The management of the risk due to the manual lifting of patients in a hospital risk-management program

摘要

Application of Law 626/94 in the health care area is still only partial and in many respects practically in the initial stages. This is due to a number of causes, including the special features of this sector and the extreme variability and diffusion of the risk factors involved. Assessment of risk, especially the newest ones (from manual patient handling to biological agents) involves considerable difficulties, also because the usual methods cannot be applied. The process of assessment and especially the management of risks in this sector is an extremely complex problem, and to address it requires the creation of an organized structure within the hospital consisting of a general manager, or a person delegated by the same, the medical director, the administrative director, the certified occupational physician, the director of prevention and protection. This management team must be flexible in character, draw up strategic plans according to priority criteria, periodically assess the state of advancement of the plans that will be carried out in phases. It is also necessary to ensure the active cooperation of worker safety representatives and of other experts who may be involved in the various topics addressed from time to time. The authors propose a method used in a three-year project, still under way, for the assessment of risk due to manual patient handling in a major Italian hospital; the data obtained from an assessment made in 58 wards were the following: about 60% of the wards showed a medium-high exposure level, 24% negligible exposure levels and 13.8% zero exposure due to the absence of disabled patients. On the basis of the initial data obtained from health surveillance programmes on a group of 431 exposed subjects, about 10% were judged fit with limitations due to spinal disorders. The main problems that have arisen (management, organisation, training, transfer of workers with limited job fitness, accreditation) are discussed. The method proposed for management of risk due to manual handling of patients is considered suitable for other risk factors, within the framework of a more far reaching programme for application of Law 626/94, as a means of permanent management of risk in a particularly complex working environment such as that of a hospital.