Dünya Sağlık Örgütü sağlığı, “sadece hastalık ve sakatlığın olmayışı değil, kişinin fiziksel, ruhsal ve sosyal olarak da tam bir iyilik halinde olması” olarak tanımlar. Peki Ameliyathane çalışanlarının karşılaştıkları risk etmenleri ve tehlikeler neler?
FİZİKSEL RİSK ETMENLERİ
Aydınlatma: Ameliyathanelerde aydınlatmanın iyi olmaması görüş alanını olumsuz etkilemekte, keskin aydınlatma da çalışanlarda yorgunluk hissine neden olabilmektedir.
Cerrahi testere bıçak gibi metalden üretilen el aletlerinin parlamaması için üretim hattında matlaştırma yöntemi kullanılsa da, ışığın derecesi yansımayı minimuma indirecek şekilde olmalıdır.
Havalandırma: Uygun havalandırma sistemlerinin olmaması ameliyathanedeki enfeksiyon riskini arttırmaktadır.
Gürültü: Hastanelerdeki tıbbi cihazların çıkardıkları sesler, havalandırma sistemlerinin sesleri, çalışan personelin ve hasta/hasta yakınlarının konuşmaları gürültülü bir ortam yaratmaktadır. İşitme sistemine zarar veren gürültü düzeyi 100-10.000 Mhz ve 85 Db’dir.
Cerrahi testere motor dizaynı gereği sahip olduğu minimum hız işitme sistemine zarar verebilmektedir. Kullanıcının sağlığı için kulak tıkacı kullanılması önemlidir.
Radyasyon: Ameliyathanelerde çalışan sağlık personelinin sağlığını tehdit eden diğer fiziksel risk etmeni ise radyasyon kaynaklı cihazların kullanımıdır. Hastaya yapılan işlemlerde kullanılan bazı cihazlar sağlık personeli için sağlığı tehdit etmektedir.
KİMYASAL RİSK ETMENLERİ
Cerrahi Duman: Koter dumanı, duman bulutu, aerosol, buhar ve hava kontaminantları gibi çeşitli isimlerle anılan cerrahi duman elektro cerrahi üniteleri, lazer, ultrasonik cihazlar ve yüksek ısı kaynaklı elektrikli cihazlar gibi ısı üreten cihazların kullanımıyla ortaya
çıkan zararlı bir yan üründür.
Lazer: Lazer, iyonlaştırıcı olmayan radyasyon olmasına rağmen, yoğunluğu ve dokulardan
madde salınımına neden olmasından dolayı güvenli değildir. Yakın çalışan personelde göz yaralanmaları riski fazla olup, doğrudan maruz kalınma ya da yansıyan radyasyon gözde özelikle retina, kornea ve lens hasarına neden olabilir.
Lateks Alerjisi: Eldiven kullanımındaki artış nedeniyle latekse olan talep artmış, üreticiler daha fazla ve daha ucuz ürün çıkarabilmek için lateksin işleme sürecinde değişiklikler yapmışlar ve kalitesiz eldiven üretimi artmıştır. Sağlık çalışanları arasında %8-25 arasında lateks alerjisi saptanmıştır.
Soap and Detergents: Healthcare personnel working in the operating room wash their hands many times a day with water-soap-detergent or solutions containing chemicals. Water, soap and detergent cause changes in the keratin layer of the skin, such as damage to the alkaline environment, destruction of lipids, deterioration of the protective properties of the skin, and damage to the water retention capacity by destroying amino acids.
Substances Used for Sterilization Purposes: Sterilization substances, which are frequently used to prevent the spread of infectious disease agents, may cause liver toxicity on healthcare workers in the long term and some negative effects during pregnancy.
Waste Gases: Exposure to anesthesia gases not only causes headaches, fatigue, irritability, nausea, but also affects the reproductive systems of healthcare personnel, causing miscarriages during pregnancy and premature births in female employees.
Biological Risk Factors: Healthcare personnel are more exposed to infectious diseases than other sector employees. The operating room is a biologically riskier department than other departments in the hospital. Although sharps injuries are the most common injuries in the operating room; Surgical power tool, screws, catheter tips, laundry forceps, guide wires, thoracars and medicine bottles also cause glove tearing and injuries.
Ergonomic Risk Factors: Ergonomics is an important issue that is overlooked. The risk of injury for employees exposed to ergonomic risk factors increases. Occupational diseases may occur when there is a discrepancy between the physical capacity of the employee and the physical conditions of a job. In particular, the ergonomics of the surgical power tool that can be controlled with one hand are important factors for the user’s wrist health and the success of the incision.
Psycho-Social Risk Factors: Operating rooms are closed environments where life-threatening situations occur, working hours are long, and personal needs cannot be met in urgent situations. In these environments, the long duration of surgeries demotivates the staff, and the lack of environments where they can meet their personal needs such as food and rest puts the staff under stress.
Work Accidents: The most common work accidents encountered by healthcare personnel working in operating rooms are soft tissue traumas, waist muscle and joint injuries, impacts and falls. It is seen that they encounter traumas.
Occupational Diseases: Health personnel working in the operating room constantly use electrical or electronic devices, heavy carrying and lifting during patient transfer, exposure to blood and body fluids, exposure to radioactive and chemical substances, having to provide services with cutting and piercing tools, and constantly being exposed to biological diseases. There is a risk of disease by exposure to agents.
Precautions Against Physical Risks
The electricity-water system must be safe, the ventilation system must be selected in accordance with the standards, the floor must be made of suitable material and warning signs must be used for wet floors. Weight limits of medical devices and materials should be specified, appropriate conditions should be created for transportation, and routine checks and inspections should be carried out by expert personnel. Employees should be informed through in-service training and orientation programs.
Precautions to be Taken Against Chemical Risks
All disinfectants and antiseptics used in the operating room should be selected appropriately and used in accordance with the user manual, and safety precautions such as protective clothing and gas mask should be taken for the Ethylene Oxide sterilizer. Appropriate physical conditions must be provided in sterilization units, and routine control of anesthesia machines must be carried out by expert employees.
Precautions to be Taken Against Biological Risks
When using cutting and piercing tools during surgery, a verbal warning should be given and instead of passing them from hand to hand, they should be placed in a sterile tray or kidney tub where the tools are placed and collected, and in cases where they need to be extended, they should be extended by keeping the sharp edges away from the hand and removed from the environment immediately after use.
Precautions to be Taken Against Psychological Risks
It is necessary to provide psychological support to personnel in areas where burnout syndrome and loss of motivation occur. In cases where support is insufficient, a change of duty area should be made as appropriate. Orientation and in-service training should be provided, duties, authorities and responsibilities should be written in order to prevent team conflict.
should be reported to the staff. Confidential surveys should be conducted regularly by the management against the risk of mobbing, and in case of mobbing, there should be a unit that the employee can easily apply to, and job satisfaction should be increased.
Precautions to be Taken Against Ergonomic Risks
Operating rooms should be designed ergonomically, and materials that lie scattered on the floor and narrow working areas should be removed. Slippery and wet floors should be cleaned immediately and warning signs should be placed if necessary. In order to alleviate the musculoskeletal system discomfort caused by static posture during long-term surgeries, fatigue-relieving mats with small air cushions should be used, and medical personnel should be provided with orthopedic shoes that fit well and support the feet, are closed at the front and are wide enough to allow finger movements, and have a heel height of at least 5 cm. It should be recommended that the patient should wear it, and the employment of appropriate number and qualifications of healthcare personnel should be ensured.
Precautions to be Taken Against Work Accidents
In order to prevent or reduce occupational accidents in working environments, the causes of occupational accidents and unsafe situations caused by employees must be determined and eliminated or minimized. In order to prevent work accidents, healthcare personnel need managerial and organizational support. Personnel who have a work accident must report the accident. Warning signs against falls and impacts should be used. Personal protective equipment should be used when using chemicals, and in case of exposure, written documents should be hung in a place where everyone can see them.
Precautions to be Taken Against Occupational Diseases
Regarding the occupational diseases to which personnel working in operating rooms are exposed, risks must first be identified and protective measures must be taken. Ensuring proper functioning of the ventilation system is among the precautions that must be taken to prevent respiratory system diseases that may occur due to chemical substances.
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