Protecting the cell from the penetration of harmful substances. Personal protective equipment against harmful substances at work

For all jobs involving exposure to conditions with high concentrations of pollutants, as well as in cases caused by public hygiene considerations, workers are provided with special clothing and personal protective equipment (PPE) at the expense of the enterprise. If (Z tφ + Z tρ + Z tτ) do not fully perform their functions, then PPE is used.

Personal protective equipment against harmful chemicals are: overalls (protective clothing); underwear; safety shoes; hats; gloves and mittens; aprons, etc.; gas masks and respirators; protective glasses; protective pastes and ointments to prevent occupational skin diseases.

In production where chemicals are used, workwear has a variety of purposes and, accordingly, is made from various materials and different cuts. The choice of fabric for workwear is based on its purpose and experimental data on resistance to environmental influences. These include: cotton, linen, wool and fabrics with special impregnations.

For skin protection workers, especially open parts of the body (face, neck, sometimes hands), and the prevention of skin diseases, along with protective clothing and personal hygiene products, use various protective (barrier) pastes, ointments and special detergents and cleansers. Ointments according to their purpose are divided into two groups:

for protection against fats and oils, petroleum products, solvents, varnishes, resins, various hydrocarbons and organic substances;

for protection against water, water-oil emulsions, aqueous solutions of acids, alkalis, salts and other substances.

Ointments of the first group are hydrophilic substances, easily wetted by water and soluble in it. Ointments of the second group contain mainly hydrophobic substances and protect the skin from aqueous solutions of various harmful substances.

If there are harmful substances in the air of industrial enterprises in the form of gases, vapors or aerosols (smoke, fog, dust) for protection respiratory organs use gas masks or respirators. All industrial gas masks are divided into two main groups: filtering and insulating.

In filter gas masks, self-rescuers and respirators, the inhaled air is purified as it passes through special sorbents (absorbers) and filters. Filtering gas masks, self-rescuers and respirators can serve to protect the respiratory system in cases where the surrounding atmosphere contains at least 16–18% oxygen, and the concentration of harmful impurities is not too high and their composition is known. Isolating devices, unlike filtering devices, completely isolate the human respiratory system from the surrounding air. Therefore, they can be used when there is a lack of oxygen in the air (less than 16%), at high concentrations of harmful substances, and also in cases where the composition of harmful substances is unknown.

Both filtering and insulating gas masks provide protection only for the respiratory system, face and eyes. Therefore, if there are harmful substances in the air that act on or through the skin, it is also necessary to wear appropriate protective clothing.

The main measure of protection against the harmful effects of chemicals on workers in conditions of possible contamination of the work area is systematic monitoring of the content of these substances in the working environment. If the content of harmful substances in the air of the working area exceeds the maximum permissible concentration, special organizational and technical measures are taken to prevent poisoning.

Organizational measures include the mandatory use of personal protective equipment (special protective clothing, shoes, mittens, helmets, gas masks and respirators, goggles, protective face shields, neutralizing pastes and ointments to protect and clean the skin). For example, persons working with leaded gasoline must be provided with vinyl chloride aprons, gloves, and rubber boots. Workers without special clothing and protective equipment (canvas jackets, trousers, rubber boots, mittens) are not allowed to work with timber treated with antiseptics.

Given the peculiarities of the professional activities of workers, when there are no technical and organizational capabilities to reduce the concentration of harmful and dangerous chemicals in the air of the working area to a safe level, working conditions are assessed according to the criteria provided by the “Guide to the hygienic assessment of factors in the working environment and the labor process. Criteria and classification of working conditions."

Classes of working conditions are established depending on the type of harmful substance of a chemical nature and the rate of excess of its maximum permissible concentration in the air of the working area. For workers who are constantly in the area where toxic substances are released, protective measures have been established by limiting the time spent in a dangerous or harmful environment (shortened working hours, breaks at work, additional leave, shortened length of service for retirement).

The government has approved a list of harmful and dangerous substances, when working with which preliminary and periodic medical examinations of workers are required. The frequency (timing) of examinations in medical institutions has also been established.

Technical measures include: sealing of equipment and communications, automatic control of the air environment, installation of natural and artificial ventilation, alarms, remote control, installation of safety signs.

Special tanks are used to transport chemically harmful liquid substances. Technological processes for loading hazardous substances, draining them or squeezing them out of tanks, as well as washing and steaming tanks are carried out in ways that prevent workers from coming into contact with hazardous substances.

Conveyors and elevators should be used to transport bulk materials to the loading site and during the loading process; for powder dusting materials (cement, lime, etc.) - pneumatic transport or conveyors using dust removal devices. For liquid hazardous substances - pipelines that prevent the leakage of these substances.

In emergency situations, a person may be exposed to harmful and dangerous chemicals for a short time, but with a significant excess of the maximum permissible concentration. There is no need to talk about permissible concentrations in emergency work areas. The protection of workers is carried out by the mandatory use of personal protective equipment and the regulation of permissible work time in the accident zone.

For all particularly hazardous work or work associated with exposure to conditions of high temperature, humidity and/or high concentrations of pollutants, as well as in cases caused by considerations of public hygiene, workers are provided with special clothing and safety equipment (goggles, masks, etc.) at the expense of the enterprise. respirators, etc.).

When working with chemicals, the use of personal protective equipment in a number of cases is crucial to ensure labor safety: when eliminating accidents, repair work inside devices, tanks, tanks and wells; when performing operations associated with the release of harmful gases, vapors, dust, crushing of solid materials (caustic soda, minerals, coal), bottling of acids and alkalis.

Personal means of protection against harmful (chemical) substances are:

1) overalls (protective clothing),

3) safety shoes,

4) hats,

5) gloves and mittens,

6) aprons, etc.,

7) gas masks and respirators,

8) safety glasses,

9) protective pastes and ointments to prevent occupational skin diseases.

In production where chemicals are used, workwear has a variety of purposes and, accordingly, is made from various materials and different cuts. However, in all cases, it must reliably protect against industrial hazards, ensure normal thermoregulation of the body, be comfortable, not restrictive, and be well cleaned of contaminants. The use of protective clothing in a production environment is mandatory. Working clothes are issued to workers free of charge and are the property of the enterprise.

The choice of fabric for workwear is based on its purpose and experimental data on resistance to environmental influences.

1) Cotton fabrics

Cotton fabrics are used for workwear that protects against dirt and dust. The best fabrics when working with irritating substances are “reinforced satin weave” fabrics - moleskins. Workwear made of thick cotton fabric is used when working with alkali solutions, but these fabrics are destroyed by the action of acids; They also cannot be used (without pre-treatment) for workwear used in conditions where it may catch fire.

2) Linen fabrics

Workwear made from linen fabric is more difficult to ignite than workwear made from cotton fabric, so it is used for hot work and in cases where there is a danger of clothing catching fire. The structure of tarpaulin canvas, especially after impregnation with special compounds, makes it waterproof. This makes it possible to make workwear from it for working in damp and wet conditions. Alkalies do not have a significant effect on linen fabrics and workwear made from them is used when working with alkali solutions. Acids destroy these tissues.

3) Wool fabrics

Woolen fabrics are more resistant to acids than cotton and linen, and are used to make acid-resistant clothing. Alkalies destroy these tissues. Coarse wool fabrics are not capable of burning, and are used for workwear used in hot work.

4) Fabrics with special impregnations

When working with chemicals, fabrics with special impregnations are also used, as well as fabrics made from synthetic fibers (chlorin, vinitron, lavsan, nitron, nylon), which are more resistant to aggressive environments than fabrics made from natural fibers.

Chlorine, obtained from chlorinated polyvinyl chloride, is resistant to acids, alkalis and oxidizing agents. Its disadvantages are: low heat resistance (65–70°C), instability to light and atmospheric influences, and the ability to dissolve in some organic solvents.

Vinitron is a modification of chlorite fiber, resistant to elevated temperatures (up to 130° C).

Lavsan is a polyester fiber that is resistant to acids, oxidizing agents, elevated temperatures, microorganisms and mold. Decomposes by strong alkalis at high temperatures.

Nitron, obtained from polyacrylonitrile, is resistant to moderate concentration mineral acids, organic solvents, bacteria, mold, and moths; heat resistant (up to 130° C).

Nylon, obtained from caprolactam, is characterized by high elasticity, tensile strength and abrasion, and resistance to alkalis; destroyed by mineral acids.

To prevent occupational diseases, personal hygiene of workers and sanitary treatment of work clothes are of great importance. Each production facility is provided with industrial and household premises: dressing rooms, showers, etc. Workwear contaminated with dust is passed through dust removal chambers, and wet clothing is passed through dryers. If necessary, special rooms are equipped for the neutralization of contaminated clothing.

Contaminated clothing must be washed periodically. The organization of washing within the time limits established for a given production (and as needed) is entrusted to the administration of the enterprise.

For skin protection workers, especially open parts of the body (face, neck, sometimes hands), and the prevention of skin diseases, along with protective clothing and personal hygiene products, use various protective (barrier) pastes, ointments and special detergents and cleansers. Ointments according to their purpose are divided into two groups:

1) for protection against fats and oils, petroleum products, solvents, varnishes, resins, various hydrocarbons and organic substances;

2) for protection against water, water-oil emulsions, aqueous solutions of acids, alkalis, salts and other substances.

Ointments of the first group are hydrophilic substances, easily wetted by water and soluble in it. These include: KHIOT-6 paste, Selissky ointment, film-forming hydrophilic ointments (“invisible gloves”), IER-1 paste of the Institute named after. Erismana, Mikolan ointment.

Ointments of the second group contain mainly hydrophobic substances and protect the skin from aqueous solutions of various harmful substances. These include: Selissky zinc stearate ointment No. 1 and its modification - ointment No. 2, Chumakov paste, IER-2 paste, sperm whale ointment, protective silicone hand cream.

Almost all ointments, after applying a thin layer to the skin, dry within a few minutes, preventing skin contact with harmful substances. Non-drying ointments fill the pores of the skin and form a thin protective layer on its surface that prevents substances from contacting the skin.

To remove contaminated and skin-staining substances that are difficult to wash off with soap and water, special detergents and leather cleansers are used.

Synthetic detergents (detergents) are also used, which have a number of advantages over soap. They are characterized by high wetting, emulsifying and washing properties and resistance to acids and hard water.

Cleaning the skin of organic dyes and pigments is carried out with special compounds.

The issuance, storage and use of preventive ointments and detergents in production is organized by administrative and technical personnel with the participation and control of the enterprise’s medical service.

If there are harmful substances in the air of industrial enterprises in the form of gases, vapors or aerosols (smoke, fog, dust) for protection respiratory organs use gas masks or respirators.

All industrial gas masks are divided into two main groups: filtering and insulating.

In filter gas masks, self-rescuers and respirators, the inhaled air is purified as it passes through special sorbents (absorbers) and filters.

Filtering gas masks, self-rescuers and respirators can serve to protect the respiratory system in cases where the surrounding atmosphere contains at least 16–18% oxygen, and the concentration of harmful impurities is not too high and their composition is known.

Isolating devices, unlike filtering devices, completely isolate the human respiratory system from the surrounding air. Therefore, they can be used when there is a lack of oxygen in the air (less than 16%), at high concentrations of harmful substances, and also in cases where the composition of harmful substances is unknown.

Isolating devices include: insulating gas masks, insulating self-rescuers, hose and linear gas masks.

Insulating gas masks consist of a front part, a breathing bag and a regenerating device.

The principle of operation of an insulating gas mask (or self-rescuer) is that the air inhaled and exhaled by a person passes through a closed system. The exhaled air enters the regenerating device. In some regenerating devices, CO 2 contained in exhaled air in an amount of 3–4% by volume, as well as water vapor, are absorbed by a special absorber, and the required amount of oxygen is added from a can. Other devices use special sorbents that absorb CO 2 and water vapor and simultaneously release the required amount of oxygen.

The purified air is collected in a rubber breathing bag and then inhaled by the person.

An insulating gas mask is a complex device with significant weight (about 11 kg). They can only be used by healthy and well-trained people. Isolating self-rescuers are built on the principle of insulating gas masks, but instead of the front part they have a mouthpiece and a nose clip. For example, insulating self-rescuers ShS-63 are designed to protect workers in the mining industry and are designed for 60 minutes during moderate work. The weight of the ShS-63 self-rescuer is about 4 kg.

When using isolating devices, you must strictly follow the instructions for their use and storage.

Hose gas masks consist of a front part and a long and very durable hose with an internal diameter of 25 mm attached to it. Hose gas masks are divided into two types: self-priming PSh-1 and with forced air supply PSh-2.

Using a PSh-1 hose gas mask with a length of 10 m, a person himself sucks in air while breathing through a hose, the end of which should be in a clean area. If clean air must be taken from remote points or when the atmosphere contains particularly toxic substances and impurities of unknown composition, use PSh-2 hose gas masks with a hose length of 20 m; atmospheric air in such cases is supplied to the hose using a manual or electric blower.

A type of hose gas masks are linear gas masks, in which compressed air, pumped by a compressor, is supplied to the front part through a system of air ducts. Pre-compressed air is cleaned of oil mist and other impurities and its pressure is reduced to an acceptable value. Hose gas masks are complemented by life belts with rope.

Hose gas masks are simple, and their use does not require lengthy preparation and training. Therefore, they should be used in cases where the worker does not need to move long distances (work is carried out in small tanks, wells, cisterns, pits, boxes, cabins, etc.).

Both filtering and insulating gas masks provide protection only for the respiratory system, face and eyes. Therefore, if there are harmful substances in the air that act on or through the skin, it is also necessary to wear appropriate protective clothing.

When working with chemicals, eye burns from splashes of hot, molten and heated substances, as well as burns from hot vapors and gases are possible. Alkalies and acids, especially nitric acid, pose a great danger to the eyes. A number of irritating substances (chlorine, ammonia, acrolein, sulfur compounds, formaldehyde, etc.) cause inflammatory processes of varying duration and severity.

To protect against chemical burns to the eyes, the following protective equipment is used in Table. 15.2.

1. Toxicity of chemicals and their effects on the human body.

Atmospheric air composition: N2=78.08%, O2=20.93%, CO2=0.03. There are a number of harmful substances in the air released into the work area as a result of technological processes.

Toxicity is the process of interaction of chemical substances with organs and tissues of the human body with the formation of new chemical compounds that are not characteristic of it, leading to disruption of the functioning of organs and the body as a whole.

Toxicity depends on:

The method of penetration of a substance into the body (Cl - entering through the respiratory organs further into the blood, through breathing - the most dangerous penetration. Through the gastrointestinal tract there is less harm. Through the skin (pores) - the surface is small.);

Physical state (gases are more dangerous);

Solubility.

Harmful substances come in solid, liquid and gaseous forms. They enter the human body through the skin, respiratory tract, and from food.

Harmful substances - which, upon contact with the human body in case of violation of safety requirements, can cause industrial injuries, prof. diseases and other deviations in the employee’s health, detected by modern research methods both during work and in the long-term life of the present and future generations.

To maintain vital functions in the human body, chemical reactions occur, the high speed of which is maintained by catalysts - enzymes. The toxic effect of a harmful substance is associated with the destruction of enzymes, which leads to inhibition of chemical reactions. Complete destruction of enzyme systems causes general damage to the entire organism, in some cases death.

Based on the nature of their toxic effects, harmful substances are divided into:

Nervous, causing central nervous system disorder,

Blood, affecting the composition of the blood,

Irritating, causing irritation of the upper and deep respiratory tract,

Mutogenic, effects on the genetic apparatus,

Carcinogenic, causing cancer,

Cauterizing, cause skin damage, the formation of ulcers and abscesses.

Based on the hazard of exposure, there are 4 hazard classes:

1. substances with maximum permissible concentrations<0,1 мг/м 3

2. substances with MPC from 0.1 to 1 mg/m 3

3. 1-10 mg/m3

4. >10 mg/m 3

Work zone- this is a space up to 2 meters high above the floor or platform on which the workplace is located.

The maximum permissible concentration of a harmful substance in the air of a working area is the concentration that, during daily work except weekends, for 8 hours or during another work shift duration, but not more than 40 hours. per week during the working period cannot cause diseases or health conditions that can be detected by modern research methods both during work and in the long-term life of the present or future generation.

The content of harmful substances in the air is regulated according to maximum permissible concentrations. There are maximum permissible concentrations: maximum one-time, average shift, average daily. If there are several harmful substances of unidirectional action in the air of the working area, then the content standardization is carried out according to the formula:

C 1 /C MPC1 + C 2 /C MPC2 +…+C n /C MPC n ≤1.

If there are harmful substances with multidirectional effects in the air of the working area, then they are rated according to the maximum permissible concentrations of each substance.

2. Industrial dust and its toxic effects.

In real production conditions and other types of activities, solid aerosols consisting of chemically inert substances (silicon dioxide SiO 2, aluminum oxide Al 2 O 3) enter the atmosphere of the working area.

Industrial dust is finely dispersed particles of solid matter suspended in the air for a long time. Dust can be: organic, inorganic and mixed. Negative consequences of the presence of dust in the air of the work area:

1. Dust can cause prof. diseases.

2. Dust (especially conductive dust) can disrupt the operation of equipment and technical means.

3. Dust can cause economic losses, because valuable substances fly away with dust particles.

Chemically inert substances, entering the human lungs, inactivate the respiratory centers - alveoli, and, ultimately, initiate pneumoconiosis - dust diseases.

Alveoli are a flask-shaped biological membrane, the neck of which in the crossbar is several micrometers. Dust entering with inhaled air mechanically injures the fabric of the neck due to sharp edges. At the site of the resulting scratch, a scar is formed, the volume of which is larger than the original tissue. Thus, gradually over a number of years, the diameter of the neck decreases and, ultimately, it becomes overgrown. This leads to the elimination of the respiratory center. With a decrease in the number of respiratory centers, oxygen starvation of the body gradually occurs - this disease is called pneumoconiosis.

3. Hygienic regulation of the content of toxic substances in the air.

The basis of legislation on the prevention of the toxic effects of substances is the system of maximum concentration limits for working air (mg/m 3 - in the Russian Federation, ppm and ppb - abroad).

4. Hygienic control of toxic substances in the air.

At enterprises, to carry out hygienic control of the content of toxic substances in the air of the working area, a plan of sampling sites is drawn up, approved by the chief engineer or the head of the enterprise in agreement with the SES.

The frequency of sampling for analysis is once a day, alternately during light and dark hours. The analysis of air samples is carried out by employees of the sanitary industrial laboratories of the enterprise and the SES. It can also be carried out by labor protection services and representatives of the enterprise administration.

Analysis methods:

Laboratory (chromatography, polarography, mass spectrometry, etc.) - have high accuracy and take a long time, require complex equipment and design, therefore they are used, as a rule, for inspection purposes;

Automatic - the use of automatic gas analyzers based on the physical principles of thermal conductometry, chromatography, etc.;

Express methods - most often used in industrial practice (for example, linear coloristic methods using indicator tubes).

5. basic measures to prevent the harmful effects of toxic substances in the air.

1. Replacement of toxic substances used in technological processes with less toxic ones.

2. The use of substances capable of dust formation in a paste or granular state.

3. Strict and precise compliance with technological regulations (maintenance of the technological process).

4. Sealing of equipment.

5. Rational, space-planning solution for industrial buildings (the hot shop should be located in a one-story building)

6. Rational placement of equipment (with high heat flows are located in separate buildings)

7. Application of means of automatic and remote control of processes (protection by distance).

8. Time protection – limiting working hours when in contact with harmful substances.

If the above methods do not give effect, then it is necessary to use ventilation of the room.

Ventilation classification:

According to the method of organizing air exchange, ventilation can be:

General exchange;

Local (fume hood, umbrella, on-board suction);

Combined.

Depending on the method of air movement:

Natural (due to different air densities at altitudes or temperatures inside and outside);

Mechanical (using fans);

Mixed.

Depending on the direction of air flow (air supply to or removal from the room):

Supply;

Hood;

Supply and exhaust.

If these methods do not have an effect, then it is necessary to use PPE. According to the method of protection, they are divided into means of protecting the body (overalls), respiratory tract (gas masks, respirators), skin (mittens, pastes).

Compensation for the harmful effects of toxic substances:

Special nutrition (adding substances to food that reduce harmful effects);

Half-holiday;

Additional leave (up to 36 days to the main one);

Providing free sanatorium and resort vouchers;

Increased tariff rate;

Shortened work experience.

All workers exposed to harmful toxic substances must undergo mandatory medical examinations on a regular basis.

Compliance with preventive measures reduces harm from exposure to toxic substances:

1. You should get a complete understanding of the drugs used: chemical name, pharmacological action, side effects, storage and use rules.

2. If possible, potential irritants should be replaced with harmless substances. Chemicals that have disinfectant properties can be replaced by cleaning agents and high temperature disinfection. They are equally or even more effective and are cheaper.

3. Use protective clothing: gloves, gowns, aprons, protective shields and goggles, shoe covers, masks and respirators. If rubber gloves cause dermatitis in people with hypersensitivity, you can wear silicone or polyvinyl chloride gloves with a cotton lining. Powders should only be handled with cotton gloves, but they do not protect the skin well when in contact with liquid chemicals. You should carefully study the guidelines on the use of certain protective equipment when working with toxic substances.

4. The preparation of disinfectant solutions must be carried out in specially equipped rooms with supply and exhaust ventilation.

5. Do not use topical medications with unprotected hands. Wear gloves or use a spatula.

6. You need to carefully care for the skin of your hands, treat all wounds and abrasions. It is better to use liquid soap. After washing, be sure to dry your hands well. Protective and moisturizing creams can help restore the skin's natural oil layer that is lost when exposed to certain chemicals.

7. In case of accidents, if the drug gets in:

In the eyes - immediately wash them with plenty of cold water;

Into the mouth - immediately rinse it with water;

On the skin - wash it off immediately;

For clothes - they change them.

8. Include training in professional safety issues in the training agenda.

9. Conduct detailed safety briefings in the workplace upon hiring;

10. High-quality preliminary and periodic preventive medical examinations.

Safety rules when working with mercury-containing equipment.

A medical thermometer may be broken during operation. The mercury itself quickly spreads into small balls and does no harm. Mercury vapor is dangerous!

Actions if a medical mercury thermometer breaks:

1. Put on a mask and rubber gloves.

2. Using a damp brush, collect the mercury balls into a scoop.

3. Transfer to a glass bottle with a stopper.

4. Rinse the area contaminated with mercury:

baking soda solution – per 1 liter of water – 100 grams; or a solution of potassium permanganate – per 1 liter of water – 50 grams; or a solution of iron sulfate per 1 liter of water - 3 grams.

5. Hand over the glass vial with the collected mercury to the person responsible for safety precautions.

6. Make an entry in the safety log about the accident.

7. Report the incident to the management of the institution where it happened.

8. Remove gloves, wash your hands with soap and warm water 2 times.

9. Remove the mask, wash your face with running water; nasal passages, oral cavity with a 0.5% baking soda solution.

10.Dip the mask and gloves into a container with a solution of 10% baking soda.

11.Have a conversation with students about the significance of the events being held.

7. Body biomechanics, ergonomics.

Nursing staff, providing care to seriously ill patients, are exposed to significant physical stress. Moving a patient in bed, propping up a bedpan, moving stretchers, gurneys, and sometimes heavy equipment can ultimately lead to spinal injury. Any rapid movement associated with moving a patient or a heavy object, any movement that is not physiological for the spine, increases the likelihood of injury. In addition, constant, even subtle “wrong”, non-physiological movements of the spine lead to injury, which will make itself felt over time.

Proper biomechanics when lifting weights are as follows:

Algorithm of actions:

1) before lifting weights, place your feet at a distance of 30 cm from each other, pushing one foot slightly forward. This ensures good support and reduces the risk of loss of balance and falling;

2) stand next to the person who will need to be lifted, so that you do not have to lean forward;

3).press the person being lifted towards you during the lifting process;

4) bend only the knees, lifting the person, keeping the torso in an upright position;

5) do not make sudden movements.

Ergonomics- a branch of science that studies the movements of the human body during work, energy expenditure and the productivity of specific human labor. Ergonomics is based on many disciplines from anatomy to psychology, and its main task is to create such working conditions for a person that would help maintain health, increase work efficiency, reduce fatigue, and simply maintain a good mood throughout the working day.

Participation in health education work among the population.

Health education is a mandatory section of the activities of every healthcare provider, a professional responsibility of every medical worker.

This is natural, since the role of the personal (behavioral) factor is great in preventing diseases and early seeking medical help. This factor affects the recovery time, the effectiveness of follow-up treatment and restoration of working capacity, and the prevention of exacerbation of diseases.

Sanitary educational work in a healthcare facility is a set of targeted sanitary and educational activities that provide for hygienic education of various populations and are organically related to the activities of a healthcare facility; it is carried out in accordance with local conditions and the tasks facing various types of healthcare facilities.

General management and control over the organization and conduct of sanitary education work is carried out by the chief physician of the healthcare institution, who works closely with the local sanitary education center, from where he receives methodological assistance and materials.

Each medical worker, in addition to conducting individual conversations with patients and their relatives in the process of providing treatment and preventive care, is obliged to spend 4 hours of his working time every month on conducting group and mass forms of sanitary educational work.

There are 3 main parts in sanitary educational work: health education in the clinic, hospital and on site.