METHODICAL INSTRUCTIONS FOR PRACTICAL LESSON in GENERAL HYGIENE FOR STUDENTS
of 2 COURSE OF DENTISTY FACULTY
LESSON № 6 (6 hours)
Themes:
1. Hygienic requirements to placing, equipment, maintenance and using of separate structural subdivisions of dentistry establishments.
2. Hygienic estimation of stay patients in hospital, occupational hygiene of medical workers, including dentistry.
3. Methods of estimation of radiation danger and parameters of protection from an external irradiation.
4. Hygienic assessment of radiation protection of personnel and radiation safety of patients during using of radioactive nuclides and other sources of ionizing radiation in patient care institutions,
in the x-ray cabinet of dentistry policlinic.
Aim:
1. To know on the hygienic conditions and harmful factors influencing the efficacy of patients’ treatment and medical workers’ health.
2. Become familiar with the legislative and organizational measures of the provision of the optimal regime, hygienic conditions for patients of the in-patient departments and the medical workers’ labour protection.
3. To know the general scheme and methods of subjective (sanitary inspection) and objective sanitary control of the conditions of patients’ stay and the conditions of medical personnel labour at the hospital.
4. Consolidate, extend and methodize knowledge about radiation hazard of population, and the personnel at work with radioactive nuclides and other sources of ionizing radiation.
5. To know methods and means of measurement of radiation levels and concentration of radioactive nuclides in the air, water, food substances, of radioactive pollution of the work surfaces, individual doses of irradiation of those working with sources of ionizing radiation, to assess their results.
PROFESSIONAL ORIENTATION OF STUDENTS
Speaking about the regime of exploitation of medical in-patient subdivisions, it should be noted that the main requirement concerning the favorable influence on patients’ treatment efficacy and conditions of medical personnel labour consists in the maintaining of optimal microclimate conditions, i.e. the rational heating of the premises in winter and air conditioning in summer. The optimal air temperature in the wards in winter and during the transitional period should range from 19 to
Radiation hygiene is a branch of hygienic science and sanitary practice, purpose of which is to provide safety for people working with sources of ionizing radiation and for population as a whole.
Tasks of radiation hygiene include:
– sanitary legislation in radiation factor sphere;
– preventive and regular sanitary control at objects, that use sources of ionizing radiation;
– hygiene and protection of personnel working with sources of ionizing radiation and personnel working in adjacent premises and on the territory of supervised zones;
– inspection of radiation level of objects of the environment (atmospheric air, air of work zone, water of reservoirs, drinking water, food substances, soil and others);
– inspection of collection, storage, removal and neutralization of radioactive waste, their entombment etc.
STUDENTS’ PRACTICAL ACTIVITIES (900-1200 hour).
Theme № 1. Hygienic requirements to placing, equipment, maintenance and using of separate structural subdivisions of dentistry establishments.
Lesson is conducted as an independent sanitary inspection of different apartments of hospital (ward, corridor, consulting room, dressing-room, apartment of daily stay of patients, room of senior sister), lot land of hospital . The inspection is conducted in accordance with the offered charts. The results of inspection are fixed in an act which consists of three parts (passport part, main part and conclusion).
SCHEME OF INSPECTION OF DENTYSTRY POLICLINIC
1. The name, address, category.
2. Lot land: area, planting of greenery, communication with a public transport, features of site and general plans.
3. Building: quantity of floors, presence of private entrance for children, type of building, list of separations and apartments of the common setting.
4. Description of separation (one): the name, floor, plan-chart of separation, list of apartments, finishing of apartments (floor, walls, ceiling, colouring).
5. Estimation of basic (works) cabinet of separation:
а) Working seating capacity, general area and area into a 1 working place, their liking for a luciferous surface;
б) Illumination: coefficient of deepening, light coefficient, general illumination, type of lamps, presence of local illumination;
в) Ventilation: coefficient of aeration, presence of artificial ventilation, description of local ventilation.
6. The sanitary state of apartments.
7. Presence of harmful chemical matters, which are used in work of doctor-dentistry (mercury, amalgam and others like that). Measures on defence of medical personnel.
8. Hygienical conclusion and suggestions.
Theme № 2 Hygienic estimation of stay patients in hospital, occupational hygiene of medical workers, including dentistry.
1. To decide situation tasks and dates to the results hygienic estimation.
Theme № 3. Methods of estimation of radiation danger and parameters of protection from an external irradiation.
1. Acquaintance with devices that are used for radiation control, their classification on purposes, types of detectors, principles of construction.
2. Measurement and assessment of absorbed dose rate in the air.
3. Determination and assessment of individual doses of external irradiation of the personnel of radiological establishment (industrial, scientific, medical).
4. Determination and assessment of radiological pollution of work surfaces, equipment, working clothes.
5. Determination and assessment of radioactivity of samples of water, soil, food substances, air.
A report of the lesson must be drawn into the protocol.
Theme № 4. Hygienic assessment of radiation protection of personnel and radiation safety of patients during using of radioactive nuclides and other sources of ionizing radiation in patient care institutions in the x-ray cabinet of dentistry policlinic.
1. By using calculation methods of determination of external radiation level and parameters of radiation protection, students solve situational tasks on hygienic assessment of labour conditions of the personnel that work with radioactive nuclides, give conclusions and give recommendations.
STUDENT’S INDEPENDENT STUDY PROGRAM
Theme № 1. Hygienic requirements to placing, equipment, maintenance and using of separate structural subdivisions of dentistry establishments.
Control questions:
1. Dentistry policlinic. Hygienic requirements to equipment and exploitations of separations of therapeutic, surgical and orthopedic departments and laboratory.
2. Modern equipping of dentistry establishment and policlinic (presence of plumbing, hot water-supply, sewage system, ventilation and others like that).
3. Hygienic bases of organization of the sanitary mode in dentistry establishments.
4. Hygienic requirements to the dentistry equipment, tools, rules of them maintenance and disinfecting.
Theme № 2 Hygienic estimation of stay patients in hospital, occupational hygiene of medical workers, including dentistry.
Control questions:
1. Hygienic requirements concerning the planning, sanitary appliance of the different type admission department and patients’ discharge.
2. Hygienic requirements concerning the planning, sanitary appliance, optimal regime of exploitation of the dentistry, therapeutic, surgical departments, the operating block and the intensive care units.
3. Hygienic requirements concerning the planning, sanitary appliance, optimal regime of exploitation of the ward sections and the wards of different departments of patient care institutions.
4. Hygienic requirements concerning the planning, sanitary facilities, optimal regime of exploitation of the X-ray, radiological, physiotherapeutic departments of the treatment institutions.
5. Patients’ nutrition organization at in-patient departments and the hygienic control of its full value and safety.
6. Sanitary and hygienic requirements concerning collection, removal and sterilization of solid, liquid and specific wastes.
7. Occupational hazards, hygiene and labour protection of different medical departments (dentistry, surgical, therapeutic, infectious diseases, psychoneurological and others) medical personnel.
8. Personal patients’ and medical workers’ hygiene within the system of health and labour protection, prophylaxis of nosocomial infection and occupational diseases.
Theme № 3. Methods of estimation of radiation danger and parameters of protection from an external irradiation.
Control questions:
1. Qualitative and quantitative characteristics of different type of ionizative radiation and their sources.
2. Units of a radio-active (activity, exposition doze, absorbed doze).
3. Biological action of ionizative radiations and conditions on which it depends.
4. Hygienical setting of norms of ionizing radiations.
5. Principles of protection from ionizative radiations (by time, distance, screen, doze).
Theme № 4. Hygienic assessment of radiation protection of personnel and radiation safety of patients during using of radioactive nuclides and other sources of ionizing radiation in patient care institutions in the x-ray cabinet of dentistry policlinic.
Control questions:
1. Mechanism of origin of different types of ionizing radiation.
2. Methods of registration of ionizing radiation
3. Features of planning and equipment of radiological separations of hospitals. Hygienical requirements.
4. Radiometry method of research ionizing radiation.
5. Dosimeter method of research ionizing radiation.
6. Classification of persons, that are exposed to the rays.
7. Limits of doses for different categories of persons, that are exposed to the rays that the groups of critical organs.
8. Groups of critical organs.
Seminar discussion of theoretical issues (1230 – 1400 hour).
1. Dentistry policlinic. Hygienic requirements to equipment and exploitations of separations of therapeutic, surgical and orthopedic departments and laboratory.
2. Modern equipping of dentistry establishment and policlinic (presence of plumbing, hot water-supply, sewage system, ventilation and others like that).
3. Hygienic bases of organization of the sanitary mode in dentistry establishments.
4. Hygienic requirements to the dentistry equipment, tools, rules of them maintenance and disinfecting.
5. Hygienic requirements concerning the planning, sanitary appliance of the different type admission department and patients’ discharge.
6. Hygienic requirements concerning the planning, sanitary appliance, optimal regime of exploitation of the dentistry, therapeutic, surgical departments, the operating block and the intensive care units.
7. Hygienic requirements concerning the planning, sanitary appliance, optimal regime of exploitation of the ward sections and the wards of different departments of patient care institutions.
8. Hygienic requirements concerning the planning, sanitary facilities, optimal regime of exploitation of the X-ray, radiological, physiotherapeutic departments of the treatment institutions.
9. Patients’ nutrition organization at in-patient departments and the hygienic control of its full value and safety.
10. Sanitary and hygienic requirements concerning collection, removal and sterilization of solid, liquid and specific wastes.
11. Occupational hazards, hygiene and labour protection of different medical departments (dentistry, surgical, therapeutic, infectious diseases, psychoneurological and others) medical personnel.
12. Personal patients’ and medical workers’ hygiene within the system of health and labour protection, prophylaxis of nosocomial infection and occupational diseases.
a. Qualitative and quantitative characteristics of different type of ionizative radiation and their sources.
b. Units of a radio-active (activity, exposition doze, absorbed doze).
c. Biological action of ionizative radiations and conditions on which it depends.
d. Hygienical setting of norms of ionizing radiations.
13. Principles of protection from ionizative radiations (by time, distance, screen, doze).
14. Mechanism of origin of different types of ionizing radiation.
a. Methods of registration of ionizing radiation
15. Features of planning and equipment of radiological separations of hospitals. Hygienical requirements.
a. Radiometry method of research ionizing radiation.
b. Dosimeter method of research ionizing radiation.
c. Classification of persons, that are exposed to the rays.
16. Limits of doses for different categories of persons, that are exposed to the rays that the groups of critical organs.
a. Groups of critical organs.
SITUATION TASKS
Task 1. The worker has 6 (six) hour working day and works on distance
Standard of answer: For calculation we use the formula:
(M x T)/R2=120, where
M – activity of a source radiation (in mg/ecv Radium)
R – distance from a source of radiation (in m)
T – time of radiation
120 – constant coeficient
M = (120 x 0,64)/(6 x 6) = 2,13 mg/ecv Radium
The note: 6 x 6 (6 hours x 6 work days per one week)
Task
Standard of answer. T = (120 x R2)/M = 120 x 1/10 = 12 hours for a week
Task 3. The sister of radiological departament during 6 hours daily prepares the preparations of Radium with activity 3,3 mg/ecv Radium. On what distance from a source she should work?
Standard of answer. R = (M x T)/ 120 =3,3 x 6 x 6/ 120 =
Task 4. The laboratorian which packs up a radioactive isotope gold Au198 with energy of radiation 0,4 MeB, will receive without protection in one week a doze of radiation of 1,0 Rad. What thickness the leaden screen should be applied for safe operating conditions of the laboratorian?
Standard of answer. The size of factor of indulgence (divisible of indulgence) is determined by formula:
K = P/P0, where
K – divisible of indulgence
P – the receive doze
P0 – maximum permissible doze
In our example: K = 1,0/0,1 = 10 times
In tab.1 we find, that necessary thickness leaden of the screen should be
Task 5. Capacity of a doze γ-radiation on workplace is P = 20 mkR/sec. A source of γ-radiation is Co60 with average energy of quantums E = 1,25 MeB. To find thickness of leaden screen, which necessary for an indulance of this radiation up to results a hygienic estimation?
Standard of answer. In tab.2 we find: P0 = 1,4 mber/h
Transfer 20 mkR/sec to proectial nomers:
20 mkR x 3600 sec/ 1000 = 72 mber/h
Divisible of indulgence in this time is:
K = P/P0 = 72/1,4 = 51 times
In tab.1 we find, that necessary thickness leaden of the screen should be
TEST QUESTIONS:
1. Results of estimation microclimate of ward of therapeutic department is next: the middle temperature of air is
A. comfortable microclimate; *
B. uncomfortable microclimate of cooling type
C. uncomfortable microclimate of heating type
D. uncomfortable microclimate with the increased humidity of air
E. uncomfortable microclimate with the increased speed of air
2. Name groups of harmful and dangerous factors, which not present in work of doctors various specializations:
А. Physical
В. technogenic*
С. Chemical
D. Biological
E.Psychophysiological
3. During work with the opened sources of ionizing radiations the complex of protective measures, which ofteame radiation asepsis, is carried out. What does not behave to these measures?
A. Maximal pressurization of working processes.*
B. Rational planning of apartments
C. Use of general and local extraction ventilation.
D. Coverage of working surfaces by materials which it is badly adsorbs radionouclidi.
E. Limitation of duration of working day.
4. Which one of the following type of ionizing radiations is not commonly encountered for medical applications?
A. X-ray,
B. gamma rays,
C. alpha particles,
D. beta particles,
E. protons.*
5. Which one of the following kind of ionizing radiations has ranges in soft tissues of the order of several millimeters?
A. X-ray,
B. gamma rays,
C. alpha particles, *
D. beta particles,
E. protons.
Individual student work (1415-1500 hour) are checked by solving situational tasks for each topic, answers in test evaluations and constructive questions (the instructor has tests & situational tasks).
INITIAL LEVEL OF KNOWLEDGE AND SKILLS
The student must know:
1. Basic hygienic requirements concerning the planning, equipment, regime, exploitation of the treatment, diagnostic, accessory and consumer subdivision of the in-patient departments.
2. Hygienic standards of microclimate, air, ventilation, natural and artificial lighting of different subdivisions of the medical institution, their importance in the patients’ treatment efficacy and the conditions of medical personnel labour.
3. Harmful and dangerous factors of different subdivisions of the medical institution (diagnostic, physiotherapeutic, balneal etc.), their influence on the patients’ and medical personnel health.
4. Qualitative and quantitative properties of ionizing radiation.
5. Sources of ionizing radiation, their occurrence in the environment.
6. Usage of radioactive nuclides and other sources of ionizing radiation in industry, medicine, scientific researches.
7. Biological effect of ionizing radiation and conditions it depends on.
8. Essence of radiation hazard at work with radioactive nuclides and other sources of ionizing radiation in different branches of industry.
9. Foundations of hygienic control of radiation safety and regulations of radiation safety and Primary sanitary regulations of work with active materials and other sources of ionizing radiation.
10. Classification of types and devices of radiation control, principles of work of those devices.
11. Physical basis of radiation.
12. Effects of ionizing radiation on living organisms.
13. Methods of radiation protection based on physical lows of weakening of ionizing radiations.
14. Basics of legislation of radiation hygiene.
The student should how:
1. To carry out the sanitary inspection and determine the objective figures of the hygienic condition of the medical institution different subdivisions.
2. To determine and assess harmful and dangerous factors of different subdivisions of the medical institution and their influence on the patients’ and medical personnel health.
3. To prepare of devices of radiation control for work, conduct measurements, read devices, assess results.
4. To conduct mathematical calculations, use hand-held computers and computers at calculations.
5. To use reference materials and standards.
REFERENCES:
Principal:
1. Hygiene and human ecology. Manual for the students of higher medical institutions/ Under the general editorship of V.G. Bardov. – K., 2009. – pp.140-159, pp. 447-515. . http://www.nmu.edu.ua/kaf55-8.php
2. Datsenko I.I., Gabovich R.D .Preventive medicine. – K.: Health, 2004, 788p.
3. Practical classes materials http://intranet.tdmu.edu.ua/data/kafedra/internal/hihiena/classes_stud/en/stomat/stomat/ptn/hygiene%20and%20ecology/2/06.%20Hygienic%20requirements%20to%20placing,%20equipment.htm
4. Lecture on hygiene.
additional:
1. Kozak D.V., Sopel O.N., Lototska O.V. General Hygiene and Ecology. – Ternopil: TSMU, 2008. – 248 p.
2. Dacenko I.I., Denisuk O.B., Doloshickiy S.L. General hygiene: Manual for practical studies. –Lviv: Svit, 2001. – P. 26-33.
3. A hand book of Preventive and Social Medicine. – Yash Pal Bedi / Sixteenth Edition, 2003 – p. 22-54.
Methodical instruction has been worked out by: ass-prof. Sopel O.M.
Methodical instruction was discussed and adopted at the Department sitting
30 august 2011, Minute № 1
Methodical instruction was adopted and reviewed at the Department sitting
28 august 2013, Minute № 1
