulp in the amount of 250-300 g. In case of constant contact with inorganic lead compounds, it is recommended to use fermented milk products instead of milk.

Issuance of pectin-enriched canned foods herbal products, drinks, jellies, jams, marmalades, fruit and fruit and vegetable juices and canned food, as well as natural fruit juices with pulp should be organized before starting work, and fermented milk products - during the working day.

Workers involved in the production or processing of antibiotics, instead of
fresh milk should be given fermented milk products enriched with probiotics (bifidobacteria, lactic acid bacteria), or colibacterin prepared on the basis of whole milk.

It is not allowed to replace milk with sour cream or butter.

Table.

Norms for the free distribution of equivalent food products that can be given to employees instead of milk > .

When ensuring safe working conditions, the employer decides to stop the free distribution of milk, taking into account the opinion of the trade union body or other body authorized by employees.

All other issues related to the free distribution of milk to employees employed in work with harmful working conditions are resolved by the employer independently.

Milk is issued to all employees employed in work with harmful working conditions, regardless of the legal form and form of ownership of the pharmacy organization.

The right to receive milk must be reflected in the local regulatory act adopted by the employer (order, order, instruction, regulation, etc.).

The provision of pharmaceutical workers with personal and collective protective equipment, sanitary facilities and devices, medical and preventive means is carried out at the expense of employers.

The means of individual and collective protection of workers are technical means used to prevent or reduce the impact on workers of harmful and dangerous production factors, as well as to protect against pollution.

At work with harmful and dangerous working conditions, as well as those performed in special temperature conditions or associated with pollution, employees are issued certified personal protective equipment, flushing and neutralizing agents.

The acquisition, storage, washing, cleaning, repair, disinfection and disposal of these funds is carried out at the expense of the employer.

The employer is obliged to ensure the storage, washing, drying, disinfection, decontamination, decontamination and repair of special clothing, special footwear and other personal protective equipment issued to employees in accordance with established standards.

The norms for the free issuance of overalls, special footwear and other personal protective equipment to employees of anticipations, enterprises and organizations of the healthcare system are contained in the Order of the Ministry of Health of the USSR No65 of 01/29/1988 (Table)

Tab. Industry regulations

free distribution of overalls, safety shoes and other personal protective equipment to employees of anticipations, enterprises and organizations of the healthcare system

free distribution of sanitary and hygienic clothes,

sanitary shoes and sanitary supplies for employees

institutions, enterprises and healthcare organizations

An important place in the field of labor regulation of workers in hazardous industries is occupied by the organization of the issuance of therapeutic and preventive nutrition to them, which strengthens health and prevents the occurrence of occupational diseases. Meals are provided free of charge both on the days of the actual performance of work and during the period of temporary disability.

In order to ensure compliance with labor protection requirements, to monitor their implementation in each organization carrying out production activities with more than 100 employees, a labor protection service is created or a position of a labor protection specialist with appropriate training or experience in this field is introduced.

In an organization with a headcount of 100 employees or less, the decision to create a labor protection service or introduce the position of an appropriate specialist is made by the employer, taking into account the specifics of the activity of this organization.

If there is no labor protection service (labor protection specialist) in the organization, the employer must conclude an agreement with specialists or organizations providing services in the field of labor protection (outsourcing or transferring the performance of non-core functions for the organization to third-party organizations).

In organizations, at the initiative of the employer or at the initiative of employees or their representative body, committees (commissions) for labor protection are created. Their composition on a parity basis includes representatives of employers, trade unions or other representative body authorized by employees. The committee (commission) organizes joint actions of the employer and employees to ensure labor protection requirements, prevent industrial injuries and occupational diseases, organize inspections of labor conditions and labor protection at workplaces and inform workers about the results of inspections, collect proposals for the section of the collective agreement (agreement) on labor protection.

It should be noted that production activities in labor protection are understood as a set of actions of employees using the means of labor necessary to turn resources into finished products, including production and processing. various kinds raw materials, construction, provision of various types of services.

Thus, summing up the above, one should once again draw the attention of managers and employees to their duties in the field of labor protection. (Table).

Table.

Obligations of the employer and employee to ensure safe working conditions and labor protection.

To be continued

Each person must observe the rules of personal hygiene. It is especially important to observe personal hygiene for employees of industrial pharmacies, since if sanitary rules are violated, intra-pharmacy infection can be transmitted and drugs can be contaminated. At the workplace, each pharmacy worker must constantly wear overalls: a dressing gown and a headdress (scarf or cap). You need to change your overalls at least twice a week. Also, pharmacy workers must have a change of shoes. Store personal and work clothing separately (in separate cabinets). During the working day, a pharmacy worker must monitor the cleanliness of hands, overalls, as well as his workplace. Hand towels are changed daily. A set of special clothing for personnel working in aseptic conditions must be sterile before starting work.

Before visiting the toilet, the pharmacy worker must take off the gown, and after visiting him, wash his hands thoroughly with soap and treat them with a disinfectant solution. This is done in the dressing room, where there should be a sink with hot and cold water, container with dez. solution. Hanger for bathrobe and towels.

It is forbidden for a pharmacy worker to go outside the production premises and, in general, outside the pharmacy, in a dressing gown, as well as to enter the production premises without a dressing gown, store personal items in the production room, store personal and industrial clothes in the same closet.

Influence of drugs and chemicals.

Most unfavorable factor The working environment in a pharmacy is the direct impact of drugs in the process of their manufacture. Medicines in the form of dust or aerosols can penetrate through the air into the body of pharmacy workers through the lungs, skin and mucous membranes in case of violation of the rules of personal hygiene, sanitary-hygienic regime or technological process.

The effect of dust on the body largely depends on the degree of its dispersion. Most types of dust are highly dispersed aerosols. Approximately 96-98% of them consist of dust particles smaller than 5 microns. Therefore, almost all drug aerosols are highly stable in air and can penetrate deeply into the lungs.

Getting on the skin and mucous membranes, in the respiratory system, aerosols of drugs can have a specific adverse effect: irritating, toxic, allergic, etc. Pharmacists-technologists, pharmacists, packers, pharmacists-analysts have the longest contact with medicinal substances and, therefore, their dust .

All pharmacy employees must comply with current safety and industrial hygiene regulations. When spilling acids, alkalis, volatile and flammable liquids into smaller containers, siphons and tippers are used. Premises for the storage of these substances must be equipped with local exhaust devices, the floors must have a slope towards the ladder. The room must have a water supply and a long hose in case of a massive spill of dangerous liquids. Personnel must use personal protective equipment for the organs of vision when steaming these substances, as well as an acid-proof apron, rubber boots, an anti-dust or universal respirator. It is also mandatory to use personal respiratory and skin protection equipment. Particular care must be taken when working with potent drugs and poisons. It is forbidden to eat in industrial premises, especially in pantries and in the assistant's.

Impact of microclimatic factors. If the sanitary regime is violated in the pharmacy, unfavorable microclimatic conditions can be created. The impact of this harmful factor First of all, they are tested by those working in the washing, distillation and sterilization, sterilization and sales areas. In the washing room, due to the need to constantly have hot water for washing dishes and other purposes, a stove (this applies to rural areas) or a gas stove burns for a long time, as a result of which the air temperature rises. Along with this, high humidity is noted in the washing room, since in the process of washing dishes from washing baths and from the surface of dishes during its air drying, a large amount of steam enters the air. High humidity combined with high temperature air has a negative effect on the human body: there is a violation of the processes of thermoregulation and the transfer of heat by evaporation is difficult, which leads to overheating.

With insufficient efficiency of the ventilation system, the washers are often forced to open the windows, which can contribute to the occurrence of colds, exacerbation of chronic inflammatory processes.

In the sterilization-distillation and sterilization rooms, the increase in air temperature is due to the heating of various devices - drying cabinets, sterilizers, distillation apparatus, etc.

To create optimal microclimatic conditions in these rooms, an efficiently operating general exchange supply and exhaust ventilation is installed.

Exposure to microbial factor Torah. Under unfavorable sanitary and hygienic conditions, microorganisms can adversely affect the quality of medicines manufactured in pharmacies and cause intra-pharmacy infections. Saprophytic microorganisms cause great damage to preparations. They break down drugs and use them as nutrients for their growth and development. Such drugs lose their therapeutic activity, and sometimes acquire toxic properties. Since glucose is a good medium for the development of microorganisms, a freshly prepared solution must be sterilized immediately.

Microbial contamination is mainly exposed to hands, overalls of pharmacy workers, which can lead to diseases if sanitary and hygienic rules are not observed. Equipment, pharmacy equipment, distilled water and medicines can also be contaminated.

Forced work posture. Pharmacy staff often performs work in a forced position of the body. Pharmacists and junior pharmacists, cleaning nurses work in a forced standing position; in a forced position

Sitting - all the main groups of workers engaged in the manufacture of medicines. With a long stay in a standing position, flat feet may develop, pain in the legs, swelling, fatigue of the muscles of the legs, cramps of the calf muscles may be noted. People who work in this position for a long time develop varicose veins. Could be thrombophlebitis.

Prolonged work in a sitting position contributes to the curvature of the spine, increased intra-abdominal pressure, stagnation of blood in the veins of the abdominal cavity and rectum, which can lead to impaired bowel function (atony, constipation) and hemorrhoids.

In the process of work, overstrain of individual muscle groups can occur, in particular, the hands and fingers when performing monotonous and small movements (hanging, packing powders, measuring liquids with a burette or pipette, etc.). This leads to myositis, and sometimes to coordinator neuroses.

To prevent the impact of this factor, it is necessary to take measures aimed at the correct equipment of workplaces, the provision of technological and organizational equipment with the means of complex and small-scale mechanization. All the necessary equipment, auxiliary material and substances from which drugs are made should be as close as possible to the workers in such a way that they can easily, without effort and unnecessary movements, perform their work. Much attention should be paid to industrial gymnastics, micro-pauses, changes in body position, and the introduction of elements of the scientific organization of labor. Important role play preliminary and periodic honey. examinations to identify the initial stages of eye disease, disorders of the musculoskeletal system and other health disorders upon admission to work and during labor activity in a pharmacy.

Prevention and protection measures. It is necessary to take measures aimed at properly equipping workplaces, ensuring technological and organizational equipment with integrated and small-scale mechanization, personal protective equipment (respirators, aprons, etc.), compliance with sanitary rules and norms.