Made available in DSpace on 2014-06-11T19:33:31Z (GMT). No. of bitstreams: 0 Previous issue date: 2008-07-23Bitstream added on 2014-06-13T18:45:18Z : No. of bitstreams: 1 magagnini_mam_me_botfm.pdf: 799353 bytes, checksum: ab2a1f8d6a820443033187b7b925857d (MD5) / Fundação para o Desenvolvimento Médico e Hospitalar (Famesp) / Secretaria de Saúde do Estado de São Paulo / O presente estudo teve como objetivos caracterizar os profissionais da equipe de enfermagem que sofreram acidentes com material biológico no período de 2001 a 2006; verificar a ocorrência de soroconversão pelos vírus da hepatite B e C e HIV por meio de exames comprobatórios e compreender o significado dos acidentes de trabalho com material biológico atribuído pelos profissionais. Estudo exploratório e descritivo de caráter retrospectivo, com abordagem quantitativa e qualitativa. No período estudado ocorreram 87 acidentes com material biológico entre os profissionais da equipe de enfermagem. Pela análise quantitativa verificou-se a maior ocorrência de acidentes nos anos de 2003, 2005 e 2006, nas unidades de Clínica médico-Cirúrgica e Pronto Socorro. Ao analisarmos os dados relacionados ao sexo, o feminino, foi o mais acometido, sendo este em maior número na instituição, pela a análise proporcional ao número total de trabalhadores, o masculino destacou-se. Empregando o mesmo cálculo, o enfermeiro foi o que mais se acidentou proporcionalmente ao número de profissionais por categoria. A lesão percutânea predominou nos acidentes, envolvendo o sangue. Em relação aos EPIs a maioria dos profissionais faziam uso no momento da exposição. Ocorreram oito acidentes com pacientes comprovados para hepatite B e C e HIV, após o seguimento desses profissionais não houve soroconversão. Ao indagar esses profissionais sobre o significado dos acidentes, emergiram quatro categorias: situação de risco, percepção de perigo, fatalidade e sentimentos envolvidos após a exposição; que permitiram correlacionar as unidades temáticas ao profissional e a organização de trabalho. Os acidentes constituiram-se em um agravo sério a esses profissionais, e permitiram uma reflexão, por parte destes, no desempenho de suas funções... / This study aimed at characterizing nursing team professionals who had suffered accidents involving biological material in the period ranging from 2001 to 2006; observing the occurrence of serum conversion by the hepatitis-B and hepatitis-C viruses and HIV through confirmatory tests and understanding the meaning of labor accidents involving biological material to such professionals. It is an exploratory, descriptive and retrospective study with a quantitative and qualitative approach. Eighty-seven accidents involving biological material occurred among nursing team professionals in the period. According to quantitative analysis, it was observed that most accidents took place in 2003, 2005 and 2006 at the medical surgery clinic and emergency units. When analyzing sex-related data, it was found that females were mostly affected as there was a larger number of female staff in the institution. The numbers of males affected was distinctive when a proportional analysis on the total numbers of staff was conducted. By using similar calculation procedures, nurses were mostly victimized by accidents proportionally to the number of professionals in each category. Percutaneous lesions predominated in the accidents involving blood. As regards individual protection equipment (IPE), most professionals were using it at the moment of exposure. Eight accidents involving patients with confirmed diagnoses for B and C hepatitis and HIV occurred. Serum conversion was not observed after the professionals’ follow-up. When the professionals were questioned about the meaning of the accidents, four categories emerged: risk situation, perception of danger, fatality and feelings involved after the exposure, which made it possible to correlate the meaning units to the professionals and the work organization. The accidents constituted a serious damage to these professionals and enabled... (Complete abstract, click electronic access below)

The most commonly used exposure assessment for heat stress is based on Wet Bulb Globe Temperature (WBGT), and the limits are based on empirical relationships that demonstrate a sustainable exposure. The ISO 7933 (2017) describes Predicted Heat Strain (PHS), which is a rational model for heat stress assessment that is used to assess time-limited exposures. Investigators have examined PHS validity under a variety of time-limited conditions. The purpose of this paper is to evaluate if PHS can predict sustainable exposures. The data used for this study were from two previous heat stress studies using a progressive heat stress protocol. The studies included 29 participants wearing four different ensembles (woven clothing, particle barrier, water barrier, and vapor barrier coveralls) at three levels of metabolic rate and relative humidity. Each trial provided data for a fully compensable (sustainable) exposure and an uncompensable (time-limited) exposure. The heat stress data from each condition were used to see if PHS demonstrated a steady-state response indicating a sustainable exposure. From the analysis, the sensitivity and specificity respectively for the ensemble types were: 1.00 and 0.18 for woven clothing, 0.95 and 0.60 for particle barrier, 0.91 and 0.83 for water barrier, 0.91 and 0.80 for vapor barrier, and 0.94 and 0.65 for all ensembles. The data show that while the sensitivity of PHS (correctly identifying unsustainable conditions) is good for the different ensembles, PHS specificity (correctly identifying sustainable exposures) was weak. From an occupational health and safety perspective, using PHS to identify sustainable exposures leads to protective decisions.

As repercussões do trabalho na vida e na saúde do Homem há muito vêm sendo objeto de estudo na história da humanidade. No Brasil esta questão necessita ser melhor compreendida, principalmente após as recentes mudanças ocorridas na Constituição, onde observamos uma atenção maior ao capítulo da Saúde e, em especial, à Saúde do Trabalhador. A municipalização da saúde impõe mudanças profundas no lidar com estas questões. A informação fidedigna é pré-requisito básico para a efetivação de ações que visem a prevenção e a promoção de saúde. Para tanto delineamos como objeto de nosso trabalho o estudo da dinâmica da Comunicação do Acidente do Trabalho no município de Ribeirão Preto, no ano de 1996. Elegemos como método investigativo o estudo descritivo transversal da trajetória da notificação do Acidente do Trabalho e de suas repercussões, traçando um paralelo entre este sistema de notificação compulsória e o sistema utilizado pelo Serviço de Vigilância Epidemiológica, também compulsório. Os dados foram obtidos através da análise de documentos e da aplicação de entrevista semi-estruturada com representantes de todos os serviços envolvidos com o Acidente do Trabalho no município. Verificamos que na prática, apesar do preconizado legalmente, as transformações necessárias não foram efetivamente implementadas. O Sistema de Informações em Saúde do Trabalhador apresenta-se incompleto, persistindo um fluxo de Comunicações de Acidentes do Trabalho (CATs) fragmentado, não permitindo o desencadeamento de ações preventivas e de controle dos agravos. Ações conjuntas entre os níveis de atuação possíveis inexistem, não havendo uma interface entre as instituições. Em razão da precariedade das informações e da atual organização destes serviços, fica inviabilizada a execução de estudos epidemiológicos, diferentemente do que ocorre no sistema utilizado pelos Serviços de Vigilância Epidemiológica municípal. Faz-se necessário o enfrentamento desta problemática, de maneira a permitir a transformação do sistema de notificação dos Acidentes do Trabalho em instrumento eficaz à prevenção e à promoção de saúde. / The effect of work in the Man’s life and health has from long been object of studies in the human kind history. In Brazil, this point must be better understood, mainly after the recent changes occurred in the Brazilian Constitution, where we can see a greater attention to the Workman’s Health. The municipalization of the Health Service urges deep changes to deal with these items. The reliability of information is a basic pre-requisite for the rendering of actions the aim the prevention of diseases and the promotion of health. For this purpose, the object of our research is the study of the dynamics of the Communication of the Work Accident, in Ribeirão Preto, in the year of 1996. We chose as a researching method the transversal descriptive study of the process of notification of the work accident and its effects, comparing this type of compulsory notification with the as well compulsory system used by the Epidemiology Vigilance Service. The data was obtained upon the analysis of documents and the application of semi-structured interview with representatives of all the services involved with Work Accident in this town. We could observed that, in fact, despite legally advocated, the necessary changes were not effectively implemented. The Information System of the Workman Health Care shows incomplete, with a fragmented flux of Work Accidents Communications (WACs) what hinders the development of preventive actions, and the control of damages. No joiner proceedings are held between institutions. Due to the precariousness of information and to the present organization of this service, evident is the unfeasibility of the execution of epidemiologic studies, different from what happens in the system used by the Municipal Epidemiology Service. It’s urgent, therefore, to face this problem, in order to transform the system of notification of work accidents into an efficient instrument of health promotion and prevention.

As repercussões do trabalho na vida e na saúde do Homem há muito vêm sendo objeto de estudo na história da humanidade. No Brasil esta questão necessita ser melhor compreendida, principalmente após as recentes mudanças ocorridas na Constituição, onde observamos uma atenção maior ao capítulo da Saúde e, em especial, à Saúde do Trabalhador. A municipalização da saúde impõe mudanças profundas no lidar com estas questões. A informação fidedigna é pré-requisito básico para a efetivação de ações que visem a prevenção e a promoção de saúde. Para tanto delineamos como objeto de nosso trabalho o estudo da dinâmica da Comunicação do Acidente do Trabalho no município de Ribeirão Preto, no ano de 1996. Elegemos como método investigativo o estudo descritivo transversal da trajetória da notificação do Acidente do Trabalho e de suas repercussões, traçando um paralelo entre este sistema de notificação compulsória e o sistema utilizado pelo Serviço de Vigilância Epidemiológica, também compulsório. Os dados foram obtidos através da análise de documentos e da aplicação de entrevista semi-estruturada com representantes de todos os serviços envolvidos com o Acidente do Trabalho no município. Verificamos que na prática, apesar do preconizado legalmente, as transformações necessárias não foram efetivamente implementadas. O Sistema de Informações em Saúde do Trabalhador apresenta-se incompleto, persistindo um fluxo de Comunicações de Acidentes do Trabalho (CATs) fragmentado, não permitindo o desencadeamento de ações preventivas e de controle dos agravos. Ações conjuntas entre os níveis de atuação possíveis inexistem, não havendo uma interface entre as instituições. Em razão da precariedade das informações e da atual organização destes serviços, fica inviabilizada a execução de estudos epidemiológicos, diferentemente do que ocorre no sistema utilizado pelos Serviços de Vigilância Epidemiológica municípal. Faz-se necessário o enfrentamento desta problemática, de maneira a permitir a transformação do sistema de notificação dos Acidentes do Trabalho em instrumento eficaz à prevenção e à promoção de saúde. / The effect of work in the Man’s life and health has from long been object of studies in the human kind history. In Brazil, this point must be better understood, mainly after the recent changes occurred in the Brazilian Constitution, where we can see a greater attention to the Workman’s Health. The municipalization of the Health Service urges deep changes to deal with these items. The reliability of information is a basic pre-requisite for the rendering of actions the aim the prevention of diseases and the promotion of health. For this purpose, the object of our research is the study of the dynamics of the Communication of the Work Accident, in Ribeirão Preto, in the year of 1996. We chose as a researching method the transversal descriptive study of the process of notification of the work accident and its effects, comparing this type of compulsory notification with the as well compulsory system used by the Epidemiology Vigilance Service. The data was obtained upon the analysis of documents and the application of semi-structured interview with representatives of all the services involved with Work Accident in this town. We could observed that, in fact, despite legally advocated, the necessary changes were not effectively implemented. The Information System of the Workman Health Care shows incomplete, with a fragmented flux of Work Accidents Communications (WACs) what hinders the development of preventive actions, and the control of damages. No joiner proceedings are held between institutions. Due to the precariousness of information and to the present organization of this service, evident is the unfeasibility of the execution of epidemiologic studies, different from what happens in the system used by the Municipal Epidemiology Service. It’s urgent, therefore, to face this problem, in order to transform the system of notification of work accidents into an efficient instrument of health promotion and prevention.

O objeto deste estudo trata do impacto do ambiente de trabalho no processo de saúde-doença dos trabalhadores de enfermagem de uma unidade ambulatorial especializada da cidade do Rio de Janeiro. Os objetivos foram: identificar os riscos ocupacionais no ambiente laboral dos trabalhadores de enfermagem da unidade em estudo; descrever a percepção do trabalhador de enfermagem sobre os impactos dos riscos ocupacionais em sua saúde; analisar o ambiente laboral destes trabalhadores com vistas à identificação de fatores de riscos que interferem negativamente na saúde; propor medidas de prevenção para minimização de impactos negativos na saúde dos mesmos, com destaque para a elaboração do Mapa de Riscos. Como suporte teórico, foram abordados conceitos e pressupostos relacionados às doenças do trabalho e sua relação com riscos ocupacionais, contextualizando-os com a configuração do mundo do trabalho em saúde, sua organização e processo laboral, assim como as vivências de prazer e sofrimento que podem alterar a saúde dos trabalhadores. Pesquisa exploratória e descritiva, de natureza qualitativa. Os sujeitos foram 40 trabalhadores de enfermagem, incluindo enfermeiros, técnicos e auxiliares de enfermagem. Os instrumentos de coleta foram a entrevista semiestruturada e a observação não participante, aplicados entre março/abril e junho/setembro de 2011, respectivamente. E cruzando as informações coletadas a partir dos dois instrumentos, buscou-se captar dados que possibilitasse a elaboração do Mapa de Risco dos setores com mais problemas em termos de deixar vulnerável a saúde dos trabalhadores, sendo elaborado Mapa de Risco da UCAMB e da CME. Enfatiza-se que houve assinatura prévia do Termo de Consentimento Livre e Esclarecido e que a pesquisa foi aprovada pelo comitê de ética do Hospital Universitário Pedro Ernesto sob número de protocolo 2528. O método de análise escolhido foi do tipo: análise temática de conteúdo, o qual possibilitou o surgimento de três categorias: riscos ocupacionais visíveis e invisíveis para o trabalhador de enfermagem; o processo de adoecimento do trabalhador no e pelo trabalho; melhorias das condições de trabalho: contribuições para proteção da saúde dos trabalhadores. Os resultados evidenciaram que o risco mais freqüentemente revelado foi de acidente, principalmente por materiais perfurocortantes, seguidos de exposição aos riscos biológicos. Porém, houve sujeitos que não perceberam a presença dos riscos ou reduziam a gravidade dos mesmos para o processo saúde-doença. As repercussões dos riscos ocupacionais no corpo dos trabalhadores foram identificadas como: estresse, varizes e distúrbios osteomusculares. Algumas sugestões elaboradas pelos sujeitos para a melhoria das condições de trabalho foram: realização de reformas estruturais, modernização dos equipamentos, incremento quantitativo dos recursos humanos, melhoria na organização do trabalho, implementação de um Núcleo da Saúde do Trabalhador. Considera-se que os objetivos deste estudo foram atingidos, no entanto, existe a clareza de que há muito a ser pesquisado sobre riscos ocupacionais e suas repercussões nos trabalhadores, assim como as intervenções necessárias para a prevenção e promoção da saúde do trabalhador. Sugerem-se novas pesquisas, como também repensar nas estratégias de ensino de formação dos trabalhadores de enfermagem, e também se faz relevante a participação da categoria em movimentos sociais para a construção de políticas públicas nesta área. / The investigation object of this study approaches the impact of workplace at nursing worker's health at a specialized ambulatory unit in Rio de Janeiro city. The objectives were: to identify occupational hazard at the workplace of nursing workers in such study site; to describe nurses perception about impacts of occupational hazards in their health; to analyze their workplace in order to identify risk factors which negatively interfere in health; to propose prevention measures in order to minimize negative impacts in their health, highlighting the elaboration of a Risk Map. As theoretical support concepts and conjectures were approached related to labor disease and its relation to the occupational hazards, contextualizing them with the configuration at the universe of health work, its organization and the labour process, as well as experiences of pleasure and suffering that can alter workers health conditions. The study was supported by Taylors current labor concepts, seeking to understand transformations that occurred at the work process, as well as experiences such as suffering-pleasure generated at work. It is a descriptive-exploratory research type, qualitative nature, developed at PPC, after approval from Ethics Committee. The subjects were 40 nursing professionals, including nurses, technicians and aid nurses. Sample tools were semi-structured interviews and non participant observation, applied between march/april and june/september, 2011 respectively. And crossing information sampled from two tools, in order to obtain data it turned possible the elaboration of the Risk Map from the part of sectors concentrating more problems in terms of letting vulnerable workers' health, and it has elaborated UCAMB and CME Risk Map. It's important to highlight that there was previous signature from the Informed Consent and this research has been approved by the Ethics Committee of Pedro Ernesto Hospital under protocol number 2528. The analysis method chosen was thematic content analysis, which has given rise to three categories: occupational hazards which are visible and invisible to the nursing worker; the process of disease in the worker because of work; improvement in working conditions: contributions in order to protect worker's health. Results have evidenced that the most frequently revealed risk was of accident, mainly by sharps injury material, followed by exposure to biological risks. However, there were subjects who didn't realize the presence of such risks because of misled view of ambulatory environment, by lack of critical view of work process and by bluntness of its critical and analysis ability due to excess of work. The repercussion of occupational hazards at the workers bodies were identified as stress, osteomuscular varicose veins disorders. Workers have pointed out some suggestions in terms of working conditions improvement, namely: accomplishment of new structure reformation, equipment update, quantitative human resources improvement, working organization improvement, implementation of Worker's Health Center. We consider that the objectives of this study were properly achieved, however, its clear that there is much more to be investigated concerning to occupational hazards and its repercussion on workers, as well as necessary intervention to prevent and promote workers health. It's also necessary a continuous investment on the development of scientific activities must be highlighted, once its important to have positive paradigmatic changes in nursery research. New researches can be suggested, as well as rethinking nursing formation teaching strategies, and it is also relevant to obtain participation from the part of the category into social actions towards the construction of public policies in this field.

Orientador: Jairo Aparecido Ayres / Banca: Heloisa Wey Berti / Banca: Maria Belén Salazar Posso / Resumo: O presente estudo teve como objetivos caracterizar os profissionais da equipe de enfermagem que sofreram acidentes com material biológico no período de 2001 a 2006; verificar a ocorrência de soroconversão pelos vírus da hepatite B e C e HIV por meio de exames comprobatórios e compreender o significado dos acidentes de trabalho com material biológico atribuído pelos profissionais. Estudo exploratório e descritivo de caráter retrospectivo, com abordagem quantitativa e qualitativa. No período estudado ocorreram 87 acidentes com material biológico entre os profissionais da equipe de enfermagem. Pela análise quantitativa verificou-se a maior ocorrência de acidentes nos anos de 2003, 2005 e 2006, nas unidades de Clínica médico-Cirúrgica e Pronto Socorro. Ao analisarmos os dados relacionados ao sexo, o feminino, foi o mais acometido, sendo este em maior número na instituição, pela a análise proporcional ao número total de trabalhadores, o masculino destacou-se. Empregando o mesmo cálculo, o enfermeiro foi o que mais se acidentou proporcionalmente ao número de profissionais por categoria. A lesão percutânea predominou nos acidentes, envolvendo o sangue. Em relação aos EPIs a maioria dos profissionais faziam uso no momento da exposição. Ocorreram oito acidentes com pacientes comprovados para hepatite B e C e HIV, após o seguimento desses profissionais não houve soroconversão. Ao indagar esses profissionais sobre o significado dos acidentes, emergiram quatro categorias: situação de risco, percepção de perigo, fatalidade e sentimentos envolvidos após a exposição; que permitiram correlacionar as unidades temáticas ao profissional e a organização de trabalho. Os acidentes constituiram-se em um agravo sério a esses profissionais, e permitiram uma reflexão, por parte destes, no desempenho de suas funções... (Resumo completo, clicar acesso eletrônico abaixo) / Abstract: This study aimed at characterizing nursing team professionals who had suffered accidents involving biological material in the period ranging from 2001 to 2006; observing the occurrence of serum conversion by the hepatitis-B and hepatitis-C viruses and HIV through confirmatory tests and understanding the meaning of labor accidents involving biological material to such professionals. It is an exploratory, descriptive and retrospective study with a quantitative and qualitative approach. Eighty-seven accidents involving biological material occurred among nursing team professionals in the period. According to quantitative analysis, it was observed that most accidents took place in 2003, 2005 and 2006 at the medical surgery clinic and emergency units. When analyzing sex-related data, it was found that females were mostly affected as there was a larger number of female staff in the institution. The numbers of males affected was distinctive when a proportional analysis on the total numbers of staff was conducted. By using similar calculation procedures, nurses were mostly victimized by accidents proportionally to the number of professionals in each category. Percutaneous lesions predominated in the accidents involving blood. As regards individual protection equipment (IPE), most professionals were using it at the moment of exposure. Eight accidents involving patients with confirmed diagnoses for B and C hepatitis and HIV occurred. Serum conversion was not observed after the professionals' follow-up. When the professionals were questioned about the meaning of the accidents, four categories emerged: risk situation, perception of danger, fatality and feelings involved after the exposure, which made it possible to correlate the meaning units to the professionals and the work organization. The accidents constituted a serious damage to these professionals and enabled... (Complete abstract, click electronic access below) / Mestre

O objeto deste estudo trata do impacto do ambiente de trabalho no processo de saúde-doença dos trabalhadores de enfermagem de uma unidade ambulatorial especializada da cidade do Rio de Janeiro. Os objetivos foram: identificar os riscos ocupacionais no ambiente laboral dos trabalhadores de enfermagem da unidade em estudo; descrever a percepção do trabalhador de enfermagem sobre os impactos dos riscos ocupacionais em sua saúde; analisar o ambiente laboral destes trabalhadores com vistas à identificação de fatores de riscos que interferem negativamente na saúde; propor medidas de prevenção para minimização de impactos negativos na saúde dos mesmos, com destaque para a elaboração do Mapa de Riscos. Como suporte teórico, foram abordados conceitos e pressupostos relacionados às doenças do trabalho e sua relação com riscos ocupacionais, contextualizando-os com a configuração do mundo do trabalho em saúde, sua organização e processo laboral, assim como as vivências de prazer e sofrimento que podem alterar a saúde dos trabalhadores. Pesquisa exploratória e descritiva, de natureza qualitativa. Os sujeitos foram 40 trabalhadores de enfermagem, incluindo enfermeiros, técnicos e auxiliares de enfermagem. Os instrumentos de coleta foram a entrevista semiestruturada e a observação não participante, aplicados entre março/abril e junho/setembro de 2011, respectivamente. E cruzando as informações coletadas a partir dos dois instrumentos, buscou-se captar dados que possibilitasse a elaboração do Mapa de Risco dos setores com mais problemas em termos de deixar vulnerável a saúde dos trabalhadores, sendo elaborado Mapa de Risco da UCAMB e da CME. Enfatiza-se que houve assinatura prévia do Termo de Consentimento Livre e Esclarecido e que a pesquisa foi aprovada pelo comitê de ética do Hospital Universitário Pedro Ernesto sob número de protocolo 2528. O método de análise escolhido foi do tipo: análise temática de conteúdo, o qual possibilitou o surgimento de três categorias: riscos ocupacionais visíveis e invisíveis para o trabalhador de enfermagem; o processo de adoecimento do trabalhador no e pelo trabalho; melhorias das condições de trabalho: contribuições para proteção da saúde dos trabalhadores. Os resultados evidenciaram que o risco mais freqüentemente revelado foi de acidente, principalmente por materiais perfurocortantes, seguidos de exposição aos riscos biológicos. Porém, houve sujeitos que não perceberam a presença dos riscos ou reduziam a gravidade dos mesmos para o processo saúde-doença. As repercussões dos riscos ocupacionais no corpo dos trabalhadores foram identificadas como: estresse, varizes e distúrbios osteomusculares. Algumas sugestões elaboradas pelos sujeitos para a melhoria das condições de trabalho foram: realização de reformas estruturais, modernização dos equipamentos, incremento quantitativo dos recursos humanos, melhoria na organização do trabalho, implementação de um Núcleo da Saúde do Trabalhador. Considera-se que os objetivos deste estudo foram atingidos, no entanto, existe a clareza de que há muito a ser pesquisado sobre riscos ocupacionais e suas repercussões nos trabalhadores, assim como as intervenções necessárias para a prevenção e promoção da saúde do trabalhador. Sugerem-se novas pesquisas, como também repensar nas estratégias de ensino de formação dos trabalhadores de enfermagem, e também se faz relevante a participação da categoria em movimentos sociais para a construção de políticas públicas nesta área. / The investigation object of this study approaches the impact of workplace at nursing worker's health at a specialized ambulatory unit in Rio de Janeiro city. The objectives were: to identify occupational hazard at the workplace of nursing workers in such study site; to describe nurses perception about impacts of occupational hazards in their health; to analyze their workplace in order to identify risk factors which negatively interfere in health; to propose prevention measures in order to minimize negative impacts in their health, highlighting the elaboration of a Risk Map. As theoretical support concepts and conjectures were approached related to labor disease and its relation to the occupational hazards, contextualizing them with the configuration at the universe of health work, its organization and the labour process, as well as experiences of pleasure and suffering that can alter workers health conditions. The study was supported by Taylors current labor concepts, seeking to understand transformations that occurred at the work process, as well as experiences such as suffering-pleasure generated at work. It is a descriptive-exploratory research type, qualitative nature, developed at PPC, after approval from Ethics Committee. The subjects were 40 nursing professionals, including nurses, technicians and aid nurses. Sample tools were semi-structured interviews and non participant observation, applied between march/april and june/september, 2011 respectively. And crossing information sampled from two tools, in order to obtain data it turned possible the elaboration of the Risk Map from the part of sectors concentrating more problems in terms of letting vulnerable workers' health, and it has elaborated UCAMB and CME Risk Map. It's important to highlight that there was previous signature from the Informed Consent and this research has been approved by the Ethics Committee of Pedro Ernesto Hospital under protocol number 2528. The analysis method chosen was thematic content analysis, which has given rise to three categories: occupational hazards which are visible and invisible to the nursing worker; the process of disease in the worker because of work; improvement in working conditions: contributions in order to protect worker's health. Results have evidenced that the most frequently revealed risk was of accident, mainly by sharps injury material, followed by exposure to biological risks. However, there were subjects who didn't realize the presence of such risks because of misled view of ambulatory environment, by lack of critical view of work process and by bluntness of its critical and analysis ability due to excess of work. The repercussion of occupational hazards at the workers bodies were identified as stress, osteomuscular varicose veins disorders. Workers have pointed out some suggestions in terms of working conditions improvement, namely: accomplishment of new structure reformation, equipment update, quantitative human resources improvement, working organization improvement, implementation of Worker's Health Center. We consider that the objectives of this study were properly achieved, however, its clear that there is much more to be investigated concerning to occupational hazards and its repercussion on workers, as well as necessary intervention to prevent and promote workers health. It's also necessary a continuous investment on the development of scientific activities must be highlighted, once its important to have positive paradigmatic changes in nursery research. New researches can be suggested, as well as rethinking nursing formation teaching strategies, and it is also relevant to obtain participation from the part of the category into social actions towards the construction of public policies in this field.

La métamorphose du risque professionnel puise ses sources dans la mutation de la représentation du risque professionnel factuel qui a permis la consécration de la notion de maladie professionnelle. Substituée à l’accident du travail comme centre de gravité du droit des risques professionnels, elle devient le point d’impulsion d’une réflexion nouvelle du concept juridique de risque professionnel entraînant la mutation du risque professionnel pris en charge. Cette métamorphose, dans le droit de la Sécurité sociale, permet la réactivation de l’obligation de sécurité de l’employeur qui irradie le droit du travail et entraîne l’affirmation du droit à la santé et à la sécurité des travailleurs. Partant, la réparation des atteintes à la santé du travailleur est considérablement étendue. Néanmoins, cette construction se heurte à des obstacles de taille, et s’accompagne d’incohérences, qu’il faut dépasser. / The metamorphosis of occupational hazard has its sources in the mutation of the representation of factual occupational hazard that led to the consecration of the notion of occupational disease. Substituted for the occupational accident as the centre of gravity of the occupational hazards law, it becomes the impetus for a new reflection about the legal concept of occupational hazard causing the mutation of occupational hazard taken charge of. This metamorphosis in the Social Security law, allows the reactivation of the employer's duty to ensure security that radiates labour law and causes the assertion of the workers’ right to health and safety. Therefore, the compensation of damages to workers’ health is considerably extended. However, this construction is fraught with obstacles, and is accompanied by inconsistencies that must be overcome.

La presente investigación tiene como propósito explicar la influencia de la prevención del riesgo laboral en el nivel de accidentes de trabajo de las empresas del Sector Textil, Lima Metropolitana 2020. El diseño de la investigación es no experimental de tipo transversal, porque se realiza sin manipular deliberadamente las variables y de alcance correlacional causal. Asimismo, la metodología que se aplicó para la recolección de datos en de enfoque cuantitativo. Para medir la opinión de los colaboradores, encargados de seguridad y salud en el trabajo del Sector Textil, en relación con las variables a estudiar y a sus referidas dimensiones, se elaboró un cuestionario tipo Likert. La confiabilidad del mencionado instrumento se determinó mediante el Coeficiente de Alfa de Cronbach (0.759) y su validación se obtuvo mendiante el juicio de expertos. De una población total de 35,739 empresas textiles, se determinó un muestreo aleatorio simple obteniendo 381 empresas. Según el análisis correlacional, existe evidencia estadística para sintetizar que la prevención de riesgo laboral y el nivel de accidentes de trabajo de las empresas del sector Textil en Lima Metropolitana están relacionados. / The purpose of this research is to explain the influence of occupational risk prevention on the level of occupational accidents in companies in the Textile sector, Lima Metropolitana 2020. The research design is non-experimental of a transversal type, because it is carried out without manipulating deliberately variables and causal correlational scope. Likewise, the methodology that was applied for data collection in a quantitative approach. To measure the opinion of the collaborators, those in charge of safety and health at work in the Textile Sector, in relation to the variables to be studied and their referred dimensions, a Likert-type questionnaire was prepared. The reliability of the aforementioned instrument was determined using Cronbach's Alpha Coefficient (0.759) and its validation was obtained through the judgment of experts. From a total population of 35,739 textile companies, a simple random sample was determined obtaining 381 companies. According to the correlational analysis, there is statistical evidence to synthesize that the prevention of occupational risk and the level of accidents at work in the companies of the Textile sector in Metropolitan Lima are related. / Tesis

Dans le contexte d’incertitude actuel entourant la problématique de l’exposition au bitume dans les travaux de revêtement routier, la thèse vise l’élaboration de principes généraux et de méthodes d’action pour des solutions préventives nouvelles permettant d’enrichir les dispositifs de prévention existants. Dans cette perspective, nous avons développé une démarche centrée sur l’association des travailleurs de tout niveau hiérarchique (opérateurs, encadrement de proximité, préventeurs et décideurs) autour « d’objets intermédiaires de prévention » afin de soutenir un débat collectif. Ce débat collectif est envisagé comme une pratique réflexive sur l’activité de travail, elle-même considérée comme la condition d’un langage commun, permettant de changer des choix initiaux et constituant une ressource pour les apprentissages mutuels entre acteurs. Pour cela, nous avons développé, repris et enrichi la notion de représentation des risques qui favorise la mise en visibilité et la reconnaissance des savoirs construits, développés et portés par les travailleurs sur leur activité et sur les façons de se protéger des dangers. Ces représentations du risque et ces savoir-faire sont un élément déterminant de la prévention car ils s’exercent à la fois dans des modes normaux et dégradés de l’activité et sont issus de l’expérience et d’une construction sociale. Nous avons développé une connaissance précise de l’activité des opérateurs de mise en oeuvre d’enrobés dans deux agences de travaux publics, qui a mis en évidence que les acteurs de terrain possèdent des connaissances fines sur les risques chimiques. Ces représentations, essentiellement permises par l’expérience du corps et des sens, ne sont pas toujours convocables pour mettre en oeuvre des activités de protection dans l’activité de travail. Elles seraient empêchées voire « enkystées » quand il semble impossible aux travailleurs de faire autrement avec la nécessité de gérer aléas, variabilités et autres dangers présents et quand leur pouvoir d’agir leur apparait comme inexistant. Pourtant, nous montrons qu’elles deviennent accessibles à partir de références à la sphère intime et domestique dans des activités réflexives qui mobilisent à la fois des données d’observations, de mesures et des verbalisations. Dans une perspective de recherche en prévention, l’objet de la thèse est alors d’établir un dialogue entre différents mondes, institutionnels et de l’entreprise, afin de permettre aux acteurs de s’investir et de mobiliser leurs ressources individuelles, collectives et organisationnelles pour proposer des solutions de prévention. Cet « espace intermédiaire de dialogue » est rendu possible par la co-construction d’objets intermédiaires en capacité 1- de produire et soutenir un débat autour des pratiques effectives des opérateurs et de leurs représentations au regard des dispositifs de sécurité existants et 2- d’être support aux dialogues et aux apprentissages mutuels. Ces objets intermédiaires de prévention sont in fine des entités circulantes pour la coproduction d’un savoir pour l’action : produire des connaissances et générer collectivement des solutions innovantes de prévention. / In the context of current uncertainty surrounding the problem of exposure to bitumen in road surfacing (coating), the aim of the thesis is to set up general principles and methods of action for new preventive solutions that will enrich the existing measures. In this perspective, we have developed an approach centred on the association of workers at all hierarchical levels (operators, proximity managers, prevention workers and decision-makers) around "intermediary objects of prevention" in order to support a collective debate. This collective debate is seen as a reflective practice on work activity, which is itself seen as the condition of a common language, allowing for initial choices to be changed and a resource for mutual learning between actors. To this end, we have developed, reworked and enriched the notion of risk representation, which promotes the visibility and recognition of the knowledge built, developed and carried by workers on their activities and on ways to protect themselves from dangers or hazards. These representations of risk and the know-hows are a decisive element of prevention because they are applied in both normal and degraded modes of the activity and are derived from experience and social construction. We have developed a fine and precise knowledge of the activity of asphalt processing operators in two public works agencies, which highlighted that the players in the field have a detailed knowledge of chemical risks. These representations, which were essentially made possible by the experience of the body and the senses, cannot always been called up with a view to setting up protective measures in the work activity. They would be prevented or even "encysted" when it seems impossible for workers to do otherwise with the need to manage the hazards, variability and other dangers present and when their power to act seems to them to be non existent. And yet, we show that they become accessible from references to the intimate and domestic sphere in reflexive activities that mobilize both data from observations, measurements and verbalizations. From a preventive research perspective, the aim of the thesis is to establish a dialogue between different institutional and corporate worlds so as to enable the actors to get involved and mobilize their individual, collective and organizational resources to propose prevention solutions. This "intermediate space for dialogue" is made possible by the coconstruction of intermediate objects capable of 1- producing and supporting a debate about the current practices of the operators and their representations with regard to the existing safety devices and 2- supporting dialogues and mutual learning. These intermediate prevention objects are ultimately circulating entities for the co-production of knowledge for action: to generate knowledge and to collectively generate innovative prevention solutions.