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Częstość występowania wypadków przy pracy wśród ratowników medycznych w latach 2001–2013 na podstawie rejestru wybranego szpitala

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Garus-Pakowska A., Gaszyńska E., Szatko F.
Medycyna Pracy
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2016
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vol. 67
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issue 2
213-221
EN
Background Paramedics are exposed to a number of factors that may have a direct or indirect impact on the risk of an accident at work. The aim of the study was to analyze the incidence of accidents at work among paramedics as well as to discuss risk factors and measures to prevent such cases. Material and Methods The data on accidents at work were obtained from unpublished internal hospital documentation. The results were subjected to statistical analysis. Results In the years 2001–2013 there were 40 events, including 6 collective accidents, in which 41 paramedics of the emergency department were injured. On average, around 3 accidents involving paramedics occurred each year. The accidents happened most frequently in the evening and at night and in the winter months (statistically insignificant relationship). Incorrect behavior of the paramedics was the most common cause of an accident (75.6%) and musculoskeletal injuries (75%) most frequently of upper and lower limbs (55%) were the most common effects of an accident. In none of the cases safety regulations were breached by employees or employer. Conclusions Accidents among paramedics can be prevented by changing the interior design of and the medical equipment installation in the rear cabin of the ambulance, conducting regular training to upgrade the skills of paramedics and enriching their knowledge about health and safety in their widest meaning. Med Pr 2016;67(2):213–221
PL
Wstęp Ratownicy medyczni narażeni są na wiele czynników mogących bezpośrednio lub pośrednio wywoływać ryzyko wystąpienia wypadku przy pracy. Celem badania była analiza wypadkowości przy pracy wśród ratowników medycznych, omówienie czynników ryzyka oraz wymogów profilaktycznych w odniesieniu do omawianych przypadków zdarzeń/wypadków. Materiał i metody Dane o wypadkach przy pracy uzyskano z niepublikowanej dokumentacji wewnętrznej wybranego szpitala specjalistycznego. Wyniki W latach 2001–2013 w dokumentacji szpitalnej odnotowano 40 zdarzeń (w tym 6 wypadków zbiorowych), w których uczestniczyli pracownicy oddziału ratunkowego. W wypadkach ucierpiało 41 ratowników medycznych. Średnio rocznie dochodziło do ok. 3 wypadków z udziałem ratowników medycznych, najczęściej wieczorem i w nocy oraz w miesiącach zimowych (zależność nieistotna statystycznie). Najczęstszą przyczyną wypadków było nieprawidłowe zachowanie się pracownika (75,6%). Z kolei najczęstsze obrażenia dotyczyły układu kostno-stawowego (75%), w tym najczęściej kończyn górnych i dolnych (55%). W żadnym analizowanym przypadku nie stwierdzono naruszenia przepisów bezpieczeństwa i higieny pracy (bhp) ani przez pracowników, ani przez pracodawcę. Wnioski Wypadkom wśród ratowników medycznych można zapobiegać poprzez zmianę układu wnętrza tylnej kabiny ambulansu i sposobu mocowania w nim wyposażenia medycznego, a także poprzez przeprowadzanie systematycznych szkoleń podnoszących kwalifikacje ratowników i wzbogacających ich wiedzę z zakresu szeroko pojętego bhp. Med. Pr. 2016;67(2):213–221
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Did legal regulations change the reporting frequency of sharp injuries of medical personnel? Study from 36 hospitals in Łódź Province, Poland

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Garus-Pakowska A., Górajski M., Szatko F.
International Journal of Occupational Medicine and Environmental Health
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2017
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vol. 31
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issue 1
37-46
EN
Objectives: The aim of the study has been to analyze the epidemiological data on sharp injuries among health care workers before and after the implementation of regulations related to the conduct of the register of sharp injuries. Material and Methods: We hypothesized that the introduction of legislation would change the existing low reportability of sharp injuries and reporting incidents would increase. In Poland the binding regulations, dating back to 2013, require the employer to keep a record of sharp injuries. Therefore, we compared the data from before and after the entry regulations. Data was collected from the records of occupational exposure/accidents at work in hospitals in the Łódź Province during 2010–2014. The feedback came from 36 hospitals (return index = 51.5%), representing a total annual average of 13 211 medical workers. Results: The incidence of injuries did not change significantly over the period 2010–2014, and the number of reported injuries in 2014 (the year when the Regulation had already been effective) was even lower than in the previous years. The average annual injury index was 12.31 injuries per 1000 employees (95% confidence interval: 11.48–13.16/1000). The incidence of injuries among nurses was significantly higher than in other groups of medical professionals (p < 0.05). These injuries most often occur while using needles (p < 0.05). Conclusions: The obligation to record occupational exposures set forth in current regulations is not likely to improve the reliability of reporting the incidents actually taking place. Further research should focus on identifying barriers to reporting cases of exposure to potentially infectious material. Action should be taken to raise awareness of medical personnel about the possible effects of exposure to infectious material, in particular, the benefits of the implementation of early post-exposure procedures. Perhaps it will increase the reporting frequency of sharp injuries of medical personnel. Int J Occup Med Environ Health 2018;31(1):37–46
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Observance of hand washing procedures performed by the medical personnel before patient contact. Part I

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Garus-Pakowska A., Sobala W., Szatko F.
International Journal of Occupational Medicine and Environmental Health
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2013
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vol. 26
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issue 1
113-121
EN
Introduction: According to the Centers for Disease Control and Prevention (CDC) as well as the World Health Organization (WHO) recommendations, medical staff are obliged to decontaminate the skin of the hands before every single patient contact. Materials and Methods: The study was performed by quasi-observation among the group of 188 medical staff (nurses and physicians) working in three selected hospitals of the Łódź province. The procedure of hand washing and disinfection performed directly before the patient contact according to the CDC and WHO recommendations were observed. The results was subject to statistical analysis (p < 0.05). Results: During 1544 hours of observation 4101 activities requiring hand washing were recorded. The medical staff obeyed the hand washing procedure before the patient contact only in 5.2% of the situations. There was no activity observed before which hand hygiene was maintained in 100% of cases. Observance of hand hygiene depended signifi cantly on the type of the performed activity, the professional group, and the workload index. A decrease in percentage observance of hand hygiene according to the time of the day was found to be of statistical signifi cance. The mean time of hand washing was 8.5 s for physicians and 6.6 s for nurses. Conclusion: The level of observance of hand washing procedures among the medical staff prior to the patient contact appears to be alarmingly below the expectations.
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Observance of hand washing procedures performed by the medical personnel after the patient contact. Part II

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Garus-Pakowska A., Sobala W., Szatko F.
International Journal of Occupational Medicine and Environmental Health
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2013
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vol. 26
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issue 2
257-264
EN
Objectives: The Centers for Disease Control and Prevention (CDC) as well as the World Health Organization (WHO) state that adequate hand hygiene maintained by medical personnel is an indispensable prerequisite for controlling nosocomial infections. The recommendations of CDC and WHO emphasize the obligation to wash hands after each contact with a patient, after the exposure to a potentially infectious material or upon the contact with objects surrounding the patient. Materials and Methods: The study was performed by quasi-observation among the group of 188 medical staff members (nurses and physicians) working in three selected hospitals of the Łódź Province. The procedure of hand washing/disinfection performed directly after the patient contact according to the recommendations of CDC and WHO was observed. The results were subject to statistical analysis (p < 0.05). Results: During 1544 h of observations, 4101 activities requiring hand washing were recorded. The medical personnel followed the hand hygiene procedures after the patient contact in 26.4% of the situations that require hygiene according to the guidelines. The level of observance of the hand washing procedures depended significantly on the type of performed activity, profession, degree of workload, index of activity, and time of duty hours. The mean time of hand washing after patient contact was 9.2 s for physicians and 6.7 s for nurses. Conclusion: Both the level of observance of hygienic procedures after the contact with patients as well as the time of hand washing are insufficient. There is an urgent need to work out educational programs on maintaining proper hand hygiene for medical personnel.
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The use of protective gloves by medical personnel

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Garus-Pakowska A., Sobala W., Szatko F.
International Journal of Occupational Medicine and Environmental Health
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2013
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vol. 26
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issue 3
423-429
EN
Introduction: To minimize the risk of cross-infection between the patient and the medical staff, it is necessary to use individual protective measures such as gloves. According to the recommendations of the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), protective gloves should always be used upon contact with blood, mucosa, injured skin or other potentially infectious material. Materials and Methods: The aim of the study was to evaluate, through quasi-observation, the use of protective gloves by medical staff according to the guidelines issued by the CDC and WHO. The results were subject to statistical analysis (p < 0.05). Results: During 1544 hours of observations, 3498 situations were recorded in which wearing protective gloves is demanded from the medical staff. The overall percentage of the observance of using gloves was 50%. The use of gloves depended significantly on the type of ward, profession, performed activity, number of situations that require wearing gloves during the observation unit and the real workload. During the entire study, as many as 718 contacts with patients were observed in which the same gloves were used several times. Conclusion: Wearing disposable protective gloves by the medical staff is insufficient.
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Dental awareness and oral health of pregnant women in Poland

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Gaszyńska E., Klepacz-Szewczyk J., Trafalska E., Garus-Pakowska A., Szatko F.
International Journal of Occupational Medicine and Environmental Health
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2015
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vol. 28
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issue 3
603-611
EN
Objectives The level of dental awareness of a pregnant woman affects the sanitary condition of her own teeth and the health of the child to be born. Poor oral health is considered to be a probable risk factor for the pre-term birth or low birth weight. The aim of this work was to assess the level of oral health knowledge that determines oral health condition of pregnant women in Poland. Material and Methods Empirical data were obtained from the National Monitoring of Oral Health and Its Determinants, financed by the Ministry of Health. This socio-epidemiological study assessed oral health status and dental health awareness, which affects that status. Study subjects included 1380 pregnant women at the age ranging from 15 to 44, randomly-selected from urban and rural environments. Dental health status was recorded in the clinical examination sheets supplied by the World Health Organization, and the socio-medical data were recorded in the questionnaire interview sheets. Results Almost 3/4 of the pregnant women evaluated their dental health as unsatisfactory or poor. Over 60% of the pregnant women rated their knowledge and practical skills concerning care of their own teeth and of the child to be born as limited, inadequate or none. Only 40% of the pregnant women provided right answers to the questions about dental issues. Conclusions Low oral health awareness results in poor oral health status of the study subjects. A statistical pregnant woman has a total of 13 teeth showing the symptoms of tooth decay or caries. Over 70% of the pregnant women developed gingivitis or periodontitis. There is an urgent need in Poland to make the European principle of treating pregnant women as a dentally vulnerable group obligatory.
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Thirty years of evolution of oral health behaviors in the working-age Poles

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Gaszyńska E., Wierzbicka M., Kaleta D., Garus-Pakowska A., Szatko F.
International Journal of Occupational Medicine and Environmental Health
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2014
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vol. 27
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issue 5
774-784
EN
Introduction: In an average Polish person aged 35–44, more than 16 teeth have or had been affected by dental caries. Of that number, almost half of the teeth have already been extracted. Oral health behaviours contribute to this civilization disease in 50%. Such poor oral health status limits the ability of the affected people to take many social and professional roles. Objectives: To evaluate current oral health behaviours and their trends among 35–44 year old Polish people during the period of recent 30 years. Material and Methods: The data were obtained from the International Collaborative Studies conducted in 1978 and 1988 at the Nofer Institute of Occupational Medicine, Łódź, Poland, under the auspices of the World Health Organization (WHO) as well as from 3 stages of the study on Nationwide Monitoring of Oral Health Status and Its Conditioning performed in 1998, 2002 and 2010. The researchers evaluated oral health behaviours and oral health condition of 5425 subjects. Results: Despite a noticeable improvement, poor oral health behaviours are observed in 30%–40% of the adults. In the analysed period, the number of people brushing their teeth at least twice a day increased by more than 10% and the number of people using dental floss increased by 38%. Only 60% of the adults visited a dentist at least once a year. Reduced accessibility of state-run, free-of-charge dental care has caused that over 58% of Poles paid for their dental services. Every 3rd person of working age has not visited a dentist for longer than 2.5 half years, primarily due to behavioural and financial reasons. Oral health behaviours of Polish people are among the poorest in Europe. Conclusions: Despite a noticeable improvement of the behaviours, gap between the Poles and citizens of other highly developed countries is around 20 years. A health promotion programme including oral health issues, if implemented in workplaces, might considerably reduce this gap.
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