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«FICHA TÉCNICA Título Segurança e Higiene Ocupacionais - SHO 2012 - Livro de Resumos Autores/Editores Arezes, P., Baptista, J.S., Barroso, M.P., ...»

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Na primeira etapa procedeu-se à aplicação de um questionário que permitiu a recolha de dados gerais e biográficos da amostra, informação sobre os incidentes de trabalho, identificação de queixas e sintomatologia de LMERT (através do Questionário Nórdico adaptado), percepção do risco de desenvolvimento de LMERT e das condições de trabalho.

Aplicou-se ainda o Índice de MAPO (Movement and Assistance of Hospital Patients) (Battevi et al., 2006), que permitiu identificar o nível de risco de LMERT para a região lombar, associado às actividades de movimentação e transferência de doentes, risco este calculado com base no número de doentes dependentes e de operadores, espaço das casas de banho e presença de obstáculos, espaço entre camas, espaço entre camas e paredes, existência, adequação e características de equipamentos, assim como, treino e formação dos profissionais relativamente ao uso desses equipamentos.

Na segunda etapa aplicou-se o método observacional REBA (Rapid Entire Body Assessment) (Hignett e McAtamney, 2000), que é um método qualitativo de análise de risco postural que inclui a estimativa da força, da carga e do tipo de pega, para aplicação a todo o corpo. Analisaram-se as actividades potencialmente predicativas de maior risco de LMERT.

3. RESULTADOS E DISCUSSÃO Da análise dos resultados salienta-se que a prevalência de queixas e sintomatologia de LMERT é elevada em ambas as classes profissionais. No entanto, verificou-se que a ocorrência de acidentes no trabalho tem maior incidência na classe profissional de ajudantes/auxiliares. Como consequência dos acidentes de trabalho perderam-se 972 dias de trabalho. Os acidentes por queda (37,5%), juntamente com as LMERT (37,5%), estão no topo da lista de causas de absentismo.

Relativamente à auto-percepção dos factores de risco para o desenvolvimento de LMERT e a associação dos mesmos com o local de trabalho e as actividades realizadas, os enfermeiros e ajudantes/auxiliares inquiridos, mencionam os seguintes factores como predicativos: escassez de espaços de trabalho; inexistência de material e equipamentos auxiliares para ajudar nas actividades que requerem maior esforço físico; superfícies de trabalho demasiado altas ou baixas; camas, cadeirões entre outros equipamentos difíceis de movimentar; mobilização e posicionamento manual de doentes;

transporte e movimentação manual de equipamentos e de doentes; movimentação manual de objectos diversos; alcançar e sustentar peso (objectos e ou pessoas) afastados do corpo; armazenamento de objectos pesados em locais demasiados altos ou baixos; pouca rotação dos trabalhadores entre as tarefas de maior exigência física; inexistência de pausas de trabalho sempre que necessário; e, muitas vezes, as camas, cadeiras de rodas, cadeirões apresentam rodas em mau estado e de muito difícil intervenção.

A presença de queixas músculo-esqueléticas auto-referidas, dor e/ou parestesias, desconforto músculo-esquelético, nos últimos 12 meses foi manifestada por 91,6% dos inquiridos, sendo que 13,9% dos inquiridos fica impedida de realizar funções. Quanto à distribuição por regiões anatómicas, verificou-se que a parte inferior e superior das costas (66,7% e 58,3%, respectivamente), ombros (44,4%) e punhos/mãos (47,2%) foram as regiões mais afectadas.

A dor nos últimos 7 dias, sintomatologia músculo-esquelética mais frequente nestes grupos profissionais, quando avaliada numa escala de 0 a 10, encontra-se presente em todas as regiões anatómicas, sendo a parte inferior das costas a que apresenta o valor médio mais elevado (3,2); seguido da parte superior das costas (2,8) e dos punhos/mãos (2,4).

Após o cálculo do índice MAPO, o valor obtido foi de 4,76, o que indica que o risco é moderado, pelo que se deve considerar uma intervenção a médio e longo prazo.

A aplicação do método REBA, cuja escala varia entre 1 e 15, permitiu a avaliação rápida das actividades potenciais para o risco de LMERT, realizadas pelos enfermeiros e ajudantes/auxiliares. Os resultados de aplicação do método REBA encontram-se apresentados na Figura 1. Estes resultados, decorrentes da análise das diferentes actividades, variam entre 4 e 11, representando níveis de risco médio (4 a 7) a muito alto (11 a 15), sendo que a maioria e a média dos resultados se encontram no nível de risco alto (8 a 10).

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A análise estatística descritiva permitiu concluir que não existe uma associação estatisticamente significativa entre a variável queixas e sintomatologia músculo-esquelética e a idade (α = 0,77) e o tempo na profissão (α = 0,47). A análise demonstrou, ainda, existir uma associação estatisticamente significativa entre a variável queixas e sintomatologia músculo-esquelética e a carga horária semanal (α = 0,02). O valor da correlação de Pearson é (ρ = 0,52), o que demonstra ser uma correlação moderada positiva, isto é, quanto maior a carga horária, maior o número de colaboradores com queixas e sintomatologia músculo-esquelética.

Tendo em consideração a análise de riscos efectuada, identificaram-se as medidas de segurança destinadas à redução e prevenção dos riscos profissionais associados às LMERT. Tais medidas encontram-se hierarquizadas de acordo com a Lei n.º 109/2009 de 10 de Setembro, a Norma Portuguesa 4397:2008 e a BS 8800:2004.





Na Tabela 1 apresentam-se as medidas de segurança propostas.

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4. CONCLUSÕES Existe vasta literatura referindo que os enfermeiros e os ajudantes/auxiliares de enfermagem são classes profissionais que, devido à especificidade das funções que têm a seu cargo, apresentam risco efectivo de desenvolvimento de LMERT.

O presente trabalho descreve um estudo, realizado a uma amostra de 36 indivíduos que trabalham numa unidade de saúde de medicina física e reabilitação, que combinou diversas metodologias. Os resultados deste estudo permitiu identificar, no contexto de trabalho analisado, a existência de níveis de risco médio a muito alto, que impunham a necessidade de se desenvolver uma intervenção planeada a curto/médio prazo destinada a prevenir a ocorrência de lesões músculoesqueléticas relacionadas com o trabalho.

5. REFERÊNCIAS Alexandre, N. M. C e Rogante, M. M. (2000). Movimentação e transferência de pacientes: aspectos posturais e ergonômicos.

Rev.Esc.Enf.USP, 34 (2), 165-173 Battevi, N., Menoni, O., Ricci, M., & Cairoli, S. (2006). MAPO index for risk assessment of patient manual handling in hospital wards: a validation study. Ergonomics, 49(7), 671-687 BS 8800 (2004) – Guide to occupational health and safety management systems. Bristish Standards Institutions (BSI) Castro, A. B. (2004). Handle with care: The American Nurses Association´s campaign to address work-related musculoskeletal disorders. Online Journal of Issues in Nursing, 9(3), 103-118 Daraiseh N, Genaidy AM, Karwowski W, Davis LS, Stambough J, Huston RI. (2003). Musculoskeletal outcomes in multiple body regions and work effects among nurses: the effects of stressful and stimulating working conditions. Ergonomics. 46 (12), 1178-1199 Hignett, S., Mcatamney, L. (2000). Rapid entire body assessment (REBA). Applied Ergonomics, 31(2), 201-205 Lei n.º 102/2009, de 10 de Setembro, Diário da República, 1.ª série - N.º 176, 6167-6192 NP 4397 (2008). Norma Portuguesa para Sistemas de gestão da segurança do trabalho. Instituto Português da Qualidade, 1-26 OSHA (2009). Guidelines for Nursing Homes. Disponível online em http://www.osha.gov/ergonomics/guidelines/nursinghome/final_nh_guidelines.html. U.S. Department of Labor of Occupational Safety and Health Administration Integrated Management Systems: On the path to maturity and efficiency assessment Domingues, Pedroa,b, Sampaio, Paulob, Arezes, Pedrob a Laboratório Químico Marques Ferreira, Rua Max Grundig, Ferreiros, Braga, Portugal. E-mail: pedrodomin@sapo.pt b University of Minho, Production and Systems Department, Guimarães, Portugal.;

E-mail: paulosampaio@dps.uminho.pt and parezes@dps.uminho.pt

1. INTRODUCTION Integrated management systems (IMS) subject had been addressed by several authors since the early nineties of the last century, mainly due to the ISO 14001 release and the potential synergies that could be developed with ISO 9001 standard (published in middle eighties). Recently, Asif et al. (2010) proposed a novel systematization scheme regarding IMS focused literature. On a national level, several papers have been published focusing IMS, namely those authored by Santos et al. (2011), Sampaio et al. (2010, 2011) and Domingues et al. (2010a,b, 2011a-e). Sampaio and Saraiva (2011) published the latest Portuguese data related to IMS (Figure 1 and 2). Those results show that the majority of the organizations with an IMS are located at the North, Centre and Lisbon regions. Regarding the IMS typology it seems possible to conclude that ISO 9001+ISO 14001 and ISO 9001+ISO 14001+OHSAS 18001/NP 4397 are the most reported options.

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Maturity assessment regarding products or systems had been described in several papers and it is currently a widely accepted methodology to comparatively ascribe an evolutionary level to the focus item. Thus, maturity models enable to pinpoint the way to go (and which requirements should be complied) in order to achieve an ultimate and last excellence level. Khoshgoftar and Osman (2009) summarized the main characteristics of the most reported maturity models.

Domingues et al. (2011e) reported a framework proposal regarding IMS maturity assessment based on published papers (Table 1) and Idrogo et al. (2011) a model focused on SMEs. Maturity model development, due to its comparative and empirical nature, should rely mostly on data collected from the focus item. It is intended that the current paper report preliminary raw results from an ongoing project focusing the maturity and efficiency levels assessment of IMS.

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2. MATERIALS AND METHODS

An online survey with 30 questions, based on a questionnaire, was held focusing Portuguese organizations with more than one certified management sub-system according to the following standards: ISO 9001, ISO 14001 and OHSAS 18001/NP 4397. The survey was conceptually supported on a Likert type scale, categorical and multiple option answers.

A pre-test performed on three companies was used to validate the questionnaire (Table 2). The results reported in the present paper were supported on 52 validate answers given by management systems managers.

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3. RESULTS AND DISCUSSION

3.1. Surveyed Organizations Characterization Figures 1 to 6 summarize the parameters chosen to characterize the surveyed organizations. Geographic location of sampled organizations (Figure 3) matches Portuguese certified organizations reality (Figure 1). Regarding to IMS typology (Figure 5) the correspondence is not so clear considering data reported on Figure 2. Figure 4 report the results regarding to organizations dimension (nº of employees). Santos et al. (2011) reported that Portuguese industry consists mainly of SMEs, making up 75% of the total labour force. Thus, at the moment, the surveyed organizations do not match the Portuguese reality being organizations dimension, related to nº of employees, higher than 100 workers (Figure 4).

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3.2. Motivations, Benefits and Obstacles Internal or mainly internal motivations, benefits and obstacles were reported by organizations related to the integration process (Table 3). Several authors classified internal motivations as the true ones enhancing and promoting the most beneficial organizational outputs. Improvement of the organizational performance has been identified on companies mainly driven by internal motivations. Companies driven by external or mainly external motivations experienced higher external acceptance improvement and external requirements compliance but a positive correlation with internal improvement performance on their processes had not being reported.

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3.3. Integration Sequence and Audits Typology An All-In or Step by Step (sequential) integration sequences were identified earlier in literature review. Results presented at Figure 7 suggest that a Step by Step integration sequence has been the option chosen by almost 65% of the sampled companies. This fact could be related to the company life cycle, that is the availability of management sub-systems standards at the moment when the decision to proceed with integration process was assumed. A Step by Step integration sequence and its organizational outputs have been addressed elsewhere (Domingues et al., 2011d). Hence, decision degrees of freedom were lesser to companies which decided management systems certification when a single standard had been released. When performing an audit under an IMS context several strategies could be followed, namely, sequential, overlapped, simultaneous or integrated. The nature of these strategies could be found in more detail at Domingues et al., (2011c). Overlapped audits have not been reported by any of the sample companies as we may see in Figure 8. Reported audits typologies were integrated (75%), simultaneous (21%) and sequential (4%).

Figure 8- Audit typology Figure 7- Integration sequence

4. CONCLUSIONS Methodologically supported in an online survey, the current study used a sample of companies that matches Portuguese geographical distribution organizations and IMS typology distribution. Company dimension (nº of employees) and activity sectors are partially reproduced by the surveyed companies comparing with the last available data. Internal or mainly internal motivations, benefits and obstacles before, during and after integration process were reported by the majority of companies. A Step by Step integration sequence and integrated audits seem to be the current strategies followed by IMS ruled companies. Regarding first framework proposal (Table 1), some adjustment on relative level location of some KPA’s should be considered.

5. REFERENCES Domingues, J. P. T., Sampaio, P. & Arezes, P. (2010a). Integrated Management Systems: a synergistic approach. Proceedings of 13th Toulon-Verona Confeence, Coimbra, Portugal (pp. -). Published on CD.



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