...

linee guida per la sorveglianza sanitaria in ambito

by user

on
Category: Documents
22

views

Report

Comments

Transcript

linee guida per la sorveglianza sanitaria in ambito
SORVEGLIANZA SANITARIA
IN AMBITO OSPEDALIERO
REGIONE PUGLIA
AREA POLITICHE PER LA PROMOZIONE DELLA SALUTE, DELLE PERSONE E DELLE PARI OPPORTUNITÀ
Servizio Programmazione Assistenza Territoriale e Prevenzione
Ufficio 1 – Sanità pubblica e sicurezza del lavoro
LINEE GUIDA PER LA SORVEGLIANZA SANITARIA IN AMBITO OSPEDALIERO
3
REGIONE PUGLIA
Assessorato Politiche della Salute
Servizio Programmazione Assistenza Territoriale e Prevenzione
COMITATO DI REDAZIONE
Fulvio Longo – Direttore Servizio PATP
Elisabetta Viesti±'LULJHQWH8I¿FLR6DQLWjSXEEOLFDHVLFXUH]]DGHOODYRUR
Domenico My -­ )XQ]LRQDULR8I¿FLR6DQLWjSXEEOLFDHVLFXUH]]DGHOODYRUR
Nicola Dipalma±6SHFLDOLVWDLQ0HGLFLQDGHO/DYRUR
Raffaello Bellino'LULJHQWH63(6$/%$7
A CURA DI: Fulvio Longo – Direttore Servizio PATP Regione Puglia
Franco Polemio±'LUHWWRUH6DQLWDULR$6/%$7
&RQVLJOLD6FDQGLI¿R±$6/%$
Mauro Carino±$6/%$
Massimo Muratore±$6//(
Maria Pia Trisorio Liuzzi±$]LHQGD2VSHGDO8QLY3ROLFOLQLFR%DUL
Cinzia Germinario±$]LHQGD2VSHGDO8QLY3ROLFOLQLFR%DUL
Nicola Labbate±8QLYHUVLWjGL)RJJLD
Giorgio Di Leone'LULJHQWH63(6$/%$
Rossella Attimonelli±,1$,/%DUL
3URJHWWRJUD¿FRHLPSDJLQD]LRQH
GRAPHIC snc, Putignano (BA)
6WDPSD
/D1XRYD7HFQRJUD¿FD0RGXJQR%$
4
SORVEGLIANZA SANITARIA
IN AMBITO OSPEDALIERO
La comunicazione per prevenire: poiché siamo convinti che diffon-­
GHUHODFXOWXUDGHOODVLFXUH]]DqO¶DUPDSLHI¿FDFHQHOODSUHYHQ]LRQH
degli infortuni e delle malattie professionali, la Regione ha deciso di rendere fruibili ad un pubblico, quanto più possibile vasto, atti di indi-­
UL]]RHGDSSURIRQGLPHQWRVXVSHFL¿FKHQRUPHLQHUHQWLODVDQLWjSXE-­
blica e la sicurezza nei luoghi di lavoro.
La terza pubblicazione della collana “I quaderni della prevenzione” riguarda la sorveglianza sanitaria degli operatori sanitari: è pleonasti-­
co ricordare che l’ospedale è per sua natura un luogo “unsafe”, laddo-­
ve è reale il rischio di contrarre malattie infettive, legato all’utilizzo di metodiche diagnostiche e terapeutiche sempre più invasive nonché alla concentrazione in spazi ristretti di un numero di pazienti potenzialmen-­
te vettori di microbi anche farmaco resistenti. Altrettanto concreto è per tali lavoratori il rischio di contrarre patologie muscoloscheletriche da VFRUUHWWDPRYLPHQWD]LRQHGLSD]LHQWLQRQDXWRVXI¿FLHQWL
Con l’obiettivo di prevenire tali eventi, questo documento è volto a tutti gli operatori della prevenzione attivi nelle strutture sanitarie pub-­
bliche e private.
Tommaso FIORE Assessore Regionale alle Politiche della Salute
5
SORVEGLIANZA SANITARIA
IN AMBITO OSPEDALIERO
INDICE
Presentazione 3DJ
Premessa 3DJ
3DJ
3DJ
3DJ
3DJ
3DJ
3DJ
3DJ
3DJ
3DJ
3DJ
3DJ
3DJ
3DJ
3DJ
3DJ
3DJ
3DJ
3DJ
Parte generale
'H¿QL]LRQLH$SSOLFD]LRQL
2ELHWWLYL
,OPHGLFRFRPSHWHQWH
$FFHUWDPHQWLVDQLWDUL
9LVLWHVXULFKLHVWD
*LXGL]LRGLLGRQHLWj
5LFRUVR
Parte speciale
5LVFKLRELRORJLFRHSUR¿ODVVLSRVWHVSRVL]LRQH
&KHPLRWHUDSLFLDQWLEODVWLFL
/DWWLFH
0RYLPHQWD]LRQHPDQXDOHGLSD]LHQWL
0DWHUQLWj
/DYRURQRWWXUQR
6WUHVVRFFXSD]LRQDOH
9HUL¿FDGLDVVHQ]DGLULVFKLDOFROFRUUHODWL
6RUYHJOLDQ]DPHGLFDGHLODYRUDWRULHVSRVWL
a radiazioni ionizzanti(secondo linee-­guida airm) 5DGLD]LRQLRWWLFKHDUWL¿FLDOL52$
3UR¿OLGLULVFKLRHSHULRGLFLWj
7
SORVEGLIANZA SANITARIA
IN AMBITO OSPEDALIERO
PRESENTAZIONE
,O'HFUHWR/HJLVODWLYRQGHODSULOHHGLOVXFFHVVLYR'/YRQGHO
DJRVWRKDQQRFRRUGLQDWROHQRUPHLQPDWHULDGLVDOXWHHVLFXUH]]DVXLOXRJKLGL
ODYRURFKLXGHQGRXQSHUFRUVRGXUDWRYDULDQQL
&RQULIHULPHQWRDLFRQWHVWLVLDRVSHGDOLHULFKHWHUULWRULDOLGHOOH$]LHQGH6DQLWDULH
/RFDOLVLqULWHQXWRQHFHVVDULRXQLIRUPDUHVXVFDODUHJLRQDOHWXWWLJOLDGHPSLPHQWLD
FDULFRGHOGDWRUHGLODYRUR'LUHWWRUH*HQHUDOHHGHOPHGLFRFRPSHWHQWHGLFLDVFXQD
$6/FRQVROX]LRQLSURFHGXUDOLHRUJDQL]]DWLYHFRHUHQWLFRQODQRUPDWLYDFLWDWD
3XUDYHQGRULVHUYDWRXQSDUWLFRODUHULJXDUGRDOOHDWWLYLWjGHOPHGLFRFRPSHWHQWH
DJOL LQGLUL]]L GL JHVWLRQH DOOH FULWLFLWj GHOOH YDOXWD]LRQL GHL JLXGL]L GL LGRQHLWj DL
UDSSRUWLWUDPHGLFLFRPSHWHQWLFRQLGLUHWWRULVDQLWDULHGLVHUYL]LGLSURWH]LRQHWDOH
GRFXPHQWRUDSSUHVHQWDDOWUHVuXQYDOLGRVXSSRUWRGLLQGLFD]LRQLHVXJJHULPHQWLSHU
WXWWLJOLDOWULDWWRULGHOODSUHYHQ]LRQHLYLFRPSUHVLLSUHSRVWLFRLQYROWLQHJOLREEOLJKL
GLWXWHODGHOODVDOXWHHVLFXUH]]DGHLODYRUDWRULHGLUDSSUHVHQWDQWLGHLODYRUDWRULSHUOD
VLFXUH]]D
1HOOD SDUWH JHQHUDOH YHQJRQR DQDOL]]DWH OH GH¿QL]LRQL DSSOLFDWLYH LGHQWL¿FDQGR
JOLRELHWWLYLGLULVFRQWURSUDWLFRQHOODSDUWHVSHFLDOHYHQJRQRHVDPLQDWLLSULQFLSDOL
ULVFKL VSHFL¿FL FRQWHVWXDOL]]DWL FRQ OD UHFHQWH QRUPDWLYD$SSDUH GLIDWWL HVVHQ]LDOH
VWDELOLUHFULWHULXQLYRFLSHUODGH¿QL]LRQHGHLSURWRFROOLVDQLWDULHSHUO¶HVSUHVVLRQH
GLJLXGL]LGLLGRQHLWjFRHUHQWLFRQLOWLSRHGLOOLYHOORGHLULVFKLODYRUDWLYLDO¿QHGL
DVVLFXUDUHLOSLHQRXWLOL]]RGHOOHULVRUVHXPDQHHGHOODSURIHVVLRQDOLWjGHJOLRSHUDWRUL
VDQLWDULQHOULVSHWWRGHOOHHVLJHQ]HGLWXWHODGHOODVDOXWH
9
SORVEGLIANZA SANITARIA
IN AMBITO OSPEDALIERO
PREMESSA
/DWXWHODGHOODVDOXWHGHLODYRUDWRULULHQWUDWUDOHPDWHULHDVVHJQDWHDOODFRPSHWHQ]D
GHOOD 5HJLRQH /R VFRSR GL TXHVWR GRFXPHQWR q GL FRQVHJXLUH XQ SL DOWR JUDGR
GL XQLIRUPLWj GHOOH DWWLYLWj GL VRUYHJOLDQ]D VDQLWDULD GHL ODYRUDWRUL HVSRVWL D ULVFKL
RFFXSD]LRQDOLLQDPELWRRVSHGDOLHURHQHOOHD]LHQGHVDQLWDULHGHOOD5HJLRQH3XJOLD
SHUPLJOLRUDUHTXDOLWjHI¿FDFLDHµEXRQDSUDWLFD¶LQGLFDQGRSHUFRUVLLOSLSRVVLELOH
FKLDULHGH¿QLWLQHOULVSHWWRGHOOHULVRUVHGLVSRQLELOLHQHOO¶DSSOLFD]LRQHGHOOHQRUPH
YLJHQWLHGLQSDUWLFRODUHGHO'HFUHWR/HJLVODWLYRQHGHO'HFUHWR/HJLVODWLYR
Q ³'LVSRVL]LRQL LQWHJUDWLYH H FRUUHWWLYH GHO GHFUHWR OHJLVODWLYR DSULOH
QLQPDWHULDGLWXWHODGHOODVDOXWHHGHOODVLFXUH]]DQHLOXRJKLGLODYRUR´
SXEEOLFDWR VX 6XSSO 2UG Q *8 Q GHO $JRVWR &RQ LO ' /YR
qVWDWRUHDOL]]DWRXQSHUIH]LRQDPHQWRGHOTXDGURQRUPDWLYRFRPSRVWRGD
DUWLFROLHYDULDOOHJDWLFRRUGLQDWLWUDGLORURDOORVFRSRGLHYLWDUHVRYUDSSRVL]LRQLH
ULGXUUHOHLQFHUWH]]HLQWHUSUHWDWLYH
,O GHFUHWR FRUUHWWLYR SURVHJXH XQ SHUFRUVR OHJLVODWLYR GXUDWR YDUL DQQL
GRSR XQ DPSLR GLEDWWLWR WUD HVSHUWL GHO VHWWRUH JUXSSL GL ODYRUR GL &RPPLVVLRQL
0LQLVWHULDOL5HJLRQL$6/,63(6/,1$,/SDUWLVRFLDOLHWF
/¶DWWXDOHVLWXD]LRQHFRQ¿JXUDLOTXDGURQRUPDWLYRFRQLOTXDOHOHD]LHQGHVDQLWDULH
GRYUDQQRFRQIURQWDUVLQHLSURVVLPLDQQL
/HSUHVHQWLOLQHHGLLQGLUL]]RUDSSUHVHQWDQRXQLQVLHPHGLVXSSRUWLLQIRUPDWLYL
LQGLFD]LRQLHVXJJHULPHQWL6LULYROJRQRDJOLRSHUDWRULGHOODSUHYHQ]LRQHQHOVHWWRUH
VDQLWDULRHSULQFLSDOPHQWHDPHGLFLFRPSHWHQWLGDWRULGLODYRURHGLULJHQWLFRLQYROWL
QHJOLREEOLJKLGLWXWHODGHOODVDOXWHGHLODYRUDWRULGLSHQGHQWLUHVSRQVDELOLGHLVHUYL]L
GLSUHYHQ]LRQHHSURWH]LRQHUDSSUHVHQWDQWLGHLODYRUDWRULSHUODVLFXUH]]D
/H LQGLFD]LRQL IRUQLWH KDQQR FDUDWWHUH GL PDVVLPD HG LQ SDUWLFRODUH LO PHGLFR
LQFDULFDWRGHOODVRUYHJOLDQ]DVDQLWDULDSRWUjDYYDOHUVHQHQHOODVXDOLEHUDUHVSRQVDELOLWj
SURIHVVLRQDOHQHOFRUVRGHOOHVFHOWHRSHUDWLYHDOXLDI¿GDWHLQXQRVSHFL¿FRFRQWHVWR
11
SORVEGLIANZA SANITARIA
IN AMBITO OSPEDALIERO
PARTE GENERALE
Definizioni e Applicazioni
3HU VRUYHJOLDQ]D VDQLWDULD VL LQWHQGH O¶LQVLHPH GHJOL DFFHUWDPHQWL VDQLWDUL VYROWL
GDOPHGLFRFRPSHWHQWH¿QDOL]]DWLDOODWXWHODGHOORVWDWRGLVDOXWHHDOODVLFXUH]]DGHL
ODYRUDWRULLQUHOD]LRQHDOOHFRQGL]LRQLGLVDOXWHGHJOLVWHVVLDOO¶DPELHQWHGLODYRURDL
IDWWRULGLULVFKLRHDOOHPRGDOLWjGLVYROJLPHQWRGHOO¶DWWLYLWjODYRUDWLYD
,OPHGLFRFRPSHWHQWHHIIHWWXDODVRUYHJOLDQ]DVDQLWDULDDQHLFDVLSUHYLVWLGDOOD
QRUPDWLYDYLJHQWHQRQFKpGDOOHLQGLFD]LRQLIRUQLWHGDOOD&RPPLVVLRQHFRQVXOWLYDDUW
GHO'/JVHVPLERJQLTXDOYROWDYHQJDLQGLYLGXDWDDOO¶HVLWRGHOODYDOXWD-­
]LRQHGHOULVFKLRGLFXLDOO¶DUWLFRORFRPPDOHWWHUDD'/JVHVPLTXDOH
PLVXUDVSHFL¿FDGLSUHYHQ]LRQHHSURWH]LRQHFTXDORUDLOODYRUDWRUHQHIDFFLDULFKLHVWD
HODVWHVVDVLDULWHQXWDGDOPHGLFRFRPSHWHQWHFRUUHODWDDLULVFKLODYRUDWLYLGLQIDVH
SUHDVVXQWLYDHGDOULHQWURGRSRSHULRGRGLPDODWWLDFRQWLQXDWLYDVXSHULRUHDJLRUQL
DUW'/JV
,OPHGLFRFRPSHWHQWHSURJUDPPDHGHIIHWWXDODVRUYHJOLDQ]DVDQLWDULDDWWUDYHUVR
SURWRFROOLVDQLWDULGH¿QLWLLQIXQ]LRQHGHLULVFKLVSHFL¿FLHWHQHQGRLQFRQVLGHUD]LRQH
JOLLQGLUL]]LVFLHQWL¿FLSLDYDQ]DWL/DVRUYHJOLDQ]DVDQLWDULDFRPSUHQGHDFFHUWDPHQ-­
WLSUHYHQWLYLHSHULRGLFLSHUFRQVWDWDUHO¶DVVHQ]DGLFRQWURLQGLFD]LRQLDOODYRURFXLL
ODYRUDWRUL VRQR GHVWLQDWL DL ¿QL GHOOD YDOXWD]LRQH GHOOD ORUR LGRQHLWj DOOD PDQVLRQH
VSHFL¿FD*OLDFFHUWDPHQWLLQFOXGRQRHVDPLFOLQLFLELRORJLFLHLQGDJLQLGLDJQRVWLFKH
PLUDWHDOULVFKLRULWHQXWHQHFHVVDULHGDOPHGLFRFRPSHWHQWH
(¶REEOLJRGHO'DWRUHGL/DYRURLQYLDUHLODYRUDWRULDOODYLVLWDPHGLFDHQWUROHVFD-­
GHQ]HSUHYLVWHGDOSURJUDPPDGLVRUYHJOLDQ]DVDQLWDULDHFRPXQLFDUHWHPSHVWLYDPHQ-­
WHDOPHGLFRFRPSHWHQWHOHFHVVD]LRQLGHLUDSSRUWLGLODYRUR'/JVDUW
'HVWLQDWDULGHOODVRUYHJOLDQ]DVDQLWDULDVRQRWXWWLLODYRUDWRULVXERUGLQDWLHDXWRQR-­
PLHVRJJHWWLHTXLSDUDWLIHUPRUHVWDQGRTXDQWRSUHYLVWRGDOO¶DUWGHO'/YR
PRGGDDUW'/YR
$OO¶LQWHUQRGHOOHVWUXWWXUHVDQLWDULHRSHUDQRLQROWUHOLEHULSURIHVVLRQLVWLLQFRQ-­
YHQ]LRQHRFRQFRQWUDWWLVSHFLDOLFKHODYRUDQRFRQPRGDOLWjVRYUDSSRQLELOLDTXHOOH
13
GHLODYRUDWRULVXERUGLQDWL1HOFDVRLQFXLULVXOWLQRHVSRVWLDULVFKLRVXOODEDVHGHO
GRFXPHQWRGLYDOXWD]LRQHGHLULVFKLD]LHQGDOHLOGDWRUHGLODYRURGHYHDFFHUWDUVLFKH
VLDQR LQ SRVVHVVR GHO JLXGL]LR GL LGRQHLWj DOOD PDQVLRQH VSHFL¿FD /H PRGDOLWj GL
DWWXD]LRQHGHOODVRUYHJOLDQ]DVDQLWDULDDFDULFRGHOVLQJRORSURIHVVLRQLVWDRSSXUHD
FDULFRGHOGDWRUHGLODYRURGHYRQRHVVHUHFRQFRUGDWHGDOOHSDUWL
/DVRUYHJOLDQ]DVDQLWDULDQRQqULYROWDLQYHFHDLODYRUDWRULFKHSXUVYROJHQGROD
ORURDWWLYLWjDOO¶LQWHUQRGHOODVWUXWWXUDVDQLWDULDVRQRDOOHGLSHQGHQ]HGLXQGDWRUHGL
ODYRURWHU]RGLSHQGHQWLGLGLWWHLQDSSDOWRFRRSHUDWLYHHWF,QTXHVWLFDVLLQIDWWLLO
GDWRUHGLODYRURWHU]RGHYHSURYYHGHUHDOODQRPLQDGHOPHGLFRFRPSHWHQWH
,QWXWWHTXHOOHVLWXD]LRQLFKHSRWUHPPRGH¿QLUHGL³ODYRURDWLSLFR´LQTXDQWRLO
WLWRODUHGHOUDSSRUWRGLODYRURQRQFRLQFLGHFRQLOGDWRUHGLODYRURGHOO¶D]LHQGDLQFXL
LOODYRUDWRUHSUHVWHUjODVXDRSHUDJOLREEOLJKLSUHYLVWLGDO'/JVHVPLVRQR
JHQHUDOPHQWHULSDUWLWLIUDLO³IRUQLWRUH´REEOLJKLJHQHULFLHO¶XWLOL]]DWRUHREEOLJKL
VSHFL¿FL/DVRUYHJOLDQ]DVDQLWDULDLQTXDQWRDWWRPHGLFRLQVFLQGLELOHGDLULVFKLVSH-­
FL¿FLSUHVHQWLQHOO¶D]LHQGDLQFXLLOODYRUDWRUHRSHUDqXQREEOLJRGHPDQGDWRDOO¶XWL-­
OL]]DWRUH
Obiettivi
/RVFRSRGHJOLDFFHUWDPHQWLVYROWLGDOPHGLFRFRPSHWHQWHqGLWXWHODUHODVDOXWH
GHO ODYRUDWRUH HVSRVWR DL ULVFKL ODYRUDWLYL DWWUDYHUVR D O¶LQGLYLGXD]LRQH QHO FRUVR
GHOOD YLVLWD PHGLFD SUHYHQWLYD GL HYHQWXDOL FRQGL]LRQL GL VDOXWH FKH SRVVRQR FRQ-­
WURLQGLFDUHPDQVLRQLFKHFRPSRUWLQRSDUWLFRODULULVFKLDOORVFRSRGLHYLWDUHRULGXUUH
O¶HVSRVL]LRQHVRJJHWWL LSHUVXVFHWWLELOL DL ULVFKL ODYRUDWLYL VRJJHWWL FRQ DIIH]LRQL VX-­
VFHWWLELOLGLDJJUDYDPHQWRLQVHJXLWRDGHVSRVL]LRQHODYRUDWLYDEODULOHYD]LRQHGX-­
UDQWHO¶DFFHUWDPHQWRPHGLFRSHULRGLFRGLHYHQWXDOLDOWHUD]LRQLLQL]LDOLGHOORVWDWRGL
VDOXWHULFRQGXFLELOLDOO¶HVSRVL]LRQHSURIHVVLRQDOH
,OSURJUDPPDGLVRUYHJOLDQ]DVDQLWDULDYLHQHUHGDWWRGRSRO¶DQDOLVLGHOOHPRGDOLWj
GLHVSRVL]LRQHHGHLULVFKLODYRUDWLYLYDOXWDWLQHOGRFXPHQWRGLYDOXWD]LRQHGHLULVFKL
'95HFRVWLWXLVFHSDUWHLQWHJUDQWHGHOORVWHVVR'95 0HGLDQWHODVRUYHJOLDQ]DVDQLWDULDSUHYHQ]LRQHVHFRQGDULDLOPHGLFRFRPSHWHQ-­
WHDFTXLVLVFHLQIRUPD]LRQLHSLGHPLRORJLFKHXWLOLSHUULIRUPXODUHOHPLVXUHGLSUHYHQ-­
]LRQHSULPDULDHSHUSURPXRYHUHLQL]LDWLYHGLIRUPD]LRQHHGLQIRUPD]LRQHVXULVFKLH
GDQQLGDODYRUR
/DVRUYHJOLDQ]DVDQLWDULDWURYDLOVXRPRPHQWRGLVLQWHVLQHOODIRUPXOD]LRQHGHO
JLXGL]LRGLLGRQHLWjDOODPDQVLRQHHVVHQGRWDOHJLXGL]LRHVSUHVVLRQHIRUPDOHHVRVWDQ-­
]LDOHGHOODFRPSDWLELOLWjGHOODYRURFRQORVWDWRGLVDOXWHULOHYDWR
14
SORVEGLIANZA SANITARIA
IN AMBITO OSPEDALIERO
Il medico competente
3HUVYROJHUHOHIXQ]LRQLGLPHGLFRFRPSHWHQWHqQHFHVVDULRSRVVHGHUHXQRGHLWL-­
WROLSUHYLVWLDOO¶DUW'/JVHDUW'/JVHGHVVHUHLVFULWWLQHOO¶HOHQ-­
FR QD]LRQDOH GHL PHGLFL FRPSHWHQWL ,Q EDVH DO '' GHO PDU]R *8 VHULH
JHQHUDOH Q GHO JLXJQR O¶(OHQFR 1D]LRQDOH GHL PHGLFL FRPSHWHQWL GL
FXLDOO¶DUWFRPPDGHOGHFUHWROHJLVODWLYRDSULOHQqWHQXWRSUHVVR
O¶8I¿FLR ,, GHOOD 'LUH]LRQH *HQHUDOH GHOOD SUHYHQ]LRQH VDQLWDULD GHO 0LQLVWHUR GHO
ODYRURGHOODVDOXWHHGHOOHSROLWLFKHVRFLDOL,O0LQLVWHURSURYYHGHDOO¶DJJLRUQDPHQWR
SHULRGLFRGHOO¶HOHQFRHGHIIHWWXDYHUL¿FKHFRQFDGHQ]DDQQXDOHDQFKHDFDPSLRQH
GHLUHTXLVLWLHGHLWLWROL/¶HVLWRQHJDWLYRGHOODYHUL¿FDFRPSRUWDODFDQFHOOD]LRQHG¶XI-­
¿FLRGDOO¶HOHQFR3HUORVYROJLPHQWRGHOOHIXQ]LRQLGLPHGLFRFRPSHWHQWHqQHFHVVDULR
SDUWHFLSDUHDSURJUDPPLGLHGXFD]LRQHFRQWLQXDLQPHGLFLQDFRQLQGLUL]]RSUHYDOHQWH
QHOODGLVFLSOLQDµPHGLFLQDGHOODYRURHVLFXUH]]DGHJOLDPELHQWLGLODYRUR¶
,OPHGLFRFRPSHWHQWHSDUWHFLSDDOODYDOXWD]LRQHGHLULVFKLHVYROJHODSURSULDRSH-­
UD LQ TXDOLWj GL GLSHQGHQWH GHO GDWRUH GL ODYRUR OLEHUR SURIHVVLRQLVWD GLSHQGHQWH R
FROODERUDWRUHGLXQDVWUXWWXUDHVWHUQDFRQYHQ]LRQDWDFRQO¶D]LHQGDVDQLWDULD
,OPHGLFRDVVHJQDWRDLVHUYL]LFKHVYROJRQRDWWLYLWjGLYLJLODQ]DQRQSXzSUHVWDUH
DGDOFXQWLWRORHGLQDOFXQDSDUWHGHOWHUULWRULRQD]LRQDOHO¶DWWLYLWjGLPHGLFRFRPSH-­
WHQWH
/HUHOD]LRQLWUDLO6HUYL]LRGL6RUYHJOLDQ]D6DQLWDULDHOD'LUH]LRQH6DQLWDULDUL-­
VXOWDQRFUXFLDOLDL¿QLGHOVXFFHVVRGHOO¶DWWLYLWjGLJHVWLRQHGHOULVFKLR1RQDQGUDQQR
FRQIXVHFRPSHWHQ]HUXRORHFRPSLWLGHO6HUYL]LRGL6RUYHJOLDQ]D6DQLWDULDFRQTXHOOL
GHO6HUYL]LRGL3UHYHQ]LRQHH3URWH]LRQH$PEHGXHRSHUDQRSHUSURPXRYHUHODVDOXWH
GHOODYRUDWRUHFROODERUDQGRQHOODYDOXWD]LRQHGHLULVFKLPDVYROJRQRDWWLYLWjGLVWLQWH
,QIDWWL OH FRPSHWHQ]H GHO 633 VRQR SUHYDOHQWHPHQWH WHFQLFKH WHVH DOOD YDOXWD]LRQH
HGHYHQWXDOPHQWHDOPLJOLRUDPHQWRGHOOHFDUDWWHULVWLFKHGHLOXRJKLGLODYRURVSHFLH
VRWWRLOSUR¿ORGHOODVLFXUH]]DPHQWUHODLQGLYLGXD]LRQHSUHFRFHHODSUHYHQ]LRQHGL
DIIH]LRQLFRUUHODELOLDOO¶DWWLYLWjODYRUDWLYDLQXQDSRSROD]LRQHHVSRVWDODYDOXWD]LRQH
GHOO¶LGRQHLWjDOODPDQVLRQHVSHFL¿FDQHOVLQJRORLQGLYLGXRVSHWWDQRDO666&LDVFXQ
VHUYL]LRSHUOHVXHFRPSHWHQ]HULVSRQGHVHSDUDWDPHQWHHGDXWRQRPDPHQWHDOGDWRUH
GLODYRURVHQ]DSRVVLELOLWjGLVRVWLWX]LRQHUHFLSURFD
6HSHUGLPHQVLRQLRFRPSOHVVLWjGHOO¶D]LHQGDVDQLWDULDO¶LQFDULFRGLPHGLFRFRP-­
SHWHQWHYLHQHDI¿GDWRDSLGLXQPHGLFRXQDWWRIRUPDOHGHOO¶D]LHQGDGHYHLQGLYL-­
GXDUHLUXROLHOHUHVSRQVDELOLWjGLRJQXQR,OPHGLFRFRPSHWHQWHqO¶XQLFRWLWRODUHGHL
FRPSLWLGLFXLDOO¶DUW'/JVHDUW'/JV7DOLFRPSLWLGHYRQR
HVVHUHVYROWLGLUHWWDPHQWHQRQSRVVRQRHVVHUHGHOHJDWLHGDSSDUHQHFHVVDULDODWUDF-­
FLDELOLWjGHJOLVWHVVL
,QULIHULPHQWRDOOD¿JXUDGHOPHGLFRFRPSHWHQWHFRQIXQ]LRQHGLFRRUGLQDPHQWR
15
VLSUHFLVDFKHWDOH¿JXUDSUHYLVWDGDOO¶DUWFRPPDGHO'/JVULVXOWDHV-­
VHUHLQGLVSHQVDELOHDL¿QLGLXQFRUUHWWRVYROJLPHQWRGHOODVRUYHJOLDQ]DVDQLWDULDQHL
FDVLGLD]LHQGHFRPHTXHOOHVDQLWDULHFRQSLXQLWjSURGXWWLYHPROWHSOLFLWjGLVHGLGL
ODYRURVLJQL¿FDWLYLWjGHOODWLSRORJLDGLULVFKLULOHYDWLHGHOHYDWRQXPHURGLODYRUDWR-­
ULHQHOOHTXDOLVRQRRSHUDWLYLGLYHUVLPHGLFLFRPSHWHQWL)HUPDUHVWDQGRO¶LQGLSHQ-­
GHQ]DGLRJQLPHGLFRQHOO¶HVHFX]LRQHGHOOHVLQJROHYDOXWD]LRQLHQHOODIRUPXOD]LRQH
GHLJLXGL]LGLLGRQHLWjVDUjFRPSLWRGHOFRRUGLQDWRUHSURPXRYHUHODFRQGLYLVLRQHGL
PRGDOLWjRSHUDWLYHLOSLSRVVLELOHXQLIRUPLHJDUDQWLUHLOFRRUGLQDPHQWRGHOOHDWWLYLWj
GHLYDULPHGLFLFRPSHWHQWLLQPRGRGDRWWLPL]]DUHLOUDSSRUWRWUDVDQLWDULRODYRUDWRUL
HVWUXWWXUHGLDSSDUWHQHQ]DWHQXWRFRQWRGHOOHGLYHUVHUHDOWjD]LHQGDOLHODSRVVLELOH
DOWHUQDQ]DSHUUDJLRQLGLIRU]DPDJJLRUHSUROXQJDWLSHULRGLGLDVWHQVLRQHGDOODYRUR
PDODWWLDHWF
/¶DWWLYLWjGHOPHGLFRFRPSHWHQWHqVYROWDVHFRQGRLSULQFLSLGHOFRGLFHHWLFRGHOOD
0HGLFLQDGHO/DYRUR&RPPLVVLRQH,QWHUQD]LRQDOHGL6DOXWH2FFXSD]LRQDOH,&2+)
9LHQHLQROWUHJDUDQWLWDDOPHGLFRFRPSHWHQWHO¶DXWRQRPLDQHOODVXDRSHUDWLYLWj/DUL-­
FHUFDGHOFRQVHQVRHGHOODFROODERUD]LRQHDOO¶HVSOHWDPHQWRGHLSURJUDPPLGLVRUYH-­
JOLDQ]D VDQLWDULD FXL SXUH LO ODYRUDWRUH q REEOLJDWRULDPHQWH VRWWRSRVWR UDSSUHVHQWD
XQDFRQGL]LRQHQHFHVVDULDDOODSUDWLFDGHOODPHGLFLQDGHOODYRUR(VVDSXzHVVHUHSHU-­
VHJXLWDDWWUDYHUVRXQDDGHJXDWDLQIRUPD]LRQHVXJOLRELHWWLYLGLWXWHODGHOODVDOXWHVXL
PHWRGLHFULWHULGLULVHUYDWH]]DGHOWUDWWDPHQWRGHLGDWLSHUVRQDOLVXOOHFRQVHJXHQ]H
GHULYDQWLGDXQUL¿XWRDFROODERUDUHHVXLEHQH¿FLFKHVLLQWHQGRQRUDJJLXQJHUHDVH-­
JXLWRGHJOLDFFHUWDPHQWLVDQLWDUL$SSDUHLQYHFHVXSHUÀXRSURFHGHUHDOODUDFFROWDGL
XQFRQVHQVRVFULWWRSHULOWUDWWDPHQWRGHLGDWLSHUVRQDOLHVHQVLELOL
/HFDUWHOOHVDQLWDULHHGLULVFKLRGHLVLQJROLODYRUDWRULGHYRQRULVSRQGHUHDLUHTXL-­
VLWLPLQLPLSUHYLVWLLQDOOHJDWR$GHO'/YRVRVWGDDUW'/YR HVRQRFXVWRGLWHQHOULVSHWWRGHOVHJUHWRSURIHVVLRQDOHDFXUDGHOPHGLFRFRPSHWHQ-­
WH FKH FRQFRUGD FRQ LO GDWRUH GL ODYRUR LO OXRJR GL FXVWRGLD (¶ DXVSLFDELOH FKH OD
FDUWHOODVDQLWDULDHGLULVFKLRVLDFRQFHSLWDLQPRGRGDHVVHUHIDFLOPHQWHWUDVIHULELOH
VXVXSSRUWRLQIRUPDWLFRHFKHGDHVVDVLDGLUHWWDPHQWHHVWUDLELOHHGHULYDELOHTXDQWR
ULFKLHVWRGDOO¶$OOHJDWR%QHOODVXDQXRYDIRUPXOD]LRQHDUW'/YR
/¶DUFKLYLD]LRQHGHLGDWLVDQLWDULLQIRUPDHOHWWURQLFDGHYHULVSHWWDUHOHQRUPHLQGLFDWH
QHO'/YR³&RGLFHLQPDWHULDGLSURWH]LRQHGHLGDWLSHUVRQDOL´2JQLD]LHQGD
GRYUjSURYYHGHUHDGHODERUDUHXQDSURFHGXUDFKHUHJROLOHPRGDOLWjGLDWXWHODGHOOD
SULYDF\ H FRQVHUYD]LRQH GHOOH FDUWHOOH VDQLWDULH SHUVRQDOLE FRQVHJQDGL FRSLD GHOOD
FDUWHOODVDQLWDULDHGLULVFKLRDOGLSHQGHQWHFKHDEELDFHVVDWRO¶DWWLYLWjODYRUDWLYD$OOD
FHVVD]LRQHGHOUDSSRUWRGLODYRURO¶RULJLQDOHGHOODFDUWHOODVDQLWDULDYHUUjFRQVHUYDWD
LQEXVWDFKLXVDVLJODWDGDOPHGLFRFRPSHWHQWHQHOO¶DUFKLYLRGHOOHFDUWHOOHVDQLWDULHHGL
ULVFKLR,WHPSLGLFRQVHUYD]LRQHVRQRGLDQQL3HULULVFKLGDDJHQWLFDQFHURJHQLH
DJHQWLELRORJLFLGHOJUXSSRHqSUHYLVWDODWUDVPLVVLRQHGHOO¶RULJLQDOHDOO¶,63(6/
16
SORVEGLIANZA SANITARIA
IN AMBITO OSPEDALIERO
/¶DWWLYLWjGLVRUYHJOLDQ]DVDQLWDULDGHOPHGLFRFRPSHWHQWHFRVWLWXLVFHXQDPRGDOLWj
GLUDFFROWDHGHODERUD]LRQHGLGDWLHSLGHPLRORJLFLLQTXDQWRFRQVHQWHGLVYROJHUHLQ-­
GDJLQLPLUDWHVXOODVDOXWHGLSDUWLFRODULFDWHJRULHGLODYRUDWRUL/DUHGD]LRQHSHULRGLFD
GHOODUHOD]LRQHVDQLWDULDUDSSUHVHQWDORVWUXPHQWRLGRQHRSHUGLIIRQGHUH ad uso interno LGDWLHOHLQIRUPD]LRQLDFTXLVLWHLQIRUPDDQRQLPDHFROOHWWLYDDUW'/JV
3DUWLFRODUH LPSRUWDQ]D DVVXPH LQROWUH LO FRQWULEXWR ULFKLHVWR DO PHGLFR FRPSH-­
WHQWHDL¿QLGHOORVYLOXSSRGHO6LVWHPD,QIRUPDWLYR1D]LRQDOHSHUOD3UHYHQ]LRQHQHL
OXRJKLGLODYRUR6,13DWWUDYHUVRORVWUXPHQWRSUHYLVWRGDOO¶DOO%VRVWGDDUW
'/YR. /DFRPSLOD]LRQHHODWUDVPLVVLRQHGHOFLWDWRDOOHJDWRVDUjHIIHWWXDWD
XWLOL]]DQGRJOLVWUXPHQWLUHVLGLVSRQLELOLGDO&RRUGLQDPHQWR7HFQLFRGHOOH5HJLRQLH
GDOO¶,VSHVO.7DOH ÀXVVR LQIRUPDWLYR DSSDUH IRQGDPHQWDOH DL ¿QL GHOOD PDSSDWXUD GHL
ULVFKLRFFXSD]LRQDOLFKHUDSSUHVHQWDXQDGHOOHDWWLYLWjLQVHULWHQHL/($UHODWLYLDOOD
WXWHODGHOODVDOXWHHVLFXUH]]DVXOODYRURHGHJOLVWHVVLSRVVLELOLGDQQLDOODVDOXWHGH-­
ULYDQWLGDOODYRURGDWLXWLOLDL¿QLGHOODSURJUDPPD]LRQHGHOOHULVSHWWLYHDWWLYLWjHSHU
O¶LQGLYLGXD]LRQHGHOOHSULRULWjGLLQWHUYHQWR
Accertamenti sanitari
*OLDFFHUWDPHQWLVDQLWDULFKHODQRUPDWLYDYLJHQWHDUWFRPPDH'/JV
H VPL DWWULEXLVFH DO PHGLFR FRPSHWHQWH VRQRD SUHYHQWLYL ESHULRGLFL F VX
ULFKLHVWDGHOODYRUDWRUHGLQRFFDVLRQHGLFDPELRPDQVLRQHHDOODFHVVD]LRQHGHOUDS-­
SRUWRGLODYRURQHLFDVLSUHYLVWLGDOODQRUPD/HYLVLWHPHGLFKHQRQSRVVRQRHVVHUHHI-­
IHWWXDWHSHUDFFHUWDUHVWDWRGLJUDYLGDQ]DHGLQDOWULFDVLYLHWDWLGDOODQRUPDWLYDYLJHQWH
DFFHUWDPHQWRGHOORVWDWRGLVLHURSRVLWLYLWjSHU+,9DUW/HJJHGHO
HVDPL¿QDOL]]DWLDYHUL¿FDUHLOSRVVHVVRGLSDUWLFRODULUHTXLVLWLHQRQFRUUHODWLDLULVFKL
FXLLOODYRUDWRUHqHVSRVWRHVDPLLQYDVLYLRUDGLRJUD¿FLFKHHVSRQJDQRHVVLVWHVVLD
IDWWRULGLULVFKLRVHQRQHVLVWHSUHFLVDLQGLFD]LRQHFOLQLFDVRQRDOWUHVu¿QDOL]]DWHDOOD
YHUL¿FDGLDVVHQ]DGLFRQGL]LRQLGLDOFROGLSHQGHQ]DHGLDVVXQ]LRQHGLVRVWDQ]HSVL-­
FRWURSHHVWXSHIDFHQWL
6RQRGDLQWHQGHUHFRPHDFFHUWDPHQWLVDQLWDULQRQVRQRVRORTXHOOLLQVHULWLQHOSUR-­
WRFROORGLVRUYHJOLDQ]DVDQLWDULDSHUGDWHSURJUDPPDWHPDDQFKHTXHOOLHIIHWWXDWLLQ
PRPHQWLGLYHUVLGDTXHOOLSUH¿VVDWLRYHLOPHGLFRFRPSHWHQWHQHUDYYLVLODQHFHVVLWj
HVVHQGRVLYHUL¿FDWRXQHYHQWRFKHLPSRQJDGLYHUL¿FDUHORVWDWRGLVDOXWHGHOODYRUD-­
WRUHHGLHVSULPHUHXQQXRYRJLXGL]LRIRUPDOHVXOODLGRQHLWjDOODPDQVLRQHVSHFL¿FD
/HLQGDJLQLFOLQLFKHHGLDJQRVWLFKHPLUDWHDOULVFKLRULWHQXWHQHFHVVDULHGDOPHGL-­
FRFRPSHWHQWHVRQRDVSHVHGHOGDWRUHGLODYRUR
*OLDFFHUWDPHQWLVDQLWDULHVHJXLWLSULPDGHOO¶DVVHJQD]LRQHGHOODPDQVLRQH(accer-­
17
tamenti preventivi KDQQR OR VFRSR GL YHUL¿FDUH FKH OH FRQGL]LRQL SVLFR¿VLFKH GHO
ODYRUDWRUHVLDQRWDOLGDUHQGHUORLGRQHRDOO¶HVSOHWDPHQWRGHLFRPSLWLFKHLOGDWRUHGL
ODYRURLQWHQGHDI¿GDUJOLVHQ]DSUHJLXGL]LRSHUODVXDVDOXWHHVLFXUH]]D'HYRQRTXLQ-­
GLPLUDUHDOO¶HVSORUD]LRQHIXQ]LRQDOHGHLSULQFLSDOLRUJDQLHGDSSDUDWLFRQSDUWLFRODUH
ULJXDUGRDJOLRUJDQLFULWLFLSHULULVFKLSURIHVVLRQDOLVSHFL¿FLGLTXHOODPDQVLRQH6L
HYLGHQ]LDODQHFHVVLWjGLUDFFRJOLHUHGDWLDQDPQHVWLFLFLUFDDELWXGLQLGLYLWDFKHSRV-­
VDQRFRVWLWXLUHFRIDWWRULGLULVFKLRVXOODYRURHVDOFROLVPRHRWRVVLFRGLSHQGHQ]DR
VLWXD]LRQLGLVWUHVVODYRURFRUUHODWRSHUJOLDGHPSLPHQWLGHOOHQRUPHYLJHQWL
/DYLVLWDPHGLFDSUHYHQWLYDYDHVHJXLWDQHOFDVRLQFXLLOGLSHQGHQWHYHQJDDV-­
VHJQDWRDGXQDXQLWjRSHUDWLYDLQFXLVLDQRSUHVHQWLULVFKLULSRUWDWLQHOGRFXPHQWRGL
YDOXWD]LRQHGHLULVFKLHSHULTXDOLLOPHGLFRFRPSHWHQWHKDGH¿QLWRLOSURJUDPPDGL
VRUYHJOLDQ]DVDQLWDULD1HOPRPHQWRLQFXLYLHQHHIIHWWXDWDODYLVLWDPHGLFDSUHYHQWLYD
LOPHGLFRFRPSHWHQWHqLQIRUPDWRVXOOHVSHFL¿FKHPDQVLRQLDVVHJQDWHDOODYRUDWRUH
/DYLVLWDPHGLFDSUHYHQWLYDYLHQHHIIHWWXDWDQHOOHVHJXHQWLRFFDVLRQLDDVVXQ]LR-­
QHRWUDVIHULPHQWRGDDOWUDD]LHQGDVDQLWDULD
/DYLVLWDqULFKLHVWDGDOO¶DUHDJHVWLRQHGHOSHUVRQDOHRGDOODGLUH]LRQHPHGLFDGHO
SUHVLGLRRVSHGDOLHURDSSHQDQRWDODVHGHGLODYRURGHOQHRDVVXQWR6XOODEDVHGHLUL-­
VFKLSUHVHQWLQHOODVHGHGLODYRURLOPHGLFRFRPSHWHQWHDVVHJQDDOODYRUDWRUHLOSUR¿OR
GLULVFKLRHGLOFRQVHJXHQWHSURWRFROORSHUODVRUYHJOLDQ]DVDQLWDULDEWUDVIHULPHQWR
RFDPELRPDQVLRQLVLDDOO¶LQWHUQRFKHDOO¶HVWHUQRGHOO¶XQLWjRSHUDWLYDVHODQXRYD
PDQVLRQHFRPSRUWDULVFKLGLYHUVLGDTXHOODGLSURYHQLHQ]D9LHQHLQWURGRWWDXQDQXR-­
YDWLSRORJLDGL³YLVLWDPHGLFDSUHFHGHQWHDOODULSUHVDGHOODYRURDVHJXLWRGLDVVHQ]D
SHUPRWLYLGLVDOXWHGLGXUDWDVXSHULRUHDLVHVVDQWDJLRUQLFRQWLQXDWLYLDO¿QHGLYHUL-­
¿FDUHO¶LGRQHLWjDOODPDQVLRQH´'/JVDUWFRPPDOHWWHWHUFRPHPRG
GDDUW'/JVFKHLQWHJUDRSSRUWXQDPHQWHORVFHQDULRGHOOHYLVLWHPHGLFKH
¿QDOL]]DWHDOODSUHYHQ]LRQHDSSDUHRYYLRFKHWDOHYLVLWDVLDULVHUYDWDDLODYRUDWRULJLj
VRWWRSRVWLDOODVRUYHJOLDQ]DVDQLWDULD /DYLVLWDqULFKLHVWDGDOUHVSRQVDELOHGLULJHQWHRSUHSRVWRRGDOVHUYL]LRLQIHU-­
PLHULVWLFR,QFDVRGLWUDVIHULPHQWRDPDQVLRQHFRQPHGHVLPRSUR¿ORGLULVFKLRLQ
JHQHUDOHDOO¶LQWHUQRGHOORVWHVVRGLSDUWLPHQWRQRQqQHFHVVDULDODYLVLWDVDOYRLOFDVR
GLSUHFHGHQWLJLXGL]LGLLGRQHLWjFRQOLPLWD]LRQLRSUHVFUL]LRQL(¶SRVVLELOHHVHJXLUH
ODYLVLWDPHGLFDSUHYHQWLYDLQIDVHSUHDVVXQWLYDDVFHOWDGHOGDWRUHGLODYRURGDSDU-­
WHGHOPHGLFRFRPSHWHQWHRGHLGLSDUWLPHQWLGLSUHYHQ]LRQHGHOOH$6/FRQUHODWLYD
HVSUHVVLRQHGHOJLXGL]LRGLLGRQHLWj9DSULYLOHJLDWRLOUXRORGHOPHGLFRFRPSHWHQWH
QHOOHYLVLWHGLSUHDVVXQ]LRQH
/HYLVLWHPHGLFKHHJOLDFFHUWDPHQWLVDQLWDULHVHJXLWLVXFFHVVLYDPHQWHaccerta-­
menti periodici)KDQQRORVFRSRGLYHUL¿FDUHLOPDQWHQLPHQWRGHOORVWDWRGLVDOXWHLQ
VHJXLWR DOO¶HVSRVL]LRQH DG XQR R SL DJHQWL SURIHVVLRQDOLSRWHQ]LDOPHQWH OHVLYL H GL
ULFHUFDUHHYHQWXDOLDOWHUD]LRQLSUHFRFLDFDULFRGLDSSDUDWLHGRUJDQLEHUVDJOLR9LH-­
18
SORVEGLIANZA SANITARIA
IN AMBITO OSPEDALIERO
QHHIIHWWXDWDSHULODYRUDWRULDGGHWWLDPDQVLRQLDULVFKLRFRQSHULRGLFLWjHWLSRORJLD
GLDFFHUWDPHQWLFRPSOHPHQWDULYDULDELOLVHFRQGRTXDQWRSUHYLVWRGDOSURJUDPPDGL
VRUYHJOLDQ]DVDQLWDULD(¶QHFHVVDULRFKHRJQLD]LHQGDVDQLWDULDGH¿QLVFDG¶LQWHVDFRQ
LOPHGLFRFRPSHWHQWHXQDSURFHGXUDFKHUHJROLO¶RUJDQL]]D]LRQHGHOODVRUYHJOLDQ]D
VDQLWDULDFRQYRFD]LRQHGHLODYRUDWRULÀXVVLGHOOHLQIRUPD]LRQLHGHOOHFHUWL¿FD]LRQL
/DYLVLWDSUHYHQWLYDHODYLVLWDSHULRGLFDVLFRQFOXGRQRFRQO¶HVSUHVVLRQHGHOJLX-­
GL]LRVXOSRVVHVVRRPDQWHQLPHQWRGHOO¶LGRQHLWjDOODPDQVLRQHVSHFL¿FD$OWHUPLQH
GHOODYLVLWDHGHJOLDFFHUWDPHQWLLOPHGLFRFRPSHWHQWHVWDELOLVFHLOSHULRGRGLYDOLGLWj
GHOJLXGL]LRHWUDVPHWWHDOGDWRUHGLODYRURDOODYRUDWRUHHGDLVRJJHWWLLQGLYLGXDWLGDOOD
SURFHGXUDD]LHQGDOHLVLQJROLJLXGL]LGLLGRQHLWjGLLGRQHLWjFRQSUHVFUL]LRQLOLPLWD]LR-­
QLGLQRQLGRQHLWj
/DVRUYHJOLDQ]DVDQLWDULDYLHQHHIIHWWXDWDLQEDVHDOODYDOXWD]LRQHGHOULVFKLRIRU-­
PDOL]]DWDQHOO¶DSSRVLWRGRFXPHQWR'/JVDUWHDUW'/JV
GLFXLLOSURJUDPPDGHOOHYLVLWHHGHJOLDFFHUWDPHQWLVDQLWDULSUHYHQWLYLHSHULRGLFL
FRVWLWXLVFRQRSDUWHLQWHJUDQWH
6LSUHFLVDLQSDUWLFRODUHDODGHFLVLRQHGLDWWXDUHODVRUYHJOLDQ]DVDQLWDULDHOD
VWHVXUDGHOUHODWLYRSURJUDPPDqSUHURJDWLYDHUHVSRQVDELOLWjGHOPHGLFRFRPSHWHQWH
L SURWRFROOL VDQLWDUL SHU ULVFKLR VSHFL¿FR VRQR SUHGLVSRVWL VXOOD EDVH GHJOL LQGLUL]]L
VFLHQWL¿FLSLDYDQ]DWLHGqSHUDOWURHYLGHQWHODQHFHVVLWjGLFRQJUXLWjIUDO¶HQWLWjGHO
ULVFKLRYDOXWDWRHGLOSURJUDPPDGLVRUYHJOLDQ]DVDQLWDULDEO¶RUJDQL]]D]LRQHGHOOD
VRUYHJOLDQ]DVDQLWDULDIDSDUWHGHOOHUHVSRQVDELOLWjGHOGDWRUHGLODYRURWDOHDWWLYLWj
YLHQHIRUPDOPHQWHGHOHJDWDDOPHGLFRFRPSHWHQWHGRWDQGRORGLULVRUVHDGHJXDWHFLO
PHGLFRFRPSHWHQWHGHYHLQIRUPDUHLOGDWRUHGLODYRURVXFRORURFKHQRQKDQQRHIIHW-­
WXDWRRQRQKDQQRFRPSOHWDWRODVRUYHJOLDQ]DVDQLWDULDFRPXQLFDQGRO¶LPSRVVLELOLWjGL
HVSULPHUHLOJLXGL]LRGLLGRQHLWjFRQHYHQWXDOHVHJQDOD]LRQHGLYLROD]LRQHGHOO¶REEOL-­
JRSHULODYRUDWRULGLVRWWRSRUVLDVRUYHJOLDQ]DVDQLWDULDHWXWWLJOLDFFHUWDPHQWLGLVSRVWL
GDOPHGLFRFRPSHWHQWHDUWFRPPDOHWWL'/JV
/HYLVLWHPHGLFKHSRVVRQRHVVHUHFRUUHGDWHGDaccertamenti clinico-­strumentali e di laboratorio complementari LQJUDGRGLLQGDJDUHODIXQ]LRQDOLWjGHJOLRUJDQLHGDS-­
SDUDWLEHUVDJOLR3HUTXDQWRSRVVLELOHWDOLDFFHUWDPHQWLFRPSOHPHQWDULGHYRQRHVVHUH
PLUDWLDOULVFKLRHFRPSUHQGRQRHVDPLSHUODYDOXWD]LRQHIXQ]LRQDOHGHLSULQFLSDOL
RUJDQLHGDSSDUDWLGRVDJJLRGLLQGLFDWRULELRORJLFLGLHVSRVL]LRQHRGLHIIHWWLSUHFRFL
LQGDJLQLSHUODGH¿QL]LRQHGLDJQRVWLFDGLDIIH]LRQLFRUUHODELOLDOO¶DWWLYLWjODYRUDWLYDR
SDWRORJLHHYHQWXDOPHQWHJLjLQDWWR
/¶DUWFRPPD'/JVSUHYHGHLQROWUHFKHLQFDVLVSHFL¿FLLOPHGLFR
FRPSHWHQWHSRVVDDYYDOHUVLGHOODFROODERUD]LRQHGLDOWULPHGLFLVSHFLDOLVWLVFHOWLLQDF-­
FRUGRFRQLOGDWRUHGLODYRURFKHQHVRSSRUWDJOLRQHUL&LzULYHVWHSDUWLFRODUHLPSRU-­
WDQ]DTXDQGRRFFRUUDGH¿QLUHXQDGLDJQRVLDO¿QHGLHVSULPHUHXQJLXGL]LROLPLWDWLYR
GHOO¶LGRQHLWjDOODPDQVLRQH
19
Visite su richiesta
,ODYRUDWRULVRJJHWWLDREEOLJRGLVRUYHJOLDQ]DVDQLWDULDLQTXDQWRHVSRVWLDULVFKL
SURIHVVLRQDOL SRVVRQR HIIHWWXDUH YLVLWH PHGLFKH VX ULFKLHVWD DUW '/JV FRPPDOHWWFVHULWHQJRQRFKHHYHQWXDOLGLVWXUELVRSUDYYHQXWLVLDQRFRUUHODELOLDL
ULVFKLSURIHVVLRQDOL,OODYRUDWRUHSXzVHJQDODUHDOPHGLFRFRPSHWHQWHFRQGL]LRQLSD-­
WRORJLFKHRVXVFHWWLELOLGLSHJJLRUDPHQWRFKHSXUQRQFDXVDWHGDOO¶DWWLYLWjODYRUDWL-­
YDSRVVDQRGDHVVDHVVHUHDJJUDYDWHDFDXVDGHOO¶DWWLYLWjODYRUDWLYDVYROWDHSHUWDQWR
VLDQRPHULWHYROLGLDWWHQ]LRQHHGLXQJLXGL]LRGLLGRQHLWjPLUDWR/DVLQJRODULFKLHVWD
SHUYLHQHJHQHUDOPHQWHDOGDWRUHGLODYRURGLULJHQWLRSUHSRVWLFKHLQROWUDDOPHGLFR
FRPSHWHQWHTXDORUDLOPHGLFRFRPSHWHQWHULWHQJDWDOHULFKLHVWDGHOODYRUDWRUHFRUUH-­
ODWDDLULVFKLSURIHVVLRQDOLRDOOHVXHFRQGL]LRQLGLVDOXWHVXVFHWWLELOLGLSHJJLRUDPHQWR
DFDXVDGHOO¶DWWLYLWjODYRUDWLYDVYROWDHIIHWWXDODYLVLWDPHGLFDDO¿QHGLHVSULPHUHLO
JLXGL]LRGLLGRQHLWjDOODPDQVLRQHVSHFL¿FD
6LHYLGHQ]LDFKHODQRUPDQRQSUHYHGHFKHLOGDWRUHGLODYRURGLULJHQWLRSUHSRVWL
SRVVDULFKLHGHUHDOPHGLFRFRPSHWHQWHO¶HVHFX]LRQHGLYLVLWHPHGLFKHDOODYRUDWRUH
DOGLIXRULGHOODYLVLWDSUHYHQWLYDSUHDVVXQ]LRQHDVVXQ]LRQHWUDVIHULPHQWRGDDOWUD
D]LHQGDVDQLWDULDFDPELRPDQVLRQLHGHOOHYLVLWHSHULRGLFKHVHFRQGRSURJUDPPDGL
VRUYHJOLDQ]DVDQLWDULDGRSRXQSHULRGRGLOXQJDGXUDWDGLDVWHQVLRQHGDOODYRURSHU
PDODWWLDLQIRUWXQLRRJUDYHLQFLGHQWH
6HXQFRPSRUWDPHQWRDQRPDORRVFRUUHWWRQRQqULFRQGXFLELOHDGXQDSDWRORJLDLO
'DWRUHGLODYRURSRWUjHVHUFLWDUHLOSRWHUHGLVFLSOLQDUHULFRQRVFLXWRJOLDLVHQVLGHOO¶DUW
FFFXLVRQRULFRQQHVVHGHOOHFRQVHJXHQ]HVXOSLDQRVDQ]LRQDWRULR
(¶IDFROWjGHO'DWRUHGLODYRURULFKLHGHUHXQDYLVLWDPHGLFDSHUODYRUDWRULQRQVRW-­
WRSRVWLDVRUYHJOLDQ]DVDQLWDULDDGHQWLSXEEOLFLHLVWLWXWLVSHFLDOL]]DWLLYLFRPSUHVDOD
&RPPLVVLRQHGLFXLDOO¶DUWGHOOD/6WDWXWRGHL/DYRUDWRUL2YHFLzQRQ
DFFDGDLO'DWRUHGLODYRURSRWUjLQFRUUHUHQHOOHVDQ]LRQLSUHYLVWHGDOO¶DUWGHOOD/
6WDWXWRGHL/DYRUDWRUL
Giudizio di idoneità
&RQO¶LGRQHLWjDOODPDQVLRQHVSHFL¿FDVLHVSULPHODFRPSDWLELOLWjIUDORVWDWRGL
VDOXWHGHOODYRUDWRUHYDOXWDWRHO¶HVSRVL]LRQHDLIDWWRULGLULVFKLRFRUUHODWLDOODPDQ-­
VLRQH VYROWD 3HU VYROJHUH XQD GHWHUPLQDWD PDQVLRQH QRQ q VHPSUH LQGLVSHQVDELOH
XQ¶LQWHJULWjSVLFR¿VLFDFRPSOHWDLQIDWWLLOFRQFHWWRGLLGRQHLWjYDULDFRQLOPRGL¿FDUVL
GHOOHFRQGL]LRQLGLVDOXWHGHOODYRUDWRUHHGHOOHFRQGL]LRQLGLODYRUR1HOO¶HVSULPHUH
LOJLXGL]LRGLLGRQHLWjDOODPDQVLRQHVSHFL¿FDLOPHGLFRFRPSHWHQWHWLHQHFRQWRGHOOH
20
SORVEGLIANZA SANITARIA
IN AMBITO OSPEDALIERO
FRQGL]LRQLGLVDOXWHGHOODYRUDWRUHGHOODVDQLWjFKHSRVVDQRFRPSRUWDUHULVFKLSHUOD
VLFXUH]]DSURSULDHSHUODLQFROXPLWjGLWHU]L
/HGLYHUVHWLSRORJLHGLJLXGL]LRIRUPXODELOLLQUHOD]LRQHDOODLGRQHLWjDOODPDQVLR-­
QHVSHFL¿FDVRQRGLVHJXLWRHOHQFDWH,GRQHLWjLGRQHLWjVHQ]DFRQGL]LRQLVXVVLVWRQR
WXWWLLUHTXLVLWLQHFHVVDULSHUO¶HVSOHWDPHQWRLQFRQGL]LRQDWRGHOODPDQVLRQHVSHFL¿FD
,GRQHLWjFRQSUHVFUL]LRQLWHPSRUDQHDRSHUPDQHQWH): riguarda il lavoratore e si ri-­
IHULVFHDSDUWLFRODULPRGDOLWjGLHVHFX]LRQHGHOOHDWWLYLWjODYRUDWLYHSHUJDUDQWLUHXQD
PDJJLRUHSURWH]LRQHLQSDUWLFRODULLQGLYLGXLHQRQDOOHRSHUD]LRQLFKHODPDQVLRQH
FRPSRUWD5DSSUHVHQWDXQDFRQGL]LRQHGLLGRQHLWjWRWDOHDOOHYDULHFRPSRQHQWLGHOOD
PDQVLRQH D SDWWR FKH VLDQR ULVSHWWDWH OH SUHVFUL]LRQL VSHFL¿FKH TXDOL DG HVHPSLR
O¶XVRGLRSSRUWXQLGLVSRVLWLYLGLSURWH]LRQHLQGLYLGXDOH'3,O¶HIIHWWXD]LRQHGLSUR¿-­
ODVVLPLUDWDHWF,GRQHLWjFRQOLPLWD]LRQLWHPSRUDQHDRSHUPDQHQWH indica una ido-­
QHLWjSDU]LDOHVRQRFLRqHVFOXVLDOFXQLFRPSLWLFKHODPDQVLRQHFRPSRUWD
4XHVWDOLPLWD]LRQHSXzHVVHUHWHPSRUDQHDRSHUPDQHQWH,QLGRQHLWjWHPSRUDQHD
o permanente):OHFRQGL]LRQLSVLFR¿VLFKHGHOODYRUDWRUHVRQRWDOLGDQRQFRQVHQWLUH
O¶HVSOHWDPHQWRGHOODPDQVLRQHVSHFL¿FDDTXDOXQTXHFRQGL]LRQHSHUXQSHULRGRGH-­
¿QLWRRLQPRGRSHUPDQHQWH
$QGUDQQRVHPSUHSUHFLVDWLLOLPLWLWHPSRUDOLGLYDOLGLWj,QSUDWLFDO¶LGRQHLWjSLHQD
KDXQDGXUDWDGLYDOLGLWjFKHIDULIHULPHQWRDOODSHULRGLFLWjGHOOHYLVLWHPHGLFKHULSRU-­
WDWDQHOSURWRFROORVDQLWDULR
3HUWXWWHOHDOWUHIRUPHGLJLXGL]LRGLLGRQHLWjqFRUUHWWRVSHFL¿FDUQHODGXUDWDSUH-­
VXPLELOH7XWWLLWLSLGLJLXGL]LGLLGRQHLWjYDQQRFRPXQLFDWLSHULVFULWWRDOGDWRUHGL
ODYRURHGDOODYRUDWRUH'/YRDUWFR
Ricorso
³$YYHUVRLJLXGL]LGHOPHGLFRFRPSHWHQWHqDPPHVVRULFRUVRHQWURWUHQWDJLRUQL
GDOODGDWDGLFRPXQLFD]LRQHGHOJLXGL]LRPHGHVLPRDOO¶RUJDQRGLYLJLODQ]DWHUULWRULDO-­
PHQWHFRPSHWHQWHFKHGLVSRQHGRSRHYHQWXDOLXOWHULRULDFFHUWDPHQWLODFRQIHUPD
ODPRGL¿FDRODUHYRFDGHOJLXGL]LRVWHVVR´DUWFRPPD'/YRHDUW
'/JV
9LHQH VDQFLWD OD SRVVLELOLWj GL ULFRUVR DOO¶RUJDQR GL YLJLODQ]D WHUULWRULDOPHQWH
FRPSHWHQWHDWXWHODGHOOHSDUWLGDWRUHGLODYRURHODYRUDWRUHLQVHJXLWRDWXWWLLWLSL
GLJLXGL]LGLLGRQHLWjHPHVVLGDOPHGLFRFRPSHWHQWH/DYLVLWDHODYDOXWD]LRQHGHO-­
OD GRFXPHQWD]LRQH GHYRQR HVVHUH SHUWDQWR HIIHWWXDWH GDO 6HUYL]LR GL 3UHYHQ]LRQH H
6LFXUH]]D$PELHQWLGL/DYRUR63(6$/WHUULWRULDOPHQWHFRPSHWHQWHSHUO¶$]LHQGD
6DQLWDULD/RFDOHRSHUO¶$]LHQGD2VSHGDOLHUD Si ricorda che con il ricorso si avvia un 21
SURFHGLPHQWRULVSHWWRDOTXDOHVLLPSRQJRQRHYLGHQWLHVLJHQ]HGLLPSDU]LDOLWjSHUWDQ-­
WRFROXLFKHqSUHSRVWRDOO¶LVWUXWWRULDGRYUjDVWHQHUVLTXDORUDLQFRQÀLWWRG¶LQWHUHVVL
FRQLOULFRUUHQWH
6LSUHFLVDFKHDQFKHLQSUHVHQ]DGLDWWLYLWjVRJJHWWHDVRUYHJOLDQ]DVDQLWDULDSXzHV-­
VHUHULFKLHVWRLOJLXGL]LRDOODFRPPLVVLRQHFRVWLWXLWDDLVHQVLDUWGHOODOHJJH
FKHVLHVSULPHUjVXOO¶LGRQHLWjDOODPDQVLRQHJHQHULFDPHQWHLQWHVDVYLQFRODWDTXLQGL
GDRJQLULIHULPHQWRDOSRVWRGLODYRURVSHFL¿FR,OJLXGL]LRGHOPHGLFRFRPSHWHQWHVXO-­
ODPHGHVLPDPDQVLRQHqGDLQWHQGHUHLQYHFHFRPHFRQWHVWXDOL]]DWRWLHQHFLRqFRQWR
delle condizioni di salute del lavoratore strettamente correlate al contesto lavorativo DWWXDOHDOOHUHODWLYHPRGDOLWjRSHUDWLYHHDLULVFKLFRQVHJXHQWL
6LVRWWROLQHDFKHODQDWXUDJLXULGLFDGHOODULFKLHVWDVHFDUWGHOODOHJJHq
XQDULFKLHVWDGLJLXGL]LRDGXQRUJDQRSXEEOLFRHQRQXQULFRUVRFRQWURXQJLXGL]LR
,QDOWUHSDUROHPHQWUHOHDWWULEX]LRQLGHOODFRPPLVVLRQHPHGLFDFLWDWDFRQFHUQRQROD
YHUL¿FDGHOO¶LGRQHLWjJHQHULFDGHOVRJJHWWRDOODYRURLJLXGL]LGLLGRQHLWjRLQLGRQHLWj
HVSUHVVLGDOPHGLFRFRPSHWHQWHULJXDUGDQRODSRVVLELOLWjSHULOODYRUDWRUHGLHVVHUH
VRWWRSRVWRRPHQRDLULVFKLVSHFL¿FLGHULYDQWLGDOODSDUWLFRODUHPDQVLRQHODYRUDWLYD,Q
TXHVWLFDVLFRPXQTXHLOJLXGL]LRGHOODFRPPLVVLRQHQRQSUHYDOHVXOJLXGL]LRGHOPH-­
GLFRFRPSHWHQWHFKHqOD¿JXUDHVSUHVVDPHQWHSUHSRVWDDOODYDOXWD]LRQHGHOO¶LGRQHLWj
DOODPDQVLRQHGHOODYRUDWRUH(YHQWXDOLSDUHULVXOODLQLGRQHLWjJHQHULFDDOODPDQVLRQH
a giudizio della commissione saranno tuttavia adeguatamente considerati dal medico FRPSHWHQWH
,OULFRUVRSXzHVVHUHSURSRVWRGDOODYRUDWRUHJLXGLFDWRLGRQHRLGRQHRFRQOLPLWD-­
]LRQLSUHVFUL]LRQLRLQLGRQHRDOODPDQVLRQHVSHFL¿FDQHOFDVRGLJLXGL]LRIRUPXODWRLQ
VHGHGLDFFHUWDPHQWRVLDSUHYHQWLYRVLDSHULRGLFR&RPHJLjSUHFLVDWRODJHQHULFLWj
GHOFRPPDGHOO¶DUW'/JVH PRGGDDUW'/JVIDULWHQHUH
SURSRQLELOHLOULFRUVRDQFKHGDSDUWHGHOGDWRUHGLODYRUR
,OULFRUVRGHYHHVVHUSUHVHQWDWRHQWURWUHQWDJLRUQLGDOPRPHQWRLQFXLLOODYRUDWRUH
GDWRUHGLODYRURKDDYXWRSLHQDFRQRVFHQ]DGHOJLXGL]LRGHOPHGLFRFRPSHWHQWH7DOH
GDWDqGHWHUPLQDELOHLQPRGRFHUWRVHLOPHGLFRFRPSHWHQWHKDFRPXQLFDWRLOJLXGL]LR
PHGLDQWHFRQVHJQDDPDQRGHOFHUWL¿FDWRIDFHQGRVLULODVFLDUHGDOO¶LQWHUHVVDWRTXLH-­
WDQ]DGLULFHYLPHQWRGDWDWDRLQDOWHUQDWLYDVHKDSURYYHGXWRPHGLDQWHUDFFRPDQ-­
GDWDFRQDYYLVRGLULFHYLPHQWR4XDORUDODTXLHWDQ]DIRVVHSULYDGHOODGDWDVLULWLHQH
YDOLGDODGDWDGLULFHYLPHQWRGLFKLDUDWDGDOO¶LQWHUHVVDWR1RQVHPSUHLQIDWWLULVXOWD
IDFLOPHQWHGRFXPHQWDELOHSHULOODYRUDWRUHODGDWDGLDUULYRGHOJLXGL]LR'LYHUVRqLO
FDVRGHOGDWRUHGLODYRURFKHSRVVLHGHJOLVWUXPHQWLWLPEURGLDUULYRSURWRFROORHFF
SHUGLPRVWUDUHGLDYHUULFHYXWRODFRPXQLFD]LRQHGHOJLXGL]LRGHOPHGLFRFRPSHWHQWH
,OPHGLFRFRPSHWHQWHGHYHLQGLFDUHQHOJLXGL]LRODSRVVLELOLWjGLSURSRUUHULFRU-­
VRFRQWURGLHVVRO¶DXWRULWjFXLSUHVHQWDUORHGLOWHUPLQHHQWURFXLSURSRUOR4XDOR-­
UDO¶LQWHUHVVDWRLQYLDVVHLOULFRUVRDGXQR63(6$/GLYHUVRHVTXHOORGLUHVLGHQ]D
22
SORVEGLIANZA SANITARIA
IN AMBITO OSPEDALIERO
TXHVW¶XOWLPRSURYYHGHUjDWUDVPHWWHUORDOVHUYL]LRWHUULWRULDOPHQWHFRPSHWHQWHGDQ-­
GRQHQHOFRQWHPSRDYYLVRDLVRJJHWWLLQWHUHVVDWL
/DGHFLVLRQHGHOO¶RUJDQRGLYLJLODQ]DWHUULWRULDOPHQWHFRPSHWHQWHGHYHHVVHUHFR-­
PXQLFDWDFRQDWWRGHOGLULJHQWHGHOVHUYL]LRDOULFRUUHQWHDOPHGLFRFRPSHWHQWHHDJOL
DOWULLQWHUHVVDWL/DGHFLVLRQHGHOULFRUVRSXzFRQVLVWHUHQHOODFRQIHUPD del giudizio HVSUHVVRGDOPHGLFRFRPSHWHQWHQHOODVXDPRGL¿FDHSXzVSLQJHUVL¿QRDOODUHYRFD
GHOJLXGL]LRGDLQWHQGHUVLTXDOHYHUDDSURSULDULIRUPDVRVWLWXWLYDGLHVVRGDLGRQHLWj
DGLQLGRQHLWjHYLFHYHUVD
/DGHFLVLRQHGHOULFRUVRKDQDWXUDJLXULGLFDGLSURYYHGLPHQWRDPPLQLVWUDWLYRJLX-­
VWL]LDOHSHUWDQWRqLPSXJQDELOHHQWURJLRUQLFRQULFRUVRJLXULVGL]LRQDOHGLQDQ]LDO
7$5 HG HQWUR FRQ ULFRUVR DPPLQLVWUDWLYR VWUDRUGLQDULR GLQDQ]L DO 3UHVLGHQWH
GHOOD5HSXEEOLFD4XDQGRLOJLXGL]LRGHOO¶RUJDQRGLYLJLODQ]DQRQSUHYHGHOLPLWD]LRQL
WHPSRUDOL GHYH LQWHQGHUVL YDOLGR ¿QR DOOD VXFFHVVLYD YLVLWD SHULRGLFD HIIHWWXDWD GDO
PHGLFRFRPSHWHQWHLQEDVHDOSURWRFROORSUHYLVWRGDOODVRUYHJOLDQ]DVDQLWDULD
23
PARTE SPECIALE
Rischio biologico e profilassi post-esposizione
/DHVSRVL]LRQHDGDJHQWLELRORJLFLFRVuFRPHGHVFULWWDQHO7LWROR;GHO'/JV
HVPLUDSSUHVHQWDXQDFRQGL]LRQHSUDWLFDPHQWHFRVWDQWHHGHVWHQVLELOHDTXDVLWXWWL
JOLRSHUDWRULVDQLWDULDGLELWLDOODFXUDGHOSD]LHQWHHDTXHOOLGHGLFDWLDGDWWLYLWjGLODER-­
UDWRULRDQDOLVLFKLPLFRFOLQLFKHHEDWWHULRORJLFKHLVWRORJLDSDWRORJLFDHWF1RQYD
SHUDOWURWUDVFXUDWDODHVSRVL]LRQHGHJOLDGGHWWLDLFDGDYHULDQDWRPRSDWRORJLHQHFUR-­
IRULLOSHUVRQDOHDGGHWWRDOODVDQLWjYHWHULQDULDLWHFQLFLGHJOLLPSLDQWLWHUPRLGUDXOLFL
HJOLDGGHWWLDOODUDFFROWDHVPDOWLPHQWRGHLUL¿XWLSRWHQ]LDOPHQWHLQIHWWL
7DOLDWWLYLWjSRLFKqQRQFRPSRUWDQRODGHOLEHUDWDLQWHQ]LRQHGLRSHUDUHFRQDJHQWL
ELRORJLFLQRQSUHYHGRQRSHULOPHGLFRFRPSHWHQWHSDUWLFRODULDGHPSLPHQWL7XWWDYLD
SRLFKqQRQqLQIUHTXHQWHODHVSRVL]LRQHDGDJHQWLELRORJLFLGHOJUXSSRHGHOO¶DOOH-­
JDWR;/9,VSHFLHQHOOHXQLWjRSHUDWLYHGLPDODWWLHLQIHWWLYHSQHXPRORJLDHODERUDWRUL
GL DQDOLVL PLFURELRORJLFKH q UDFFRPDQGDELOH OD VRUYHJOLDQ]D FRVWDQWH GHOO¶DGHPSL-­
PHQWRGHJOLREEOLJKLGHOGDWRUHGLODYRURLQPDWHULDGLPLVXUHHOLYHOOLGLFRQWHQLPHQWR
DOO;/9,,VFHOWDHIRUQLWXUDGLLGRQHLGLVSRVLWLYLGLSURWH]LRQHPLVXUHLJLHQLFKH
3DUWLFRODUPHQWH HI¿FDFH SXz ULVXOWDUH OD SDUWHFLSD]LRQH GHO PHGLFR FRPSHWHQWH
QHOODHVWHQVLRQHGHOODUHOD]LRQHGLYDOXWD]LRQHGLULVFKLRHQHOOHDWWLYLWjGLIRUPD]LRQH
HGLQIRUPD]LRQH,ODYRUDWRULDGGHWWLDGDWWLYLWjFRPSRUWDQWLXVRGLDJHQWLGHOJUXSSR
RYYHURVRQRLVFULWWLLQXQUHJLVWURLOGDWRUHGLODYRURLVWLWXLVFHHGDJJLRUQDWDOHUHJL-­
VWURHQHFXUDODWHQXWDWUDPLWHLOUHVSRQVDELOHGHOVHUYL]LRGLSUHYHQ]LRQHHSURWH]LRQH
9HUUDQQRLOOXVWUDWHGLVHJXLWROHSURFHGXUHHGLULIHULPHQWLQRUPDWLYLFKHLQWHUHV-­
VDQRLOPHGLFRFRPSHWHQWHQHLULJXDUGLGHOO¶HVSRVL]LRQHDJOLDJHQWLELRORJLFLSLUDS-­
SUHVHQWDWLLQDPELWRVDQLWDULR
VIRUS EPATITE B: YHUUDQQRHIIHWWXDWLQHOFRUVRGHOODYLVLWDSUHYHQWLYDJOLHVDPL
GLODERUDWRULRSHUODGH¿QL]LRQHGHLPDUNHUVYLUDOL+%V$JDQWL+%V$JFRQWLWRORDQ-­
WL+%F$J/HYDOXWD]LRQLFKHQHFRQVHJXRQRYHQJRQRGHVFULWWHLQ7DE,PHGHVLPL
PDUNHUVYHUUDQQRWHVWDWLRJQLDQQLQHOODYRUDWRUHYDFFLQDWRSHULOPRQLWRUDJJLR
24
SORVEGLIANZA SANITARIA
IN AMBITO OSPEDALIERO
GHO WLWROR DQWLFRUSDOH FKH DQFKH VH LQIHULRUH D P8,?PO QRQ ULFKLHGH SDUWLFRODUL
SURYYHGLPHQWLVHQRQXQVRORULFKLDPRSRVWYDFFLQDOH,QIDWWLODULVSRVWDDQWLFRUSDOH
ULVXOWDULDWWLYDUVLDXWRQRPDPHQWHGRSRLOQXRYRFRQWDWWR'01RYHPEUH
1HOODYRUDWRUHQRQYDFFLQDWRRQRQUHVSRQGHULOFRQWUROORGRYUjHVVHUHHIIHWWXDWRFRQ
FDGHQ]DGHOOHYLVLWHSHULRGLFKHHDQQXDOPHQWHQHJOLDGGHWWLDGDWWLYLWjLQYDVLYH
VIRUS EPATITE C: O¶DQWL+&9YHUUjWHVWDWRDOODSULPDYLVLWDHVXFFHVVLYDPHQWH
FRQODFDGHQ]DGHOOHYLVLWHSHULRGLFKH$QQXDOPHQWHQHJOLDGGHWWLDGDWWLYLWjLQYDVLYH
,QWDEYHQJRQRGHVFULWWLLWHVWFXLVRWWRSRUUHLODYRUDWRULDQWL+&9HOHULFDGXWHGHJOL
HVLWLVXOJLXGL]LRGLLGRQHLWjODYRUDWLYD
HIV: LOWHVWYDHIIHWWXDWRDOODSULPDYLVLWDHGHYHQWXDOPHQWHQHOFRUVRGHOOHYLVLWH
SHULRGLFKHSUHYLRFRQVHQVRLQIRUPDWRHVHFRQGROHPRGDOLWjGLOHJJH9DQQRDTXHVWR
SURSRVLWRULFRUGDWHOHOLQHHJXLGDSHUJOLRSHUDWRULVDQLWDULSHULOFRQWUROORGHOOHLQIH-­
]LRQLGD+,9&RPPLVVLRQH1D]LRQDOHSHUODORWWDFRQWURO¶$,'6'0
MISURE di EMERGENZA IN CASO DI INCIDENTE DA CONTATTO CON HBV, HCV, HIV:1HOOHWDEYHQJRQRGHVFULWWHOHSURFHGXUHGDDGRWWDUH(¶HYLGHQWH
FKHLOFRLQYROJLPHQWRGHOPHGLFRFRPSHWHQWHVDUjGLYHUVRDVHFRQGDGHOODGLVSRQLEL-­
OLWjGLXQDXQLWjRSHUDWLYDGLPDODWWLHLQIHWWLYHDOODTXDOHYDQQRFRPXQTXHDI¿GDWHLQ
PRGRHVFOXVLYROHPLVXUHGLSRVWHVSRVL]LRQHDG+,9
MYCOBACTERIUM TUBERCULOSIS: $QFRUD RJJL OD WXEHUFRORVL UDSSUHVHQWD
XQRGHLSUREOHPLSLVHULGLVDOXWHSXEEOLFDDFDXVDGHOODGLIIXVLRQHGLFHSSLGLPLFR-­
EDWWHULRIDUPDFRUHVLVWHQWLHDOODVWUHWWDDVVRFLD]LRQHGHOO¶LQIH]LRQHFRQIDVFHVRFLDOL
GHEROL,QDPELWRRFFXSD]LRQDOHODWUDVPLVVLRQHQRVRFRPLDOHGHOOD7%GDSD]LHQWLD
RSHUDWRUL VDQLWDUL q VWDWD DPSLDPHQWH GRFXPHQWDWD ,O UHFHQWH LQFUHPHQWR GL QXRYL
FDVLGLDJQRVWLFDWLGLLQIH]LRQHWXEHUFRODUHWUDLSD]LHQWLFKHJLXQJRQRDOOHFXUHRVSH-­
GDOLHUH VRSUDWWXWWR LQ UHSDUWL D ULVFKLR WUD FXL SURQWR VRFFRUVR PDODWWLH LQIHWWLYH
SQHXPRORJLDRVWHWULFLD H JLQHFRORJLD DWWULEXLELOH DJOL LPSRQHQWL ÀXVVL LPPLJUDWRUL
GLVRJJHWWLSURYHQLHQWLGDSDHVLDGDOWRULVFKLRUHQGHUDJLRQHGHOODQHFHVVLWjGLDSSOL-­
FDUHSURJUDPPLGLPRQLWRUDJJLRDWWLYRVXWDOLRSHUDWRUL6LQRDSRFRWHPSRDGGLHWUR
LOWHVWFXWDQHRWXEHUFROLQLFR7&7UDSSUHVHQWDYDO¶XQLFDPHWRGRORJLDGLVSRQLELOHLQ
JUDGRGLGLDJQRVWLFDUHO¶LQIH]LRQHWXEHUFRODUHODWHQWH,7/5HFHQWHPHQWHVRQRVWDWL
LQWURGRWWLQXRYLWHVWLQYLWURSHUODGLDJQRVLGL7%LO4XDQWLIHURQ7%*ROG47)*
HLO763277%SURSRVWLSHUODVRUYHJOLDQ]DVDQLWDULDGHJOLRSHUDWRULVDQLWDULHVSRVWLD
0\FREDFWHULXPWXEHUFXORVLV7DOLWHVWVLEDVDQRVXOODPLVXUD]LRQHGLLQWHUIHURQJDP-­
PD,)1ȖSURGRWWRGDOOHFHOOXOH7LQULVSRVWDDJOLDQWLJHQLVSHFL¿FLGHOPLFREDWWHULR
WXEHUFRODUH$SSDUHGLSULPDULDLPSRUWDQ]DLOFRQWUROORGHOSHUVRQDOHVDQLWDULRYHQXWR
25
DFRQWDWWRFRQLPDODWLGL7%&SROPRQDUHDWWLYD1HOSHUVRQDOHVDQLWDULRFKHSHUODSUL-­
PDYROWDYLHQHDFRQWDWWRFRQLOPLFREDWWHULRO¶DWWLYD]LRQHLPPXQRFRPSHWHQWHULVXOWD
ULOHYDELOHVHWWLPDQHGRSRLOSULPRFRQWDWWRULVSHWWLYDPHQWHFRQWHVWLQYLYRLQWUD-­
GHUPRUHD]LRQHGL0DQWRX[RFRQLWHVWLQYLWUR3HUTXDQWRULJXDUGDLWHVWLQYLYROD
SRVLWLYLWjGHOWHVWFXWDQHRWXEHUFROLQLFRGH¿QLWDLQEDVHDOODHQWLWjGHOSRPIRPLVXUDWR
DRUHLQDVVRFLD]LRQHFRQGH¿QLWHFRQGL]LRQLFOLQLFKHWHVWLPRQLDVRORO¶DYYHQX-­
WDHVSRVL]LRQHDOEDFLOOR/¶LGHQWL¿FD]LRQHGHOORVWDWRGLSRUWDWRUHGLµLQIH]LRQHWXEHU-­
FRODUHODWHQWH¶,7/qIRQGDPHQWDOHSHUODSUHYHQ]LRQHHGLQ7DEVLGHVFULYRQROH
SURFHGXUHGLPRQLWRUDJJLRGHOODYRUDWRUHDQFKHDOODOXFHGHOOHLQGLFD]LRQLFRQWHQXWH
QHO'35Q/H/LQHH*XLGD86$SUHYHGRQRO¶XWLOL]]RGHOWHVW
4)7*LQWXWWHOHVLWXD]LRQLQHOOHTXDOLLOWHVWFXWDQHRqJHQHUDOPHQWHXVDWRFRPSUHVL
JOLVFUHHQLQJGHLFRQWDWWLODYDOXWD]LRQHGLVRJJHWWLYDFFLQDWLFRQ%&*GLUHFHQWHLP-­
PLJUD]LRQHHJOLVFUHHQLQJSHULQIH]LRQHWXEHUFRODUHGHJOLRSHUDWRULVDQLWDULUHFHQWL
FRQWULEXWL86$GHOODOHWWHUDWXUDVXSSRUWDQRXOWHULRUPHQWHYDOLGLWjHFRQYHQLHQ]D
GHL QXRYL WHVW LPPXQRORJLFL QHOO¶XWLOL]]R FRPH WHVW GL VFUHHQLQJ , &'& FDQDGHVL
SHUDOWURKDQQRUHFHQWHPHQWHFRQFOXVRFKHQRQYLVRQRDQFRUDHYLGHQ]HVXI¿FLHQWLSHU
SURSRUUHO¶XWLOL]]RGLWHVWLPPXQRORJLFLSHUODVRUYHJOLDQ]DVDQLWDULDGHJOLRSHUDWRUL
VDQLWDUL2FFRUURQRXOWHULRULDSSURIRQGLPHQWLSHUSURSRUUHO¶XWLOL]]RVXYDVWDVFDOD
DQFKHLQUHOD]LRQHDLFRVWLGHOODPHWRGLFDHDOODEDVVDFRQFRUGDQ]DULVFRQWUDWDFRQLO
7&7LQDOFXQLVWXGL/HOLQHHJXLGDQD]LRQDOLIRUQLUDQQRUDFFRPDQGD]LRQLVXOO¶XWLOL]]R
GHLQXRYLHGHOYHFFKLRWHVWGLVFUHHQLQJSHUO¶LQIH]LRQHWXEHUFRODUHHVRQRLQFRUVRGL
GH¿QL]LRQH
/¶XVRGHO4)7*SUHVHQWDGLYHUVLYDQWDJJLULVSHWWRDOWHVWFXWDQHRWXEHUFROLQLFR
QHVVXQDQHFHVVLWjGLULWRUQRGHOO¶RSHUDWRUHVDQLWDULRSHUODOHWWXUDGHOULVXOWDWRPLQRUH
YDULDELOLWjLQWHUHLQWUDRVVHUYDWRUHQHOODOHWWXUDGHLULVXOWDWLUDSLGDGLVSRQLELOLWjGHJOL
VWHVVLDVVHQ]DGLHIIHWWRERRVWHUHOHYDWDVSHFL¿FLWjGRYXWDDOODVWLPROD]LRQHFRQDQ-­
WLJHQLVSHFL¿FLSHULO0WXEHUFXORVLVFKHHOLPLQDODSRVVLELOLWjGLIDOVLSRVLWLYLGRYXWL
DOODYDFFLQD]LRQHFRQ%&*/LQHHJXLGDEDVDWHVXOO¶HYLGHQ]DSXEEOLFDWHLQ,QJKLOWHUUD
SURSRQJRQRODYDFFLQD]LRQHFRQ%&*SHUWXWWLJOLRSHUDWRULVDQLWDULPHQWUHLQ,WDOLDOD
QRUPDWLYDYLJHQWHLPSRQHODYDFFLQD]LRQHVRORLQVLWXD]LRQLGLULVFKLRGLHVSRVL]LRQH
DFHSSLPXOWLIDUPDFRUHVLVWHQWL
MYCOBACTERIUM BOVIS : LOSHUVRQDOHGHOO¶DUHDYHWHULQDULDRSHUDQWHLQVWDO-­
OHGHYHHVVHUHVRWWRSRVWRDGLQWUDGHUPRUHD]LRQHVHF0DQWRX[HDPLVXUHGLSUR¿ODVVL
VSHFLDOLVWLFDLQFDVRGLFXWLFRQYHUVLRQHUHFHQWH
TOXOPLASMA, ROSOLIA, CITOMEGALOVIRUS, HERPES (TORCH) : il test va HVHJXLWRLQSULPDYLVLWDVXOOHODYRUDWULFLLQHWjIHUWLOHLPSLHJDWHLQ87,1SHGLDWULDH
PDODWWLHLQIHWWLYHDO¿QHGLSUHYHQLUHHIIHWWLOHVLYLVXOQDVFLWXURLQFDVRGLJUDYLGDQ]D
26
SORVEGLIANZA SANITARIA
IN AMBITO OSPEDALIERO
8QDFFHQQRPHULWDODHVSRVL]LRQHSHUFRQWDWWRDFFLGHQWDOHGHOSHUVRQDOHYHWHUL-­
QDULR LPSLHJDWR DOO¶DSHUWR SHU LO FRQWUROOR GHOOH JUHJJLQHOOH VWDOOH H QHL ODERUDWRUL
GL SURGX]LRQH GL DOLPHQWL QHL FRQIURQWL GL DJHQWL ELRORJLFL DQFKH LQ TXDOFKH FDVR
SDUWLFRODUPHQWH SHULFRORVL EUXFHOOH ]HFFKH FRPH SDUDVVLWL H YHWWULFL GL YLURVL H
ULFNHWWVLRVLYLUXVGLHQFHIDOLWLDQLPDOL,Q¿QHVLGHYHVRWWROLQHDUHLOUXRORGHOPHGLFR
FRPSHWHQWHQHOO¶LVWUXLUHLOODYRUDWRUHVXLYDQWDJJLHGLQFRQYHQLHQWLIRUQLWLGDOOHYDFFL-­
QD]LRQLFKHSRVVRQRHVVHUHUDFFRPDQGDWHHDQFKHUL¿XWDWHGDOODYRUDWRUH,QRJQLFDVR
LOGDWRUHGLODYRURKDO¶REEOLJRGLPHWWHUHDGLVSRVL]LRQHGHOODYRUDWRUHYDFFLQLHI¿FD-­
FL,OPHGLFRFRPSHWHQWHSRWUjVRPPLQLVWUDUOLQHOOXRJRGLODYRURPDWUDWWDQGRVLGL
SHUVRQDOHLPSLHJDWRLQVDQLWjqRSSRUWXQRDYYDOHUVLGHJOLDPEXODWRULGLYDFFLQD]LRQH
GHL GLSDUWLPHQWL GL SUHYHQ]LRQH GHOOH VWHVVH$6/ FKH VX ULFKLHVWD GHO PHGLFR FRP-­
SHWHQWHVRPPLQLVWUDQRJUDWXLWDPHQWHLOYDFFLQRULODVFLDQGRRSSRUWXQDFHUWL¿FD]LRQH
3HUODDSSOLFD]LRQHGHOOHYDFFLQD]LRQLVLRIIUHLOULIHULPHQWRGHOOH/LQHHGLLQGLUL]]R
UHJLRQDOLVXOOD3UR¿ODVVLGHOULVFKLRELRORJLFRGDLQÀXHQ]DYDULFHOODPRUELOORSDUR-­
WLWHURVROLDHSDWLWH%HWHWDQRGRFXPHQWRDOOHJDWRDOODGHOLEHUDGL*5QGHO
27
Tabella 1 HBV
7$%+%9
+%V$J
+%V$E
+%F$E
3RUWDWRUH
DSSURIRQGLUH
FRQ+%9
'QDODERUD
WRULRFOLQLFD
!P8, YDFFLQDWR
P8, QRQYDFFLQDWRRQRQUHVSRQGHU
8VRGL
'3,
YDOXWD]LRQH
SHU
HYHQWXDOL
PDQRYUH
LQYDVLYH
1RQYDFFLQDWRQRQUHVSRQGHUFRQVLJOLDUHYDFFLQD]LRQHHRXQ
ULFKLDPR
9LUXVHSDWLWHJXDULWD
1RYDFFLQD]LRQH
&RQVLJOLDUHYDFFLQD]LRQH
28
SORVEGLIANZA SANITARIA
IN AMBITO OSPEDALIERO
Tabella 2 HCV
anti&9 Nessun SURYYHGL-­
mento +&951$-­ idoneo +&951$ Seguire con infettivologo 8VRGL'3,
valutazione SHUHYHQWXDOL
manovre invasive 29
Tabella 3
75$80,'$&217$772$&&,'(17$/(
&21/,48,',(7(6687,%,2/2*,&,+%9
Paziente HBsAg e anti HBsAg Lavoratore
anti HBsAg +
Nessun
provvedimento
30
Paziente HBsAg+
e/o non noto
Lavoratore
anti HBsAg Monitoraggio
a 45, 90, 180
giorni
Lavoratore
anti HBsAg +
Nessun
provvedimento
Lavoratore
anti HBsAg ,PPXQRSURÀODVsi
SORVEGLIANZA SANITARIA
IN AMBITO OSPEDALIERO
Tabella 4
75$80,'$&217$772$&&,'(17$/(
&21/,48,',(7(6687,%,2/2*,&,+&9
Paziente
anti HCV –
anti HCV +
Lavoratori
anti HCV –
monitoraggio 45, 90, 180 giorni
31
Tabella 5
3UR¿ODVVLSRVWHVSRVL]LRQHDGLQIRUWXQLRDULVFKLRELRORJLFR33(
3URFHGXUDRSHUDWLYDGDDWWXDUHLQFDVRGLLQIRUWXQLRVXOODYRURGDSDWRJHQLDWUDVPLVVLRQH
HPDWLFD+%9+&9+,9
OPERATORE SANITARIO
SXQWXUDRWDJOLR±
contaminazione cute o mucose)
WUDWWDPHQWRORFDOHVDQJXLQDPHQWRODYDJJLRGLVLQIH]LRQH
FRPSLOD XQLWDPHQWH DO 5HVSRQVDELOH GHOO¶82 LO PRGXOR GL
UDFFROWDGDWLLQIRUWXQLRDULVFKLRELRORJLFRFRQSDUWLFRODUHULIHULPHQWR
D FDXVH FLUFRVWDQ]H OXRJR GHOO¶LQIRUWXQLR FDUDWWHULVWLFKH H
sierologia del soggetto fonte
5()(5(17(81,7$¶
OPERATIVA
&RPSLOD H ¿UPD XQLWDPHQWH DOO¶RSHUDWRUH VDQLWDULR LO PRGXOR GL
UDFFROWDGDWLLQIRUWXQLRDULVFKLRELRORJLFR
,QYLDO¶RSHUDWRUHDO3URQWR6RFFRUVRSLYLFLQRFRQLOPRGXORGLUDFFROWD
GDWLLQIRUWXQLRDULVFKLRELRORJLFRFRPSLODWR
MEDICO DI PRONTO SOCCORSO
&RPSOHWD LO WUDWWDPHQWR ORFDOH GHO OD VHGH GL FRQWDWWR HR DWWLYD RSSRUWXQH
PLVXUHGLSUR¿ODVVL
&RPSLODLOUHIHUWRHGLOSULPRFHUWL¿FDWRGLLQIRUWXQLRFDXWHODWLYR
,QYLDFRPXQLFD]LRQHDOOD'LUH]LRQH6DQLWDULD
(IIHWWXD LO SUHOLHYR SHU JOL HVDPL GL ODERUDWRULR DO WHPSR ]HUR H DYYLD DO
ODERUDWRULRDQDOLVL
DIREZIONE SANITARIA
$FTXLVLVFH QRWL]LH XWLOL SHU LQROWUDUH OD GHQXQFLD GL LQIRUWXQLR DJOL RUJDQL
FRPSHWHQWL
$FFHUWDOHFDXVHHOHFLUFRVWDQ]HSHUJOLHYHQWXDOLSURYYHGLPHQWLGHOFDVR
7UDVPHWWHLOPRGXORGLUDFFROWDGDWLLQIRUWXQLRDULVFKLRELRORJLFRHGLOUHIHUWRGHO
3URQWR6RFFRUVRDO6HUYL]LRGL6RUYHJOLDQ]D6DQLWDULD8I¿FLR0HGLFR&RPSHWHQWH
/$%25$725,2$1$/,6,
(IIHWWXDJOLHVDPLGLODERUDWRULRULFKLHVWLGDO36HGDO6HUYL]LRGL
6RUYHJOLDQ]D6DQLWDULD8I¿FLR0HGLFR&RPSHWHQWH
6(59,=,2',6259(*/,$1=$
SANITARIA (UFFICIO MEDICO COMPETENTE)
32
5LFHYH LO PRGXOR GL UDFFROWD GDWL LQIRUWXQLR D ULVFKLR
ELRORJLFRHGLOUHIHUWRGHO3URQWR6RFFRUVR
$YYLD SURJUDPPD GL 33( 3UR¿ODVVL 3RVW(VSRVL]LRQH
VXOOD EDVH GHOOD VLWXD]LRQH YDFFLQDOH H GDWL VDQLWDUL
GHOO¶RSHUDWRUHVDQLWDULR
7UDVPHWWHHVLWRGHJOLHVDPLDOO¶RSHUDWRUHVDQLWDULR
SORVEGLIANZA SANITARIA
IN AMBITO OSPEDALIERO
Tabella 6
7$%7%&(35(9(1=,21(
,175$'(5025($=,21(
',0$1728;R
4XDQWLIHURQ7%*2/'
4)7*
9DFFLQDWR%%*
1RQ
9DFFLQDWR
%%*
1HJDWLYR
1HJDWLYR
R
R
3RVLWLYR
3RVLWLYR
0RQLWRUDJJLR
0RQLWRUDJJLR
VHF9G5
VHF9G5
3QHXPRORJLD
3QHXPRORJLD
0,QIHWWLYH
0,QIHWWLYH
&KLU3ROPRQDUH
&KLU3ROPRQDUH
0HGLFLQD
0HGLFLQD
/XQJRGHJHQ]D
/XQJRGHJHQ]D
/DE0LFURELRORJLD
/DE0LFURELRORJLD
3RVLWLYR
1HJDWLYR
1HJDWLYR
3RVLWLYR
0RQLWRUDJJLR
DQQXDOHELHQQDOH
&XWLFRQYHUVLRQH
9DFFLQR%%*
0RQLWRUDJJLR
DQQXDOHELHQQDOH
SRVLWLYL]]D]LRQHUHFHQWH
&RQWDWWDUHVSHFLDOLVWDSHUSURILODVVL
/H LQL]LDWLYH GL VRUYHJOLDQ]D VDQLWDULD SRWUDQQR FRLQYROJHUH L FHQWUL DQWL
/HLQL]LDWLYHGLVRUYHJOLDQ]DVDQLWDULDSRWUDQQRFRLQYROJHUHLFHQWULDQWLWXEHUFRODULGL
WXEHUFRODULGLULIHULPHQWRWHUULWRULDOH
ULIHULPHQWRWHUULWRULDOH
6259(*/,$1=$6$1,7$5,$263('$/,($=,(1'(6$1,7$5,(5(*,21(38*/,$
SDJGL
33
Chemioterapici antiblastici
4XHVWHVRVWDQ]HVRQRHVFOXVHGDOODGH¿QL]LRQHGLDJHQWLRSUHSDUDWLFKLPLFLSH-­
ULFRORVLGLVRVWDQ]HRSUHSDUDWLFDQFHURJHQLHPXWDJHQLDLVHQVLGHL'/JVH
LQTXDQWRPHGLFDPHQWLDGXVRXPDQRHSHUWDQWRQRQULHQWUDQRQHOOHSUHYL-­
VLRQLGHO7LWROR,;&DSR,H&DSR,,GHO'/JVLQWHJUGD'/JV
/D&RPPLVVLRQH&RQVXOWLYD7RVVLFRORJLFD1D]LRQDOHKDLQGLFDWRWXWWDYLDODQHFHVVLWj
FKHWDOLIDUPDFLLQDPELWRRVSHGDOLHURYHQJDQRWUDWWDWLFRQOHPHGHVLPHFDXWHOHGHOOH
VRVWDQ]HFDQFHURJHQH
6L ULWLHQH FKH OD VRVSHWWD D]LRQH FDQFHURJHQD VLDVRSUDWWXWWR QHL FRQIURQWL GHOO¶
DSSDUDWRHPRSRLHWLFRSHUFXLJOLDFFHUWDPHQWLPLUDWLGLSULPROLYHOORLQFOXGHUDQQR
HPRFURPRFRQIRUPXODSLDVWULQHHGHYHQWXDOPHQWHUHWLFRORFLWLROWUHDGXQDYDOXWD-­
]LRQHEDVHGLIXQ]LRQDOLWjHSDWLFDHUHQDOH
$QGUDQQRDGHJXDWDPHQWHFRQVLGHUDWLDQFKHULVFKLGLYHUVLGDTXHOOLFDQFHURJHQL
HGLQSDUWLFRODUHO¶HFFHVVRGLLQWHUUX]LRQLLQYRORQWDULHGLJUDYLGDQ]DHOHUHD]LRQLGD
LSHUVHQVLELOLWj
3XU LQ FDUHQ]D GL ULOLHYL HSLGHPLRORJLFL VXOOD FRQVLVWHQ]D UHDOH GHO SUREOHPD q
IXRU GL GXEELR FKH OD SDWRORJLD DOOHUJLFD q OD SL GHVFULWWD LQ FRQFRPLWDQ]D DOO¶XVR
SURIHVVLRQDOHGLIDUPDFL
3UHYDOJRQROHGHUPRSDWLHGHOOHPDQLFRQFDUDWWHULVWLFKHGLWLSRHF]HPDWRVR1RQ
PDQFDQRLQOHWWHUDWXUDOHGHVFUL]LRQLGLFDVLGLRUWLFDULDSUXULWRHUXVKHULWHPDWRVR
GHOOHPDQLHDYDPEUDFFLULQLWHDVPDEURQFKLDOHHGHPDGHOODJORWWLGHHLQPRGRGHO
WXWWRVSRUDGLFRVKRFNDQD¿ODWWLFR
,OPHGLFRFRPSHWHQWHGRYUjFRQVLGHUDUHTXHOOHVLWXD]LRQL¿VLRORJLFKHHSDWRORJL-­
FKHFRQJHQLWHRDFTXLVLWHFKHSRWUHEEHURFRQ¿JXUDUHFDVLGLSDUWLFRODUHVXVFHWWLELOLWj
RFKHSRWUHEEHURDJJUDYDUVLGDOO¶HVSRVL]LRQHSURIHVVLRQDOHGDDQWLEODVWLFL
,QSDUWLFRODUHVRQRGDFRQVLGHUDUHWDODVVHPLHHPRJORELQRSDWLHFDUHQ]DGL*3'
HULWURFLWDULDDQHPLHOHXFRSHQLHSLDVWULQRSHQLHDOWHUD]LRQLGHOODIXQ]LRQDOLWjUHQDOH
HGHSDWLFDSUHJUHVVDHVSRVL]LRQHSURIHVVLRQDOHDUDGLD]LRQLLRQL]]DQWLRDVRVWDQ]H
FDQFHURJHQH SUHJUHVVH WHUDSLH FDSDFL GL LQGXUUH LSRSODVLD PLGROODUH LQ SDUWLFRODUH
WUDWWDPHQWLFRQDQWLEODVWLFLRFRQUDGLD]LRQLLRQL]]DQWLFRQGL]LRQLGLDWRSLD
,O PHGLFR FRPSHWHQWH YDOXWHUj LQROWUH O¶RSSRUWXQLWj GL SUHGLVSRUUH VSHFL¿FKH
LQGDJLQL GL PRQLWRUDJJLR ELRORJLFR /D SHULRGLFLWj GHOOD VRUYHJOLDQ]D VDQLWDULD VDUj
VXJJHULWDLQUDSSRUWRDOO¶LQWHQVLWjGHOO¶HVSRVL]LRQHO¶DGHJXDWDDGR]LRQHGLSURWH]LRQL
SHUVRQDOLHO¶XWLOL]]RGLFDELQHDÀXVVRODPLQDUHYHUWLFDOH
3XUWHQHQGRSUHVHQWHODWLSRORJLDGHOOHUHDOWjHGHJOLDPELHQWLGLODYRURDWWXDOLOD
PDQLSROD]LRQHGHLFKHPLRWHUDSLFLDQWLEODVWLFLGRYUjHVVHUHHVHJXLWDLQVLWXD]LRQLSUR-­
WHWWHHGDSHUVRQDOHTXDOL¿FDWRGHELWDPHQWHLQIRUPDWRGHLULVFKLHIRUPDWRDGRSHUDUH
LQVLFXUH]]D3URYY*8VHUJHQQGHO
34
SORVEGLIANZA SANITARIA
IN AMBITO OSPEDALIERO
Lattice
,JXDQWLLQODWWLFHVRQRLGLVSRVLWLYLGLSURWH]LRQHLQGLYLGXDOHSLDPSLDPHQWHXWL-­
OL]]DWLHSLIUHTXHQWHPHQWHUHVSRQVDELOLGLVHQVLELOL]]D]LRQHDOODWWLFHGLJRPPDLQ
RFFDVLRQHGLODYRURSHUJOLRSHUDWRULVDQLWDUL,SURYYHGLPHQWLGDDGRWWDUHLQFDVRGL
ULVFRQWURGLDOOHUJLDDOODWWLFHYDULDQRLQIXQ]LRQHGHOTXDGURFOLQLFRFRQVLGHUDQGRLO
ULVFKLRGLFRPSDUVDGLUHD]LRQLDQFKHGLQRWHYROHJUDYLWj
'DOO¶HVDPHHGDOFRQIURQWRWUDOLQHHJXLGDLWDOLDQHHGLQWHUQD]LRQDOLHPHUJHXQD
VRVWDQ]LDOHXQLIRUPLWjGLYHGXWHVXLSURWRFROOLGLFRPSRUWDPHQWRSHUODSUHYHQ]LRQH
HODJHVWLRQHGHOO¶DOOHUJLDDOODWWLFHLQDPELWRVDQLWDULRLQSDUWLFRODUHYLqSLHQDFRQ-­
FRUGDQ]DVXLVHJXHQWLSXQWLDVLUDFFRPDQGDO¶XVRGLJXDQWLGLPDWHULDOHGLYHUVRGDO
ODWWLFHGRYHLOULVFKLRELRORJLFRVLDOLPLWDWRELQFDVRGLXVRGLJXDQWLLQODWWLFHqRS-­
SRUWXQRVFHJOLHUHJXDQWLVHQ]DSROYHUHOXEUL¿FDQWHHDEDVVRFRQWHQXWRSURWHLFRSRL-­
FKpULGXFRQRO¶HVSRVL]LRQHDGDOOHUJHQLGHOODWWLFHLQSDUWLFRODUHO¶DVVHQ]DGLSROYHUH
FRQVHQWHGLHYLWDUHO¶DHURGLVSHUVLRQHGHJOLDOOHUJHQLFLJXDQWLFRVLGGHWWLµLSRDOOHUJH-­
QLFL¶QRQULGXFRQRLOULVFKLRGLLSHUVHQVLELOLWjGLWLSRLPPHGLDWRDODWWLFHPDSRVVRQR
ULGXUUHO¶LQFLGHQ]DGLUHD]LRQLDJOLDGGLWLYLFKLPLFLGHOODJRPPDGHUPDWLWLDOOHUJLFKH
GDFRQWDWWRGGRSRDYHULQGRVVDWRJXDQWLLQODWWLFHODYDUHOHPDQLFRQVDSRQHQHXWURH
ULVFLDFTXDUHHHIIHWWXDUHSURJUDPPLGLIRUPD]LRQHPLUDWLSHULODYRUDWRULGHOFRPSDU-­
WRVDQLWj,QULIHULPHQWRDLTXHVWLRQDULSHULGHQWL¿FDUHVRJJHWWLFRQVRVSHWWDDOOHUJLDDO
ODWWLFHDLSHUFRUVLGLDJQRVWLFLHDGDOWUHLQIRUPD]LRQLXWLOLVLULPDQGDDOOH/LQHH*XLGD
SHUODSUHYHQ]LRQHGHOOHUHD]LRQLDOOHUJLFKHQHOOHVWUXWWXUHVDQLWDULHGHOOD5HJLRQH'H-­
OLEHUD'*$5(63XJOLDQƒ
,QSUHVHQ]DGLIDWWRULSUHGLVSRQHQWLDWRSLDDVPDHULQLWHQRQSURIHVVLRQDOLVWRULD
GLSUHHVLVWHQWHGHUPDWLWHGHOOHPDQLHOHYDWDLQWHQVLWjHGXUDWDGHOO¶HVSRVL]LRQHHWF
OHYLVLWHSHULRGLFKHVDUDQQRSLIUHTXHQWLGRSRXQDGHJXDWRSURJUDPPDIRUPDWLYR
4XDORUD LO PHGLFR FRPSHWHQWH ULVFRQWUL O¶HVLVWHQ]D GL XQD SDWRORJLD GD JXDQWL FRQ
FRUUHWWDGLDJQRVLH]LRORJLFDVDUDQQRDGRWWDWLSURYYHGLPHQWLGLIIHUHQ]LDWLLQIXQ]LR-­
QHGHOWLSRUHD]LRQL,J(PHGLDWHTXDOLRUWLFDULDRFXORULQLWHDVPDEURQFKLDOHVKRFN
DQD¿ODWWLFRRGHUPDWLWLFHOOXORPHGLDWHLUULWDWLYHHGHOODVHYHULWjGHOTXDGURFOLQLFR
,Q FDVR GL UHD]LRQLJUDYLTXDOL VKRFN DQD¿ODWWLFRHGHPDGHOODJORWWLGHRUWLFDULDJH-­
QHUDOL]]DWDVLSURYYHGHUjDOORVSRVWDPHQWRGHOODYRUDWRUHSUHVVRXQDXQLWjRSHUDWLYD
RYHQRQVLDULFKLHVWRO¶XVRGLGLVSRVLWLYLLQODWWLFH1HLFDVLLQFXLVLDGLI¿FROWRVDOD
ULFRQYHUVLRQHDGDOWULFRPSLWLSRWUjHVVHUHFRQVLGHUDWRO¶XVRHVFOXVLYRHVLVWHPDWLFR
GLGLVSRVLWLYLlatex-­safeGDSDUWHGLWXWWRLOSHUVRQDOHGHOO¶XQLWj
(¶DXVSLFDELOHFKHLQIXWXURYHQJDXOWHULRUPHQWHLQQDO]DWRLOOLYHOORTXDOLWDWLYR
GHLJXDQWLHGHJOLDOWULGLVSRVLWLYLSUHYHGHQGRFKHOHD]LHQGHSURGXWWULFLTXDQWL¿FKLQR
QRQVRORLOFRQWHQXWRSURWHLFRWRWDOHPDDQFKHOHIUD]LRQLDOOHUJHQLFKHGHOODWWLFHH
YHQJDQRVWDELOLWLGHLOLPLWLTXDQWLWDWLYLDOFRQWHQXWRDOOHUJHQLFR
35
Movimentazione manuale di pazienti
*OLRSHUDWRULVDQLWDULDGGHWWLDOO¶DVVLVWHQ]DGHLSD]LHQWLULHQWUDQRWUDOHFDWHJRULH
SHUOHTXDOLqVWDWRSRVVLELOHGLPRVWUDUHXQDXPHQWRGHLFDVLGLSDWRORJLHPXVFROR
VFKHOHWULFKHULFRQGXFLELOLDOO¶DWWLYLWjODYRUDWLYD9LqHYLGHQ]DVFLHQWL¿FDFKHSRVVRQR
VXVVLVWHUHQXPHURVLIDWWRULLQGLYLGXDOLFKHFRQGL]LRQDQRXQDPDJJLRUHVXVFHWWLELOLWj
DOIDWWRUHGLULVFKLRPRYLPHQWD]LRQHPDQXDOHGLSD]LHQWLQRQVRORSHULOWUDWWRGRUVR
ORPEDUHPDDQFKHSHUDOWULGLVWUHWWLRVWHRDUWLFRODULVSDOODUDFKLGHFHUYLFDOHRDOWUL
DSSDUDWLFDUGLRYDVFRODUHUHVSLUDWRULR
,OPHGLFRFRPSHWHQWHGHYHHIIHWWXDUHODVRUYHJOLDQ]DWHQHQGRFRQWRGLTXDQWRSUH-­
YLVWRLQSDUWLFRODUHDO7LWROR9,HGLQDOOHJDWR;;;,,,'/JVVRVWGDDUW'
/JVFRDGLXYDQGRLOVHUYL]LRGLSUHYHQ]LRQHHSURWH]LRQHQHOODFDUDWWHUL]]D-­
]LRQHGHLIDWWRULGLULVFKLRHQHOOHDWWLYLWjGLIRUPD]LRQHHLQIRUPD]LRQHFRQVLGHUDQGR
OHHYHQWXDOLRSSRUWXQLWjGLVSRQLELOLVWUXPHQWDOLWjYDULHYDOXWD]LRQH¿VLDWULFDHWFSHU
ODULFROORFD]LRQHGLODYRUDWRULFRQDIIH]LRQLFURQLFKH
,OSURFHVVRGLYDOXWD]LRQHSXzVHJXLUHXQSHUFRUVRSURJUHVVLYRFKHSDVVDGDXQ
SULPROLYHOORFKHKDIXQ]LRQHGLLQGLYLGXDUHLUHSDUWLPDQVLRQLLQFXLLOULVFKLRqSUH-­
VHQWHHSXzFRQVHQWLUHXQDVWLPDVHPLTXDQWLWDWLYDGHOULVFKLRDGXQVHFRQGROLYHOOR
FRQVWLPHTXDQWLWDWLYHGHOULVFKLR
/¶XVRGLLQGLFLVLQWHWLFLHV0$320RYLPHQWD]LRQHH$VVLVWHQ]D3D]LHQWL2VSH-­
GDOL]]DWLUDSSUHVHQWDXQHOHPHQWRXWLOHQHOOHYDOXWD]LRQLGHOULVFKLRQHOOH8QLWj2SH-­
UDWLYHHGKDDYXWRSDUWLFRODUHULOLHYRQHOOHTXDQWL¿FD]LRQLGHOOHVLQJROHYDOXWD]LRQLPH-­
GLFRDVVLFXUDWLYH$L¿QLGHOULFRQRVFLPHQWRGHOODQDWXUDSURIHVVLRQDOHGHOODPDODWWLD
qVWDWDULWHQXWDFRPSDWLELOHXQDHVSRVL]LRQHDULVFKLRGLDOPHQRFLQTXHDQQLVHO¶LQGLFH
0$32qDOPHQRSDULDFLQTXH&LUFRODUH,1$,/QGHO
4XHVWDPHWRGRORJLDGLYDOXWD]LRQHGHOULVFKLRKDSURGRWWRYDULVWXGLPXOWLFHQWULFL
WUDVYHUVDOLLFXLULVXOWDWLKDQQRSHUPHVVRGLVWDELOLUHXQYHURHSURSULRLQGLFHGLULVFKLR
DFXLFRUULVSRQGRQROLYHOOLGLSUREDELOLWjGLGLVWXUELORPEDULDFXWLFUHVFHQWLLQUHOD]LR-­
QHDOO¶DXPHQWRGHOYDORUHQXPHULFRGHOO¶LQGLFH±ULVFKLRWUDVFXUDELOH
ULVFKLRPHGLRVXSHULRUHDULVFKLRHOHYDWR,OPHWRGRqVWDWRHVWHVRGDLUHSDUWLGL
GHJHQ]DDGDOWUHDUHHVDQLWDULHGLLQWHUHVVHWUDFXLEORFFKLRSHUDWRULSURQWRVRFFRUVR
VHUYL]LDPEXODWRULDOLGD\KRVSLWDOH56$
,SXQWLGLFRQYHUJHQ]DGHOODPHWRGRORJLD0$32FRQDOWULPHWRGLVRQRUDSSUHVHQ-­
WDWLGDOO¶LQGLYLGXD]LRQHGLGHWHUPLQDQWLGLULVFKLRSURSULGHOO¶DWWLYLWjGLDVVLVWHQ]D
SUHVHQ]D GL SD]LHQWL GD PRYLPHQWDUH FRPSOHWDPHQWH R SDU]LDOPHQWH SUHVHQ]D
HWLSRORJLDGLDWWUH]]DWXUHLQJUDGRGDDXVLOLDUHODPRYLPHQWD]LRQHVROOHYDSD]LHQWL
EDUHOOHHUJRQRPLFKHWHOLRWDYROHDGDOWRVFRUULPHQWRFLQWXUHHUJRQRPLFKHOHWWLHU-­
JRQRPLFLFDUUR]]LQHHUJRQRPLFKHHFFRUJDQLFRDGHJXDWRDOOHHVLJHQ]HDVVXQ-­
]LRQHGLSRVWXUHLQFRQJUXHGHWHUPLQDWHGDVSD]LDUUHGLRDWWUH]]DWXUHQRQDGHJXDWH
36
SORVEGLIANZA SANITARIA
IN AMBITO OSPEDALIERO
IRUPD]LRQHDOULVFKLRVSHFL¿FR/DPHWRGRORJLDSUHYHGHGLDFTXLVLUHXQDVHULHGL
LQIRUPD]LRQLPHGLDQWHXQFROORTXLRFRQSHUVRQDOHFRQHVSHULHQ]DGHOUHSDUWRRGHOVHW-­
WRUHDQDOL]]DWRFDSRVDODHWFVHJXLWRGDXQVRSUDOOXRJRSHUO¶DQDOLVLGHWWDJOLDWDGHOOH
DWWUH]]DWXUHHGHJOLVSD]L$SSDUHIRQGDPHQWDOHIRUQLUHHOHPHQWLGLVLQWHVLSHUGH¿QLUH
OHD]LRQLSLQHFHVVDULHQRQWUDVFXUDQGRJOLDVSHWWLHFRQRPLFLDI¿QFKpODULOHYD]LRQH
GHOULVFKLRQRQULVXOWLPHURDWWRIRUPDOHSHUDVVROYHUHDJOLDGHPSLPHQWLOHJLVODWLYL
3HUTXDQWRULJXDUGDODULOHYD]LRQHGXUDQWHOHYLVLWHSHULRGLFKHGLHYHQWXDOLDOWHUD-­
]LRQL LQL]LDOL GHOOR VWDWR GL VDOXWH ULFRQGXFLELOL DOO¶HVSRVL]LRQH SURIHVVLRQDOHLO FRQ-­
fronto tra le linee guida internazionali in medicina del lavoro evidenzia unasostanziale FRQFRUGDQ]DWUDGLHVVH6WDDOHWDOHGLOSURJUHVVLYRULFRUVRDJOLHVDPLVWUX-­
PHQWDOLHGDVSHFLDOLVWLYLHQHSURSRVWRGDYDULGLDJUDPPLGLDJQRVWLFLLQWHUQD]LRQDOL
$&2(0/¶DQDPQHVLPLUDWDSHUDIIH]LRQLDFDULFRGHOUDFKLGHORPERVDFUDOH
GRYUj FRQVLGHUDUH O¶DQ]LDQLWj ODYRUDWLYD VSHFL¿FD SUHJUHVVH DWWLYLWj VRYUDFFDULFDQWL
LOGLVWUHWWRHYHQWXDOHDVVHQWHLVPRSHUDIIH]LRQLGHOUDFKLGHORPERVDFUDOHPDJJLRUH
VXVFHWWLELOLWj SHU SUHVHQ]D GL GLVFRSDWLH VSRQGLOROLVL H VSRQGLOROLVWHVL GLPRU¿VPL-­
TXDOLVFROLRVLHVWHQRVLGHOFDQDOHVSLQDOHHVLWLGLLQIRUWXQLRVWHRSRURVL3HUTXDQWR
ULJXDUGDLOGRORUHRFFRUUHUjGLIIHUHQ]LDUHWUDUDFKLDOJLDVHPSOLFHQRQVSHFL¿FDODSL
IUHTXHQWHUDGLFRORSDWLDHSDWRORJLDVSLQDOHJUDYHFRQVLGHUDQGRDGHJXDWDPHQWHSHVR
FRUSRUHRHWjVFRODULWj$QGUDQQRDGHJXDWDPHQWHFRQVLGHUDWHDIIH]LRQLDFDULFRGHOOD
VSDOODHGHOO¶DUWRVXSHULRUH
4XHVWLRQDULRDQDPQHVWLFRHGHVDPHFOLQLFRIXQ]LRQDOHQRUPDOL]]DWRUDSSUHVHQWD-­
QRVWUXPHQWLXWLOLHUDFFRPDQGDELOL
1HOODIRUPXOD]LRQHGHOJLXGL]LRGLLGRQHLWjDQGUDQQRHYLWDWHGL]LRQLJHQHULFKH³QRQ
GHYHPRYLPHQWDUHFDULFKL´³QRQGHYHHIIHWWXDUHVIRU]L¿VLFL´³HYLWDUHFRPSLWLJUD-­
YRVL´8WLOHPRGDOLWjGLIRUPXOD]LRQHVDUjTXHOODGLULIHULUVLDQDOLWLFDPHQWHDOSLDQR
GLODYRURVSHFL¿FDQGRFRQFKLDUH]]DLFRPSLWLFKHQRQSXzHIIHWWXDUHLOVLQJROROD-­
YRUDWRUH/DSUHVFUL]LRQHGLXQGHWHUPLQDWRDXVLOLRDSSDUHLQROWUHGLQRWHYROHULOLHYR
RSHUDWLYR ,O PRQLWRUDJJLR SHULRGLFR PHVL DSSDUH RSSRUWXQR SHU YDOXWDUH
O¶DQGDPHQWRGHOODSDWRORJLDHO¶DSSOLFD]LRQHGHOJLXGL]LR$QFKHQHOFDVRGLYDOXWD-­
]LRQHSHUFDPELRPDQVLRQHDSSDUHSDUWLFRODUPHQWHXWLOHGLVSRUUHGLSLDQLGLODYRUR
FKH GHVFULYDQR DQDOLWLFDPHQWH WLSRORJLD H PRGDOLWj GL PRYLPHQWD]LRQH PDQXDOH GL
SD]LHQWLHPRGDOLWjG¶LPSLHJRGLHYHQWXDOLDXVLOL
Maternità
,O'HFUHWR/HJLVODWLYRQƒGHO0DU]RSUHYHGHOHPLVXUHSHUODWXWHOD
GHOODVLFXUH]]DHGHOODVDOXWHGHOOHODYRUDWULFLJHVWDQWLSXHUSHUHRLQSHULRGRGLDOODW-­
37
WDPHQWR¿QRDVHWWHPHVLGRSRLOSDUWRHLOVRVWHJQRGHOODPDWHUQLWj/HPLVXUHVRQR
SUHVHGDOGDWRUHGLODYRURSHUOHODYRUDWULFLFKHKDQQRLQIRUPDWRLOGDWRUHGLODYRUR
GHOSURSULRVWDWRFRQIRUPHPHQWHDOOHGLVSRVL]LRQLYLJHQWLIDWWRVDOYRTXDQWRSUHYLVWR
GDOO¶DUWFRPPD(VSRVL]LRQHDUDGLD]LRQLLRQL]]DQWL³(¶IDWWRREEOLJRDOOHODYR-­
UDWULFLGLFRPXQLFDUHDOGDWRUHGLODYRURLOSURSULRVWDWRGLJUDYLGDQ]DQRQDSSHQD
DFFHUWDWR´
9DOXWD]LRQHGHLULVFKLFRPSDWLELOLFRQORVWDWRGLJUDYLGDQ]D
DUW'/JV
/DWXWHODGHOODPDWHUQLWjFRPSUHQGHLOSHULRGRGLJUDYLGDQ]DH¿QRDPHVLGL
HWjGHO¿JOLRDUW'/JVSHUTXDQWRULJXDUGDODODYRUDWULFHHLOSHULRGR
HPEULRQDOHIHWDOHHLSULPLDQQLGLYLWD¿QRDOƒDQQRSHUTXDQWRULJXDUGDLOEDP-­
ELQR/DYDOXWD]LRQHGHLULVFKLSHUODODYRUDWULFHWHQHQGRFRQWRDQFKHGHJOLDVSHWWL
UHODWLYLDOEDPELQRGHYHHVVHUHHIIHWWXDWDQHOO¶DPELWRGHOODFRPSOHVVLYDYDOXWD]LRQH
GHLULVFKLTXLQGLDSULRUL4XHVWDYDOXWD]LRQHXWLOL]]DFULWHULVSHFL¿FLLQTXDQWRKD
O¶RELHWWLYRGLWXWHODUHODODYRUDWULFHLQSDUWLFRODULVLWXD]LRQL¿VLRORJLFKHJUDYLGDQ]D
DOODWWDPHQWR R GL UHVSRQVDELOLWj JHQLWRULDOH H LO SURGRWWR GHO FRQFHSLPHQWR SULPD
GHOSDUWRHQHLSULPLDQQLGLYLWD$L¿QLGLWDOHYDOXWD]LRQHqQHFHVVDULRWHQHUHFRQWR
GHJOLHIIHWWLVSHFL¿FLFKHODWLSRORJLDHO¶HQWLWjGHLULVFKLHVLVWHQWLQHOO¶DELWRODYRUDWLYR
KDQQRVXOOHVLWXD]LRQLHVXJOLHYHQWLWXWHODWLFRQVLGHUDQGRODSDUWLFRODUHRUJDQL]]D-­
]LRQHGLODYRURHO¶HVLVWHQ]DRPHQRGLLGRQHHPLVXUHSUHYHQWLYH$L¿QLGHOODWXWHOD
GHOODVDOXWHVRQRFRQVLGHUDWLLOSHULRGRGLJUDYLGDQ]DHTXHOORGLDOODWWDPHQWRPHQWUH
LOSXHUSHULRFLRqLOSHULRGRGLWHPSRFRPSUHVRWUDLOSDUWRHODULSUHVDGHOO¶DWWLYLWjFL-­
FOLFDRYDULFDGXUDWDFRQYHQ]LRQDOHGLVHWWLPDQHH¿QRDVHWWLPDQHGHOEDPELQR
QRQYLHQHSUHVRLQFRQVLGHUD]LRQHLQTXDQWRqFRSHUWRLQ,WDOLDGDOSHULRGRGLFRQJHGR
REEOLJDWRULRSHUPDWHUQLWj
Rischio chimico:HVSRVL]LRQHDGDJHQWLFKLPLFLSHULFRORVLRFDQFHURJHQLPXWDJHQL
DLVHQVLGHOO¶DUWH'/JV$GHFFH]LRQHGLVLWXD]LRQLDPSLDPHQWH
GRFXPHQWDWH VXO 'RFXPHQWR GL 9DOXWD]LRQH GHO 5LVFKLR O¶RULHQWDPHQWR FKH VL GR-­
YUHEEHDVVXPHUHqTXHOORGHOULVFKLRFKLPLFRµLUULOHYDQWHSHUODVDOXWH¶7XWWDYLDSHU
O¶HVWUHPDPROWHSOLFLWjHYDULDELOLWjGHJOLDJHQWLFKLPLFLSUHVHQWLQHOVHWWRUHVDQLWDULRq
QHFHVVDULRGLYROWDLQYROWDYDOXWDUHODSHULFRORVLWjSHUODJUDYLGDQ]DGHOO¶HVSRVL]LRQH
DL VLQJROL SURGRWWL 6RQR GD FRQVLGHUDUH LQ SDUWLFRODUH L FRPSLWL FRQ HVSRVL]LRQH D
VRVWDQ]HHSUHSDUDWLFODVVL¿FDWLWRVVLFL7PROWRWRVVLFL7FRUURVLYL&HVSORVLYL
(QRFLYL;QRHVWUHPDPHQWHLQ¿DPPDELOL)6RQRGDFRQVLGHUDUHFRPXQTXH
DWWLYLWjDULVFKLROHDWWLYLWjFRQHVSRVL]LRQHDVRVWDQ]HHSUHSDUDWLFODVVL¿FDWLHFRP-­
SRUWDQWLXQRRSLULVFKLGHVFULWWLGDOOHVHJXHQWLIUDVLSHULFRORGLHIIHWWLLUUHYHUVLELOL
PROWRJUDYL5SRVVLELOLWjGLHIIHWWLLUUHYHUVLELOL5SXzSURYRFDUHVHQVLELOL]-­
]D]LRQHPHGLDQWHLQDOD]LRQH5SXzSURYRFDUHVHQVLELOL]]D]LRQHSHUFRQWDWWRFRQ
38
SORVEGLIANZA SANITARIA
IN AMBITO OSPEDALIERO
ODSHOOH5SHULFRORGLJUDYLGDQQLSHUODVDOXWHLQFDVRGLHVSRVL]LRQHSUROXQJDWD
5SXzGDQQHJJLDUHLEDPELQLQRQDQFRUDQDWL5ODYRULFRQPDQLSROD]LRQHGL
DQWLEODVWLFLDQWLYLUDOLHDQWLPLWRWLFL
Rischio biologicoODYRULFRQULVFKLRGLHVSRVL]LRQHDGDJHQWLELRORJLFLSRWHQ]LDO-­
PHQWHLQIHWWLYLJUXSSLGLULVFKLRGDDGLFXLDUW'/JVHG$OO;/9,
VRVW GD DUW GHO ' /JV VLD FRPH XVR GHOLEHUDWR FKH FRPH SRWHQ]LDOH
HVSRVL]LRQHPDQLSROD]LRQHGLVDQJXHHGHULYDWLFRQWDWWRGLUHWWRFRQDQLPDOLQHOOD
PLVXUDLQFXLVLDQRWRFKHWDOLDJHQWLROHWHUDSLHFKHHVVLUHQGRQRQHFHVVDULHPHWWRQR
LQSHULFRORODVDOXWHGHOOHJHVWDQWLHRGHOQDVFLWXURGXUDQWHODJHVWD]LRQHHSHUPHVL
GRSRLOSDUWR
Posture incongrueODYRULFKHFRPSRUWDQRXQRVWD]LRQDPHQWRLQSLHGLSHUSLGL
PHWjGHOO¶RUDULRGLODYRURRFKHREEOLJDQRDGXQDSRVL]LRQHHUJRQRPLFDPHQWHLQFRQ-­
JUXDSHUORVWDWRGLJUDYLGDQ]DMovimentazione manuale carichi (MMC): solleva-­
PHQWRWUDVSRUWRHVSLQWDGLJUDGRPHGLRHOHYDWR5LVFKL¿VLFL ODYRULFKHFRPSRUWDQR
O¶HVSRVL]LRQHGLUHWWDRULÀHVVDDOOHUDGLD]LRQLLRQL]]DQWLGXUDQWHODJHVWD]LRQHHSHU
PHVLGRSRLOSDUWR ODYRULFKHFRPSRUWLQRFROSLRYLEUD]LRQLPHFFDQLFKH¿QRDO
WHUPLQHGHOFRQJHGRGLPDWHUQLWj DWPRVIHUHGLVRYUDSUHVVLRQHHOHYDWDDGHVHPSLR
LQFDPHUHLSHUEDULFKH
Mezzi di trasportoFRQGX]LRQHGLPH]]LGLWUDVSRUWR TXDOLDXWRDPEXODQ]HHWF¿QR
DOWHUPLQHGHOFRQJHGRGLPDWHUQLWjLavoro notturno HSURQWDGLVSRQLELOLWj (dalle ore DOOHVRQRYLHWDWLGDOO¶DFFHUWDPHQWRGHOORVWDWRGLJUDYLGDQ]D¿QRDOFRPSLPHQWR
GLXQDQQRGLHWjGHOEDPELQRPHQWUHqIDFROWDWLYRSHUODODYRUDWULFHPDGUH¿QRDOO¶HWj
GLWUHDQQLGHOEDPELQRH[DUW'/JV
3URFHGXUHSHUO¶DWWXD]LRQHGHOODWXWHODGHOODPDWHUQLWjQHOSHULRGRGLJUDYLGDQ]D
H ¿QR DO VHWWLPR PHVH GL HWj GHO ¿JOLR/¶LWHU FRPSOHVVLYR GHJOL DGHPSLPHQWL SRWUj
HVVHUHLOVHJXHQWHODODYRUDWULFHVHJQDODSHULVFULWWRDOGDWRUHGLODYRURLOVXRVWDWRGL
JUDYLGDQ]DDOOHJDQGRFHUWL¿FDWRPHGLFRFRQODGDWDSUHVXQWDGHOSDUWR,OGDWRUHGLOD-­
YRURQHLQYLHUjFRPXQLFD]LRQHSHUFRQRVFHQ]DDOO¶XI¿FLRDUHDJHVWLRQHGHOSHUVRQDOH
6HO¶DWWLYLWjGHOODODYRUDWULFHQRQULVXOWDDULVFKLRSHUODJUDYLGDQ]DQRQYHQJRQRHI-­
IHWWXDWHPRGL¿FD]LRQLGHOODYRURGHOODJHVWDQWHLQFDVRFRQWUDULRRFFRUUHUjYDOXWDUHOD
SRVVLELOLWjGLULRUJDQL]]DUHLFRPSLWLLQPRGRGDUHQGHUHODPDQVLRQHFRPSDWLELOHFRQ
ORVWDWRGLJUDYLGDQ]DRSSXUHVSRVWDUHODODYRUDWULFHLQXQOXRJRGLODYRURFKHSUHVHQWL
ULVFKLFRPSDWLELOLFRQORVWDWRGLJUDYLGDQ]DSHUWXWWHTXHVWH¿QDOLWjFLVLDYYDUUjGHO
PHGLFRFRPSHWHQWHHGHOUHVSRQVDELOHGHOVHUYL]LRGLSUHYHQ]LRQHHSURWH]LRQHLTXDOL
DQDOL]]HUDQQRLULVFKLVSHFL¿FLUHODWLYLDOODODYRUDWULFHLQRJJHWWR
)OHVVLELOLWjGHOFRQJHGRGLPDWHUQLWjDUW'/JV)HUPDUHVWDQGROD
GXUDWDFRPSOHVVLYDGHOFRQJHGRGLPDWHUQLWjOHODYRUDWULFLKDQQRODIDFROWjGLDVWHQHUVL
GDOODYRURDSDUWLUHGDOPHVHSUHFHGHQWHODGDWDSUHVXQWDGHOSDUWR'33HQHLTXDWWUR
39
PHVLVXFFHVVLYLDOSDUWRDFRQGL]LRQHFKHLOJLQHFRORJRHLOPHGLFRFRPSHWHQWHVHOD
ODYRUDWULFHqVRWWRSRVWDDVRUYHJOLDQ]DVDQLWDULDDWWHVWLQRFKHWDOHRS]LRQHQRQDUUHFKL
SUHJLXGL]LRDOODVDOXWHGHOODJHVWDQWHHGHOQDVFLWXUR/DODYRUDWULFHFKHGHVLGHULXVX-­
IUXLUHGHOODQRUPDSUHYLVWDQHOO¶DUWFLWDWRGRYUjHQWURLOWHUPLQHGHOƒPHVHDDFTXL-­
VLUHLOFHUWL¿FDWRGHOJLQHFRORJRREEOLJDWRULDPHQWHGHO6HUYL]LR6DQLWDULR1D]LRQDOH
R FRQ HVVR FRQYHQ]LRQDWR FKH DWWHVWL LO QRUPDOH GHFRUVR GHOOD JUDYLGDQ]D LQ TXHO
SHULRGRƒPHVHEVHODODYRUDWULFHqVRWWRSRVWDDVRUYHJOLDQ]DVDQLWDULDGHYHSUH-­
VHQWDUHWUDPLWHODSURSULD'LUH]LRQHULFKLHVWDDOPHGLFRFRPSHWHQWHGLYLVLWDPHGLFD
DOWHUPLQHGHOODTXDOHLOPHGLFRGRYUjDWWHVWDUHFKHO¶RS]LRQHGLSRVWLFLSDUHGLXQPHVH
LOFRQJHGRGLPDWHUQLWjFRQWLQXDQGRO¶DWWLYLWjODYRUDWLYDQRQDUUHFKLSUHJLXGL]LRDOOD
VDOXWHGHOODJHVWDQWHHGHOQDVFLWXURFWDOLGRFXPHQWLVDUDQQRLQYLDWLGDOODODYRUDWULFH
DOO¶XI¿FLRDUHDJHVWLRQHSHUVRQDOHSHUJOLDVSHWWLGLFRPSHWHQ]D
3URFHGXUHSHUODJHVWLRQHGHOODODYRUDWULFHDOULHQWURGDOODJUDYLGDQ]D¿QRDO
7° mese post-­partum e durante l’allattamento) /¶DUWGHO'/JVSUHYHGH
³ODWXWHODGHOODVDOXWHGHOOHODYRUDWULFLGXUDQWHLOSHULRGRGLJUDYLGDQ]DH¿QRDVHWWH
PHVL GL HWj GHO ¿JOLR FKH KDQQR LQIRUPDWR LO GDWRUH GL ODYRUR GHO SURSULR VWDWR«´
1HOO¶DVVHJQD]LRQH GHO ODYRUR DO ULHQWUR GDOOD JUDYLGDQ]D GHYH HVVHUH HVFOXVR LO OD-­
YRURQRWWXUQRHOHUHSHULELOLWjQRWWXUQH¿QRDOFRPSLPHQWRGLXQDQQRGHOEDPELQR
DUW ' /JV )LQR DOO¶HWj GL WUH DQQL GHO EDPELQR LO ODYRUR QRWWXUQR
SXzHVVHUHVYROWRVRORFRQLOFRQVHQVRGHOODODYRUDWULFHDUW'/JV
/¶RUDULR GL ODYRUR SRWUj HVVHUH ULGRWWR QHOOD PLVXUD SUHYLVWD GDOO¶DUW GHO ' OJV
RUH DO JLRUQR SHU RUDUL XJXDOL R VXSHULRUL D RUH RUD DO JLRUQR SHU
RUDULRLQIHULRUHDRUHSHUODGXUDWDGLXQDQQR6HODODYRUDWULFHYLHQHLQVHULWDQHO
ODYRURSUHFHGHQWHDOFRQJHGRGLPDWHUQLWjDWWLYLWjQRQDULVFKLRQRQYLqQHFHVVLWj
GLXOWHULRULYLVLWHGDSDUWHGHOPHGLFRFRPSHWHQWHDPHQRFKHODODYRUDWULFHQRQOD
ULFKLHGDHVSUHVVDPHQWHYLVLWDDULFKLHVWDSHUSUREOHPLGLVDOXWHVRSUDYYHQXWLRVHVLD
LQVFDGHQ]DODSUHFHGHQWHYLVLWDSHULRGLFD
Normativa di riferimento
/ Q 7XWHOD ODYRUDWULFL PDGUL '35 Q 5HJRODPHQWRHVHFX]LRQHGHOOD/'/JVQ7XWHOD/DY0DGUL
5HFHSLPHQWRQRUPH&((/Q$UW'LYLHWRGHOODYRURQRWWXUQR
GHOOHJHVWDQWL/Q)OHVVLELOLWjGHOO¶DVWHQVLRQHREEOLJDWRULD'HFUHWR
,QWHUPLQ OXJOLR Q 5HJ DWWXD]LRQH GHOO¶DUW GHOOD /HJJH '/JVQ7HVWRXQLFRGHOOHGLVSRVL]LRQLOHJLVODWLYHLQPDWHULDGLWX-­
WHODHVRVWHJQRGHOODPDWHUQLWjHGHOODSDWHUQLWjDQRUPDGHOO¶DUWLFRORGHOODOHJJH
PDU]RQ
40
SORVEGLIANZA SANITARIA
IN AMBITO OSPEDALIERO
Lavoro notturno
&RQ LO GHFUHWR OHJLVODWLYR DSULOH Q SXEEOLFDWR VXOOD *8 Q GHO
qVWDWDGDWDDWWXD]LRQHDOOHGLUHWWLYH&(H&(FRQFHUQHQWL
DOFXQLDVSHWWLGHOO¶RUJDQL]]D]LRQHGHOO¶RUDULRGLODYRUR,QEDVHDOODUWFRPPD
OHWWHUDHGHO'/JVVLFRQVLGHUDQRODYRUDWRULQRWWXUQLWXWWLFRORURFKHVYRO-­
JRQRODSURSULDDWWLYLWjODYRUDWLYDDQFKHLQRUDULRQRWWXUQRFRVuFRPHGH¿QLWRGDOOH
GLVSRVL]LRQLGHLVLQJROLFRQWUDWWLFROOHWWLYLQD]LRQDOLGLODYRURDSUHVFLQGHUHGDOQXPH-­
URGLWXUQLQRWWXUQLUHDOPHQWHHIIHWWXDWLQHOO¶DQQR,QGLIHWWRGLGLVFLSOLQDFROOHWWLYDq
FRQVLGHUDWRODYRUDWRUHQRWWXUQRTXDOVLDVLODYRUDWRUHFKHVYROJDODYRURQRWWXUQRSHUXQ
PLQLPRGLRWWDQWDJLRUQLODYRUDWLYLDOO¶DQQR1HOFDVRGHOSHUVRQDOHVDQLWDULRGHO661
ODGLVFLSOLQDFROOHWWLYDQRQPDQFDHSUHYHGHLOODYRURQRWWXUQR
/DYDOXWD]LRQHGHOULVFKLRGDODYRURQRWWXUQRVLEDVDVXQXPHURGLQRWWLHIIHWWXDWH
VFKHPD GHL WXUQL DGRWWDWR FULWHUL SHU OD JHVWLRQH GHOOH VLWXD]LRQL GL HPHUJHQ]D H GL
FDUHQ]DGLRUJDQLFRFRHVLVWHQ]DGLDOWULIDWWRULGLULVFKLRDJHQWLFKLPLFLVWUHVVHFF
$WDO¿QHLOOLYHOORGLWXUQLQRWWXUQLDQQRLQGLFDWRGDOO¶DUWGHO'/JV
HTXLYDOHQWHDWXUQLQRWWXUQLVHWWLPDQDRPHVHSXzHVVHUHFRQVLGHUDWRFRPHLO
OLYHOOR G¶D]LRQH FRUULVSRQGHQWH DG XQD VLWXD]LRQH GL ULVFKLR PDJJLRUH FKH ULFKLHGH
VSHFL¿FKHPLVXUHGLSUHYHQ]LRQH
,Q EDVH DOOH GLVSRVL]LRQL QRUPDWLYH YLJHQWL VRQR HVFOXVL GDO ODYRUR QRWWXUQR D
SUHVFLQGHUHGDTXDOVLDVLYDOXWD]LRQHPHGLFDOHGRQQHLQVWDWRGLJUDYLGDQ]DH¿QR
DOFRPSLPHQWRGLXQDQQRGLHWjGHOEDPELQRLPLQRUL1RQVRQRLQROWUHREEOLJDWLD
SUHVWD]LRQLGLODYRURQRWWXUQRODPDGUHRLOSDGUHGLXQ¿JOLRGLHWjLQIHULRUHDDQQL
O¶XQLFRJHQLWRUHDI¿GDWDULRGLXQ¿JOLRFRQYLYHQWHGLHWjLQIHULRUHDDQQLLOODYRUD-­
WRUHFKHDEELDDSURSULRFDULFRXQVRJJHWWRGLVDELOHDLVHQVLGHOOD/
/DYDOXWD]LRQHGHOORVWDWRGLVDOXWHGHLODYRUDWRULQRWWXUQLGHYHDYYHQLUHDOPHQR
RJQLGXHDQQLSHULOWUDPLWHGHOPHGLFRFRPSHWHQWHDWWUDYHUVRFRQWUROOLSHULRGLFLYROWL
DYHUL¿FDUHO¶DVVHQ]DGLFRQWURLQGLFD]LRQLDOODYRURQRWWXUQR'/YROXJOLR
Q
1HOIRUPXODUHLOJLXGL]LRGLLGRQHLWjqRSSRUWXQRFKHLOPHGLFRFRPSHWHQWHFRQVL-­
GHULDWWHQWDPHQWHYDULHFRQGL]LRQLWUDFXLHWjPDJJLRUHGLDQQLSDUWLFRODULWHUDSLH
IDUPDFRORJLFKHFRUUHODWHDLULWPLFLUFDGLDQLRFKHLQWHUIHULVFRQRFROVRQQRHWLOLVPR
PDODWWLD GLDEHWLFD JUDYL GLVWXUEL YLVLYL DIIH]LRQL UHVSLUDWRULH FURQLFKH GLVWXUEL GHO
VRQQRHV26$6QRQDGHJXDWDPHQWHWUDWWDWLPDODWWLHFDUGLRYDVFRODULTXDOLFDUGLR-­
SDWLDLVFKHPLFDHDOWHUD]LRQLGHOULWPRJUDYLPDODWWLHQHXURSVLFKLDWULFKHHSLOHVVLD
JUDYLDIIH]LRQLWLURLGHHLQVXI¿FLHQ]DUHQDOHFURQLFDQHRSODVLHPDOLJQHLQIDVHGLWUDW-­
WDPHQWR4XHVWLRQDULYDOLGDWLSRVVRQRHVVHUHXVDWLSHUODTXDQWL¿FD]LRQHGHOJUDGRGL
VRQQROHQ]DYLJLODQ]D,OJLXGL]LRGLLGRQHLWjSXzHVVHUHJUDGXDWRLQEDVHDOODSDWRORJLD
ULVFRQWUDWDSHULODYRUDWRULFKHHIIHWWXDQRXQQXPHURFRQVLVWHQWHGLWXUQLQRWWXUQLLQ-­
41
GLFDWLYDPHQWHWXUQLDQQRSUHYHGHQGRDQFKHXQDOLPLWD]LRQHDOQXPHURPDVVLPR
GHLWXUQLQRWWXUQLVXEDVHVHWWLPDQDOHPHQVLOH
Stress occupazionale
/DYDOXWD]LRQHGHLULVFKLGHYHULJXDUGDUHWXWWLLULVFKLSHUODVLFXUH]]DHVDOXWHGHL
ODYRUDWRULLYLFRPSUHVLTXHOOLFROOHJDWLDOORVWUHVVODYRURFRUUHODWRDUWFRHELV
'/JVPRGGDDUW/JV/RVWUHVV VLGH¿QLVFHFRPHVLQGURPHGL
DGDWWDPHQWRUHODWLYDPHQWHDVSHFL¿FDDOOHVROOHFLWD]LRQLGHOO¶DPELHQWHHVWHUQRHRLQ-­
WHUQR(¶XQPHFFDQLVPRGHOWXWWR¿VLRORJLFRHXVWUHVVFKHFLFRQVHQWHGLULVSRQGHUH
DOOHULFKLHVWHGHOODYLWD7XWWDYLDODULVSRVWDGLVWUHVVSXzGLYHQLUHGLVIXQ]LRQDOHSHU
LQDGHJXDWD LQWHQVLWj GHJOL VWLPROL VRYUD R VRWWRVWLPROD]LRQH SHU HFFHVVLYD GXUDWD
GHJOLVWHVVLSHUFDUDWWHULVWLFKHGLSHUVRQDOLWjGHOVRJJHWWR
,O1,26+LQSDUWLFRODUHGH¿QLVFHORVWUHVVODYRURFRUUHODWRµXQLQVLHPHGLUHD]LRQL
¿VLFKHHGHPRWLYHGDQQRVHFKHVLPDQLIHVWDTXDQGROHULFKLHVWHSRVWHGDOODYRURQRQ
VRQRFRPPLVXUDWHDOOHFDSDFLWjULVRUVHRHVLJHQ]HGHOODYRUDWRUH¶ Se non gestite in PDQLHUDDGHJXDWDDOOHSRVVLELOLWjGLFRPSHQVD]LRQHGHOOHSHUVRQHHVSRVWHDQFKHOHLQ-­
WHUD]LRQLSUHVHQWLLQDPELWRODYRUDWLYRSRVVRQRUHFDUHGDQQLDOODVDOXWHHDOEHQHVVHUH
SURSULRFRPHDOWULIDWWRULGLULVFKLR6LVRWWROLQHDO¶LPSRUWDQ]DGHOOLYHOORTXDOLWDWLYR
GHO FOLPD RUJDQL]]DWLYR HGL XQD EXRQD FRPXQLFD]LRQH SHU WUDVPHWWHUH PHVVDJJL HG
HYLWDUHFRQÀLWWL
/HGLI¿FROWjFRQQHVVHDOODvalutazione del rischio GDVWUHVVRFFXSD]LRQDOHLQVDQLWj
VRQRDWWULEXLELOLDOODFRPSOHVVLWjHGDOODPXOWLIDWWRULDOLWjGHOULVFKLRVWHVVRHGLQROWUH
DOODGLVRPRJHQHLWjGHLPRGHOOLYDOXWDWLYLSHUO¶HVSHULHQ]DWXWWRUDQRQFRQVROLGDWDQHOOD
ORURDSSOLFD]LRQH/DYDOXWD]LRQHGHOORVWUHVVODYRURFRUUHODWRGRYUjHVVHUHHIIHWWXDWD
LQEDVHDOOHLQGLFD]LRQLGHOOD&RPPLVVLRQH&RQVXOWLYD3HUPDQHQWHSHUOD6DOXWHH6L-­
FXUH]]DVXO/DYRURFRQREEOLJRGDODJRVWR
,QSDUWLFRODUHO¶,63(6/DWWUDYHUVRXQD¿WWDUHWHGLFROODERUD]LRQLLQWHUQD]LRQDOL
QHLGLYHUVLSDHVLGHOO¶8QLRQH(XURSHDKDVFHOWRGLDSSOLFDUHSHUODYDOXWD]LRQHHJH-­
VWLRQHGHOULVFKLRVWUHVVODYRURFRUUHODWRLO0RGHOOR0DQDJHPHQW6WDQGDUGVDSSURQ-­
WDWRGDOO¶+HDOWKDQG6DIHW\([HFXWLYH+6(YDOLGDWRLQ*UDQ%UHWDJQDH,UODQGD,O
PRGHOOR,63(6/+6(YDOLGDWRLQ,WDOLDQHOFRUVRGHOqFRQWHVWXDOL]]DWRDOOD
QRUPDWLYDYLJHQWHHVLSURSRQHGLIRUQLUHDOGDWRUHGLODYRURXQSHUFRUVREDVDWRVX
SULQFLSLVROLGDPHQWHVXSSRUWDWLGDOODOHWWHUDWXUDVFLHQWL¿FDLQOLQHDFRQTXDQWRSUHYL-­
VWRGHOO¶$FFRUGRHXURSHRGHOO¶RWWREUHFRQLOFRLQYROJLPHQWRSDUWHFLSDWRGHL
ODYRUDWRULHGHOOH¿JXUHGHOODSUHYHQ]LRQH
6LULWLHQHDXVSLFDELOHO¶XVRLQWHJUDWRGLVWUXPHQWLSHUODYDOXWD]LRQHVLDVRJJHWWL-­
42
SORVEGLIANZA SANITARIA
IN AMBITO OSPEDALIERO
YDTXHVWLRQDULVWDQGDUGL]]DWLLQWHUYLVWHVWUXWWXUDWHVFDOHGLYDOXWD]LRQHVLDRJJHW-­
WLYDWHFQLFKHGLMREDQDO\VLVFKHFNOLVWVRVVHUYD]LRQDOLLQGLFDWRULGLSHUIRUPDQFH
SUHVWD]LRQHFKHWHQJDQRFRQWRGLYDULSDUDPHWULWUDFXLUDSSRUWRIUDRSHUDWRULDWWHVL
VXOODEDVHGHJOLRUJDQLFLHRSHUDWRULHIIHWWLYDPHQWHLQVHUYL]LRUDSSRUWRIUDSD]LHQWL
RVSHGDOL]]DWLHRSHUDWRULVDQLWDULUDSSRUWRIUDRSHUDWRULDVVHQWLSHUPDODWWLDHRSH-­
UDWRULLQVHUYL]LRJLRUQDWHGLUHFXSHURQRQXVXIUXLWHGRSRLOWXUQRQRWWXUQRJLRUQLGL
DVVHQ]DSHUPDODWWLDQXPHURPHGLRGLSD]LHQWLGHFHGXWLFRPSRUWDPHQWLRSHUDWLYL
TXDOLLOQXPHURPHGLRGLLQIRUWXQLFRQHVSRVL]LRQHDGDJHQWLELRORJLFL
/HFRQVHJXHQ]HDPHGLROXQJRWHUPLQHGHOORVWUHVVODYRURFRUUHODWRGDPRQLWR-­
UDUHLQVRUYHJOLDQ]DVDQLWDULDLQFOXGRQRPDODWWLHFDUGLRYDVFRODULJDVWURLQWHVWLQDOL
FXWDQHH GLVIXQ]LRQL PHWDEROLFKH RUPRQDOL SDWRORJLH LPPXQLWDULH QHRSODVWLFKH
VLQGURPLGHSUHVVLYHEXUQRXW
/¶RELHWWLYR¿QDOHFRQVLVWHQHOO¶RWWHQHUHULVXOWDWLVXOSLDQRGHOPLJOLRUDPHQWRRU-­
JDQL]]DWLYRGHOOHVWUXWWXUHDWWUDYHUVRD]LRQLULYROWHDPLJOLRUDUHFRQGL]LRQLGLODYRUR
HEHQHVVHUHGHLODYRUDWRULDPLJOLRUDUHLOVHQVRGLDSSDUWHQHQ]DDOO¶RUJDQL]]D]LRQH
DVRWWROLQHDUHHVRVWHQHUHO¶LPPDJLQHGHOO¶$]LHQGD6DQLWDULDDULGXUUHFRQÀLWWXDOLWj
DVVHQWHLVPRLQIRUWXQLHGHUURUL
Verifica di assenza di rischi alcol-correlati
&RQOD/HJJHQGHOPDU]R/HJJHTXDGURLQPDWHULDGLDOFROHGL
SUREOHPL DOFRO FRUUHODWL LO OHJLVODWRUH KD VWDELOLWR FKH QHOOH DWWLYLWj ODYRUDWLYH FKH
FRPSRUWDQRXQHOHYDWRULVFKLRGLLQIRUWXQLVXOODYRURRYYHURSHUODVLFXUH]]DO¶LQ-­
FROXPLWjRODVDOXWHGHLWHU]LH¶IDWWRGLYLHWRGLDVVXQ]LRQHHGLVRPPLQLVWUD]LRQHGL
EHYDQGHDOFROLFKHHVXSHUDOFROLFKHWDOLPDQVLRQLVRQRVWDWHLQVHJXLWRLQGLYLGXDWHFRQ
SURYYHGLPHQWRGHOOD&RQIHUHQ]DSHUPDQHQWHSHULUDSSRUWLWUDOR6WDWROH5HJLRQLHOH
3URYLQFHDXWRQRPHGL7UHQWRH%RO]DQRQHOODVHGXWDGHOPDU]R
/¶DUW 6RUYHJOLDQ]D VDQLWDULD GHO ' /JV VWDELOLVFH DO FRPPD FKH
³>@1HLFDVLHGDOOHFRQGL]LRQLSUHYLVWHGDOO¶RUGLQDPHQWROHYLVLWHGLFXLDOFRPPD
OHWWHUHDEGHELVHHWHUVRQRDOWUHVu¿QDOL]]DWHDOODYHUL¿FDGLDVVHQ]DGL
FRQGL]LRQLGLDOFROGLSHQGHQ]DHGLDVVXQ]LRQHGLVRVWDQ]HSVLFRWURSHHVWXSHIDFHQWL´
2FFRUUHSHUDOWURULFRUGDUHFRPHLOVXFFLWDWRDUWGHO'/JVVLDVWDWRPRGL¿-­
FDWRGDO'/JVFRQO¶LQWURGX]LRQHGHOVHJXHQWHFRPPDELV³(QWURLOGL-­
FHPEUHFRQDFFRUGRLQ&RQIHUHQ]D6WDWR5HJLRQLDGRWWDWRSUHYLDFRQVXOWD]LRQH
GHOOHSDUWLVRFLDOLYHQJRQRULYLVLWDWHOHFRQGL]LRQLHOHPRGDOLWjSHUO¶DFFHUWDPHQWR
GHOOD WRVVLFRGLSHQGHQ]D H GHOO¶DOFRO GLSHQGHQ]D´. 7XWWDYLD DG RJJL WDOH SURYYHGL-­
PHQWRQRQqDQFRUDVWDWRDGRWWDWRSHUFXLSHUVLVWRQRGHOOHGLIIHUHQ]HWUDODOLVWDGHOOH
43
PDQVLRQLGDFRQWUROODUHDL¿QLGHOO¶DVVHQ]DGLFRQGL]LRQLGLDOFROGLSHQGHQ]DHTXHOOD
GHLODYRUDWRULGDVRWWRSRUUHDGDFFHUWDPHQWLDWWLDGHVFOXGHUHFRQGL]LRQLGLWRVVLFRGL-­
SHQGHQ]DRFRPXQTXHGLDVVXQ]LRQHGLVRVWDQ]HVWXSHIDFHQWLRSVLFRWURSH3HUWDQWR
LOSHUVRQDOHVDQLWDULRYDVRWWRSRVWRVRORDJOLDFFHUWDPHQWLSHUODYHUL¿FDGLDVVHQ]DGL
ULVFKLDOFROFRUUHODWL
5HFHQWHPHQWHOD5HJLRQH3XJOLDKDSXEEOLFDWRJOLDWWLGLLQGLUL]]RSHUODYHUL¿FD
GLDVVHQ]DGLULVFKLDOFROFRUUHODWLDGRSHUDGHLPHGLFLFRPSHWHQWL'HOLEHUD]LRQHGHO-­
OD*LXQWD5HJLRQDOHDSULOHQFXLQHOOHSUHVHQWLOLQHHJXLGDIDFFLDPR
ULIHULPHQWRHGDOOHTXDOLVLULPDQGDSHUPDJJLRULDSSURIRQGLPHQWL
$WWXDOPHQWH QRQ YLHQH GHVFULWWR LQ OHWWHUDWXUD VFLHQWL¿FD XQ HVDPH VSHFL¿FR H
VHQVLELOHGLDOFROLVPRQHOOHIDVLSUHFRFL/¶DOFROHPLDLQUDJLRQHGHOODVXDEUHYHHPL-­
YLWDJNJKGRSRDVWHQVLRQHGDJOLDOFROLFLSXULQSUHVHQ]DGLHOHYDWHVHQVLELOLWj
HVSHFL¿FLWjqJLXVWL¿FDWDXQLFDPHQWHFRPHWHVWGLDFFHUWDPHQWRLQFDVR
GLLQWRVVLFD]LRQHDFXWD/DFRQWHPSRUDQHDSRVLWLYLWjDȖ*7H0&9LQVRJJHWWRFRQ
DEXVRGLDOFROSUHVHQWDXQJUDGRGLVHQVLELOLWjYDULDELOHGDODOHXQDVSHFL¿FLWj
YDULDELOHGDODO/D7UDQVIHUULQD'HVLDODWD6LHULFD&'7KDXQ¶HPLYLWDGL
VHWWLPDQHGRSRODFRPSOHWDDVWHQVLRQHGDJOLDOFROLFLHULVXOWDHVVHUHSLVHQVLELOHQHO
VHVVRIHPPLQLOH,OVXRLQFUHPHQWRDYYLHQHGRSRJLRUQLGLDVVXQ]LRQHGLJ
GLHHULPDQHHOHYDWRSHUJLRUQL1HLYDULVWXGLSUHVLLQHVDPHODVXDVHQVLELOLWj
YDULDGDODOHODVXDVSHFL¿FLWjGDOO¶DO3XzGDUHLQROWUHIDOVLSRVLWLYL
LQFDVRGLHSDWRSDWLDQRQDOFROLFDGLVRUGLQLHUHGLWDULGHOPHWDEROLVPRJOLFRSURWHLFRH
WUDSLDQWLGLIHJDWR
'DWLGLOHWWHUDWXUDPRVWUDQRSHULTXHVWLRQDULYDOLGDWLGDOODFRPXQLWjVFLHQWL¿FD
XQ¶DFFXUDWH]]DGLDJQRVWLFDVXSHULRUHDJOLHVDPLELRFKLPLFLDGHV**7R0&9QHO-­
ORVFUHHQLQJGHLSUREOHPLDOFROFRUUHODWL,QSDUWLFRODUHO¶$8',7UHDOL]]DWRVSHFL¿FD-­
PHQWHSHULOULFRQRVFLPHQWRGHLEHYLWRULDULVFKLRKDPRVWUDWRYDORULGLVHQVLELOLWjH
VSHFL¿FLWjSDULULVSHWWLYDPHQWHDOHPHQWUHLO&$*(PROWRVHPSOLFHGLIDFLOH
VRPPLQLVWUD]LRQHHEXRQDDI¿GDELOLWjVHPEUDSUHIHULELOHTXDQGRLOWHPSRDGLVSRVL-­
]LRQHqOLPLWDWR3HUOHUDJLRQLVRSUDHVSRVWHVLULWLHQHGLVHJQDODUHO¶$8',7&RLO
&$*(FRPHJOLVWUXPHQWLSLLGRQHLSHUXQYHORFHVFUHHQLQJGLSULPROLYHOORQHJOL
DPELHQWLGLODYRURPHQWUHJOLHVDPLGLODERUDWRULRVXFFLWDWLSRVVRQRFRPXQTXHHVVHUH
XWLOLSHUIRUQLUHXOWHULRULVXFFHVVLYLHOHPHQWLGLDJQRVWLFL
,OPHGLFRFRPSHWHQWHQHOO¶HIIHWWXDUHODYHUL¿FDGLDVVHQ]DGLSUREOHPLDOFROFRU-­
UHODWLLQRFFDVLRQHGHOODVRUYHJOLDQ]DVDQLWDULDVXJOLRSHUDWRULFKHVYROJRQROHPDQ-­
VLRQLHOHQFDWHQHOO¶DOOHJDWR,GHOO¶,QWHVD6WDWR5HJLRQLGHOPDU]RUDFFRJOLHUj
XQ¶DQDPQHVLDOFRORJLFDGHWWDJOLDWDHFRQGXUUjXQHVDPHRELHWWLYRPLUDWRDQFKHDOOD
ULFHUFDGHLVHJQLHVLQWRPLSLIUHTXHQWLQHOVRJJHWWRDIIHWWRGDOEHUHSUREOHPDWLFR
DOLWRVLDOFROLFDFRQJLXQWLYDLQLHWWDWDOLYLGLFRQWXVLRQLHWUDXPLEUXFLDWXUHGLVLJD-­
UHWWHWUDLQGLFHHPHGLRHSDWRPHJDOLDGLVWXUELFDUGLRYDVFRODULLSHUWHQVLRQHDUWHULR-­
44
SORVEGLIANZA SANITARIA
IN AMBITO OSPEDALIERO
VD WDFKLFDUGLD JDVWURLQWHVWLQDOL LSRUHVVLD GLDUUHD QDXVHD YRPLWR HSLJDVWUDOJLD
GHUPDWRORJLFL GLVFURPLH FXWDQHH SVRULDVL HF]HPD GLVFRLGH SUXULWR QHXURORJLFL
LQVWDELOLWj SRVWXUDOH WUHPRUH FUDPSL H SDUHVWHVLH DJOL DUWL GLVRULHQWDPHQWR VWDWR
FRQIXVLRQDOHSVLFKLFLLQVRQQLDDQVLDGHSUHVVLRQHDOOXFLQD]LRQL6XFFHVVLYDPHQWH
VRPPLQLVWUHUjXQRGHLTXHVWLRQDULPLUDWLSUHFHGHQWHPHQWHFLWDWL,QFDVRGLQHJDWLYLWj
DJOLDFFHUWDPHQWLGL,OLYHOORDQDPQHVLHVDPHRELHWWLYRVRPPLQLVWUD]LRQHGLTXH-­
VWLRQDULRLOPHGLFRFRPSHWHQWHFRQFOXGHO¶DFFHUWDPHQWRFRQJLXGL]LRGLLGRQHLWjDOOD
PDQVLRQHVSHFL¿FDFRPXQLFDQGRORSHULVFULWWRDOODYRUDWRUHHDOGDWRUHGLODYRURLQ
FDVRGLSRVLWLYLWjDJOLDFFHUWDPHQWLGLVFUHHQLQJLOODYRUDWRUHVDUjDYYLDWRDJOLDFFHUWD-­
PHQWLGL,,OLYHOORSUHVVROHVWUXWWXUHDOO¶XRSRGHSXWDWHFRQODULFHUFDGLPDUNHUVELROR-­
JLFLTXDOLȖ*70&9HR&'7/DFRQIHUPDDWWUDYHUVRJOLDFFHUWDPHQWLGLODERUDWRULR
GLXQXWLOL]]RSUREOHPDWLFRGLDOFROGHWHUPLQHUjDGRSHUDGHOPHGLFRFRPSHWHQWH
DO¶HPLVVLRQHGLXQJLXGL]LRGLQRQLGRQHLWjDOODPDQVLRQHVSHFL¿FDWHPSRUDQHD
RGH¿QLWLYDFRPXQLFDWRSHULVFULWWRDOODYRUDWRUHHDOGDWRUHGLODYRUR
EXQ¶D]LRQHGLVHQVLELOL]]D]LRQHQHLFRQIURQWLGHOGLSHQGHQWHHGHLVXRLIDPLOLDUL
¿QDOL]]DWDDOO¶DYYLRGLXQ¶D]LRQHGLUHFXSHURHYHQWXDOPHQWHDQFKHDWWUDYHUVRLOFRLQ-­
YROJLPHQWRGHOPHGLFRGLPHGLFLQDJHQHUDOHGHOOH82GLDOFRORJLDWHUULWRULDOPHQWH
FRPSHWHQWLHGHOOHDVVRFLD]LRQLGLDXWRPXWXRDLXWR
FO¶LQYLRGLFRPXQLFD]LRQHDOOD3UHIHWWXUDSHUO¶HYHQWXDOHUHYLVLRQHGHOODSDWHQWH
$YYHUVRLOJLXGL]LRGHOPHGLFRFRPSHWHQWHqDPPHVVRULFRUVRDLVHQVLGHOO¶DUW
FGHO'/JVHQWURWUHQWDJLRUQLGDOODFRPXQLFD]LRQHGHOJLXGL]LRPHGH-­
VLPRDOO¶RUJDQRGLYLJLODQ]DWHUULWRULDOPHQWHFRPSHWHQWH'LWDOHSRVVLELOLWjLOODYRUD-­
WRUHGHYHHVVHUHIRUPDOPHQWHLQIRUPDWRDPH]]RGLFRPXQLFD]LRQHVFULWWD
(QWUR L PHGHVLPL WUHQWD JLRUQL LO ODYRUDWRUH SXz ULFKLHGHUH D SURSULH VSHVH OD
ULSHWL]LRQHGHOO¶DQDOLVLSUHVVRORVWHVVRODERUDWRULRHVXOORVWHVVRFDPSLRQHSUHFHGHQ-­
WHPHQWHSUHOHYDWR$WDOHVFRSRLODERUDWRULVRQRWHQXWLDFXVWRGLUHLFDPSLRQLLQFDVR
GL SRVLWLYLWj SHU DOPHQR QRYDQWD JLRUQL GDOO¶HPLVVLRQH GHO UHIHUWR ,O ODYRUDWRUH KD
IDFROWjGLULFKLHGHUHFKHODULSHWL]LRQHGHOO¶DQDOLVLDYYHQJDDOODVXDSUHVHQ]DRDOOD
SUHVHQ]DGLXQSURSULRFRQVXOHQWHWHFQLFRFRQRQHUHHFRQRPLFRDVXRFDULFR/¶HI-­
IHWWXD]LRQHGHOO¶DQDOLVLGLYHUL¿FDGRYUjHVVHUHFRPXQLFDWDDOODYRUDWRUHHDOPHGLFR
FRPSHWHQWHFRQXQDQWLFLSRGLDOPHQRTXLQGLFLJLRUQLULVSHWWRDOODGDWDLQGLYLGXDWD
,QFDVRGLULVXOWDWRGLVFRUGDQWHODULYDOXWD]LRQHXOWHULRUHPHGLDQWHULFRQVLGHUD-­
]LRQHGHLGDWLSURGRWWLGDJOLDFFHUWDPHQWLSUHFHGHQWLHQRQDWWUDYHUVRXOWHULRUHDQDOLVL
DQGUj HVHJXLWD GD XQD VWUXWWXUH GL WRVVLFRORJLD IRUHQVH WUD TXHOOH LQGLYLGXDWH GDOOD
5HJLRQHGLFRQFHUWRWUDLOGDWRUHGLODYRURHLOODYRUDWRUHFKHGRYUjHVSULPHUHXQ
JLXGL]LR¿QDOH
,OJLXGL]LRGLQRQLGRQHLWjWHPSRUDQHDDOODPDQVLRQHVSHFL¿FDSRWUjHVVHUHUHYR-­
FDWRDGRSHUDGHOPHGLFRFRPSHWHQWHDVHJXLWRGLVRSUDYYHQXWDQHJDWLYLWjGHLPDUNHUV
ELRORJLFLVXFDPSLRQLULSHWXWLFRQSHULRGLFLWjDOPHQRPHQVLOHFRQGDWHQRQSURJUDP-­
45
PDWHGDOODYRUDWRUHHGDWWHVWD]LRQHGLFRVWDQWHSDUWHFLSD]LRQHDOOHDWWLYLWjGDSDUWH
GHOOH82GL$OFRORJLDRGHLJUXSSLDFXLqDI¿GDWRLQWUDWWDPHQWRLQXQDUFRWHP-­
SRUDOHGLDOPHQRVHLPHVL/DSHULRGLFLWjGHOODVRUYHJOLDQ]DVDQLWDULDVXFFHVVLYDDOOD
ULDPPLVVLRQHDOODPDQVLRQHDULVFKLRVYROWDFRQOHVWHVVHPRGDOLWjSUHFHGHQWHPHQWH
GHVFULWWHGRYUjHVVHUHVHPHVWUDOHSHUXQSHULRGRGLDOPHQRFLQTXHDQQL
Radioprotezione
4XDQWRULFKLHVWRLQPDWHULDGD'/JVH'/JVWURYDQHLSULQFL-­
SLVRVWDQ]LDOHFRQIHUPDQHOOHEDVLQRUPDWLYHDWWXDOLGHOODUDGLRSURWH]LRQH'/YR
'/YR'0,QIDWWLDQFKHLQTXHVWRDPELWRODVRUYHJOLDQ]D
PHGLFDqWHVDDGXQDYDOXWD]LRQHGHOORVWDWRGLVDOXWHFKHGHYHHVVHUHFRPSDWLELOHFRQ
LULVFKLVSHFL¿FLDO¿QHGLIRUPXODUHXQJLXGL]LRGLLGRQHLWj
7DOHFRPSDWLELOLWjYDYHUL¿FDWDSHULRGLFDPHQWHDWWXDQGRPLVXUHGLSUHYHQ]LRQHH
FRJOLHQGRQHOORVWHVVRWHPSRLVHJQLLQL]LDOLGLSDWRORJLHRFFXSD]LRQDOL6LULFKLDPDQR
GLVHJXLWRDOFXQLDVSHWWLSDUWLFRODULGHOODVRUYHJOLDQ]DVDQLWDULDLQUDGLRSURWH]LRQHDOOD
OXFHGHOODQRUPDWLYDYLJHQWH
/DVRUYHJOLDQ]DPHGLFDGHLODYRUDWRULHVSRVWLFODVVL¿FDWLGLFDWHJRULD$GDD
P6YDQQRqDVVLFXUDWDGDO0HGLFR$XWRUL]]DWRFRQSHULRGLFLWjVHPHVWUDOHTXHOOD
GHLODYRUDWRULFODVVL¿FDWLLQFDWHJRULD%GDDP6YDQQRGDO0HGLFR$XWRUL]]DWR
RGDO0HGLFR&RPSHWHQWHFRQSHULRGLFLWjDQQXDOH3HUHQWUDPEHOHFDWHJRULHGLODYR-­
UDWRULHVSRVWLYLqDQFKHO¶REEOLJRGHOODVRUYHJOLDQ]D¿VLFDHGRVLPHWULFDDVVLFXUDWD
GDOO¶(VSHUWR4XDOL¿FDWR
,OPHGLFRFRPXQLFDSHULVFULWWRDOGDWRUHGLODYRURHDOODYRUDWRUHLOJLXGL]LRGL
LGRQHLWjHLOLPLWLGLYDOLGLWjGHOORVWHVVR
3ULPDGHOODFHVVD]LRQHGHOUDSSRUWRGLODYRURLOGDWRUHGLODYRURGHYHSURYYHGH-­
UHDFKHLOODYRUDWRUHVLDVRWWRSRVWRDYLVLWDPHGLFD,QWDOHRFFDVLRQHLOPHGLFRGHYH
IRUQLUHDOODYRUDWRUHOHHYHQWXDOLLQGLFD]LRQLUHODWLYHDOOHSUHVFUL]LRQLPHGLFKHGDRV-­
VHUYDUH,QWDOHRFFDVLRQHYDFRQVHJQDWDDOODYRUDWRUHFRSLDGHOGRFXPHQWRVDQLWDULR
SHUVRQDOHFRQO¶LQGLFD]LRQHGLIRUQLUHDOQXRYRGDWRUHGLODYRUROHGRVLSUHJUHVVHLQ
FDVRGLQXRYDRFFXSD]LRQHFRQHVSRVL]LRQHD5,
,OPHGLFRGHYHULFKLHGHUHO¶DOORQWDQDPHQWRGHLODYRUDWRULQRQLGRQHLHSURSRUUHLO
UHLQVHULPHQWRGHJOLVWHVVLTXDQGRVLDFFHUWLGHOODFHVVD]LRQHGHOODQRQLGRQHLWj
,OPHGLFRqWHQXWRDGDVVLFXUDUHO¶DQDOLVLGHLULVFKLLQGLYLGXDOLHODFRQVXOHQ]DDO
GDWRUHGLODYRURSHUODPHVVDLQDWWRGHOOHSURFHGXUHXWLOLDOSURJUDPPDGLVRUYHJOLDQ-­
]DVDQLWDULDFROODERUD]LRQHFRQO¶HVSHUWRTXDOL¿FDWRSHUSUDWLFKHGLSURQWRVRFFRUVR
LQFDVRGLHPHUJHQ]DSHUODIRUPD]LRQHSHULUDSSRUWLFRQJOLRUJDQLGLYLJLODQ]D
46
SORVEGLIANZA SANITARIA
IN AMBITO OSPEDALIERO
WHQXWDGHOO¶DUFKLYLRVDQLWDULRRUJDQL]]D]LRQHGLXQDUHWHSHUJOLDFFHUWDPHQWLVDQLWDUL
QHFHVVDUL
,OPHGLFRGHYHSURYYHGHUHDGLVWLWXLUHWHQHUHDJJLRUQDWRHFRQVHUYDUHSHURJQL
ODYRUDWRUHLOGRFXPHQWRVDQLWDULRSHUVRQDOH'2637UDJOLDOWULGHYRQRHVVHUHDQQR-­
WDWLLGDWLGRVLPHWULFLFKHVRQRIRUQLWLFRQIUHTXHQ]DDOPHQRVHPHVWUDOHGDOO¶HVSHUWR
TXDOL¿FDWR
-­ I lavoratori hanno diritto ad accedere ai risultati delle valutazioni di dose e ai ULVXOWDWLGHJOLDFFHUWDPHQWLVDQLWDUL
,O'263GHYHHVVHUHFRQVHUYDWRVLQRDOODGDWDLQFXLLOODYRUDWRUHFRPSLHLOƒ
DQQRGLHWjHLQRJQLFDVRSHUDOPHQRDQQLGRSRODFHVVD]LRQHGHOODYRURFRPSRU-­
WDQWHODHVSRVL]LRQHD5,/DRVVHUYD]LRQHGLWDOHVFDGHQ]DqGHPDQGDWDDOO¶,63(6/
DFXLLOPHGLFRqWHQXWRDGLQYLDUHLO'263HODVFKHGDGRVLPHWULFDHQWURPHVLGDOOD
FHVVD]LRQHGHOUDSSRUWRGLODYRURRGDOODFHVVD]LRQHGLLPSUHVDFRPSRUWDQWHODHVSR-­
VL]LRQHD5,$TXHVWRSURSRVLWRVLVRWWROLQHDODQHFHVVLWjFKHLOGDWRUHGLODYRURFR-­
PXQLFKLDOPHGLFRODFHVVD]LRQHGHOUDSSRUWRGLODYRURHQWURWHUPLQLFKHFRQVHQWDQR
LOULVSHWWRGHOOHSUHFHGHQWLVFDGHQ]H/¶REEOLJRGLFRQVHJQDDOO¶,63(6/QRQVXVVLVWH
QHOFDVRLQFXLLOODYRUDWRUHFHVVLO¶DWWLYLWjFRQHVSRVL]LRQHD5,LQFRVWDQ]DGLUDS-­
SRUWRGLODYRUR,QWDOFDVRLO'263YDFRQVHUYDWRQHOO¶DUFKLYLR¿QRDOODFHVVD]LRQH
GHOUDSSRUWRGLODYRURVHPSUHVRWWRODUHVSRQVDELOLWjGHOPHGLFRGLUDGLRSURWH]LRQH
6L VHJQDOD FKH O¶,VSHWWRUDWR 0HGLFR &HQWUDOH GHO /DYRUR LQ ULVSRVWD DG XQ TXHVLWR
SRVWRGDOO¶$,50$VVRFLD]LRQH,WDOLDQD5DGLRSURWH]LRQH0HGLFDKDFRQIHUPDWROD
SRVVLELOLWjFKHQHOFDVRGLWUDVIHULPHQWRGLXQODYRUDWRUHGDXQDVWUXWWXUDGHO661DG
XQ¶DOWUDGHOODVWHVVDUHJLRQHLO'263SRVVDVHJXLUHLOODYRUDWRUH
(QWURJLRUQLGDOODGLDJQRVLLOPHGLFRGHYHFRPXQLFDUHDOOD'LUH]LRQH3URYLQ-­
FLDOH GHO /DYRUR H DJOL RUJDQL GHO 661 FRPSHWHQWL SHU WHUULWRULR L FDVL GL PDODWWLD
SURIHVVLRQDOH , PHGLFL OH VWUXWWXUH VDQLWDULH SXEEOLFKH H SULYDWH QRQFKp JOL LVWLWXWL
DVVLFXUDWLYLSXEEOLFLHSULYDWLFKHUHIHUWDQRFDVLGLQHRSODVLHGDORURULWHQXWHFDXVDWH
GDHVSRVL]LRQHODYRUDWLYDD5,WUDVPHWWRQRDOO¶,63(6/FRSLDGHOODUHODWLYDGRFXPHQ-­
WD]LRQHHTXHOODLQHUHQWHO¶DQDPQHVLODYRUDWLYD
,ODYRUDWRULVRQRFODVVL¿FDWLDOWHUPLQHGHOODYLVLWDPHGLFDSUHYHQWLYDDUW'YR
HGHOOHYLVLWHPHGLFKHSHULRGLFKHHVWUDRUGLQDULHDUW'YRLQD
LGRQHL E LGRQHL D GHWHUPLQDWH FRQGL]LRQL F QRQ LGRQHL H ULVSHWWLYDPHQWHLQ D
LGRQHLELGRQHLDGHWHUPLQDWHFRQGL]LRQLFQRQLGRQHLGODYRUDWRULVRWWRSRVWLD
VRUYHJOLDQ]DPHGLFDGRSRODFHVVD]LRQHGHOODYRURFKHOLKDHVSRVWLDOOHUDGLD]LRQL
LRQL]]DQWL/DVRUYHJOLDQ]DPHGLFDHFFH]LRQDOHDUW'YRLQRFFDVLRQHGL
FRQWDPLQD]LRQLHRGLVRYUDHVSRVL]LRQLDOGLVRSUDGHLOLPLWLFRQVHQWLWLSHUODFDWHJRULD
GLDSSDUWHQHQ]DqDVVLFXUDWDHVFOXVLYDPHQWHGDSDUWHGHO0HGLFR$XWRUL]]DWR
,QIXQ]LRQHGHOOHGLIIHUHQWLWLSRORJLHGLULVFKLRLOPHGLFRDGGHWWRDOODVRUYHJOLDQ-­
]DPHGLFDFRQVLGHUDFRQSDUWLFRODUHDWWHQ]LRQHDL¿QLGHOODYDOXWD]LRQHGHOO¶LGRQHL-­
47
WjDOODYRURFKHHVSRQHDOOHUDGLD]LRQLLRQL]]DQWLH[DUW'0OHVHJXHQWL
FRQGL]LRQL ¿VLRSDWRORJLFKH D FRQGL]LRQL VXVFHWWLELOL GL HVVHUH DWWLYDWH R DJJUDYDWH
GDOOHUDGLD]LRQLLRQL]]DQWLEFRQGL]LRQLVXVFHWWLELOLGLDXPHQWDUHO¶DVVRUELPHQWRGL
VRVWDQ]HUDGLRDWWLYHRGLULGXUUHO¶HI¿FDFLDGHLPHFFDQLVPL¿VLRORJLFLGLGHSXUD]LRQH
RHVFUH]LRQHFFRQGL]LRQLFKHSRQJRQRSUREOHPLGLRUGLQHWHUDSHXWLFRLQRFFDVLRQH
GLHYHQWXDOHVRYUDHVSRVL]LRQHVSHFLHVHOLPLWDQROHSRVVLELOLWjGLGHFRQWDPLQD]LRQH G FRQGL]LRQL VXVFHWWLELOL GL HVVHUH FRQIXVH FRQ SDWRORJLH GHULYDQWL GD UDGLD]LR-­
QL LRQL]]DQWL R DWWULEXLWH DOO¶D]LRQH OHVLYD GHOOH UDGLD]LRQL LRQL]]DQWL /¶HOHQFR QRQ
HVDXVWLYRGL FXL DO FLWDWR DUW SUHVHQWH QHOO¶$OOHJDWR WHFQLFR ULSRUWD OH VHJXHQWL
SULQFLSDOL FRQGL]LRQL ¿VLRSDWRORJLFKH D OHVLRQL SUHFDQFHURVH PDODWWLH QHRSOD-­
VWLFKH VLQGURPL PLHORGLVSODVWLFKH HFF E FRQGL]LRQL SDWRORJLFKH FKH GHWHUPL-­
QLQR XQ¶DEQRUPH SHUPHDELOLWD¶ FXWDQHRPXFRVD DIIH]LRQL FXWDQHH LQ¿DPPDWR-­
ULH DFXWHFURQLFKH HF]HPL SVRULDVL HFF RYYHUR ULGX]LRQH GHOOD IXQ]LRQDOLWD¶
GHJOL HPXQWRUL LQVXI¿FLHQ]D UHQDOH LQVXI¿FLHQ]D HSDWLFD HFF WLUHRSDWLH HFF FDOFXQHSDWRORJLHFXWDQHHSVRULDVLHF]HPLHFFRWRULQRODULQJRLDWULFKHRGRQWRLD-­
WULFKHUHVSLUDWRULHDOWHUD]LRQLGHOODIXQ]LRQDOLWD¶HSDWLFDRUHQDOHWLUHRSDWLHHFFG
PDODWWLHQHRSODVWLFKHRSDFLWD¶GHOFULVWDOOLQRDOFXQHHPRSDWLHHFF
Sorveglianza medica dei lavoratori esposti
A radiazioni ionizzanti (secondo linee-guida airm)
Accertamenti consigliati per visita preventiva:
(PRFURPRFRPSOHWRJOLFHPLDFUHDWLQLQHPLDFROHVWHURORWRWDOHHG+'/WULJOLFH-­
ULGLWUDQVDPLQDVLHJDPPD*7HOHWWURIRUHVL$37737¿EULQRJHQRELOLUXELQDWRWDOH
H IUD]LRQDWD SUR¿OR WLURLGHR )7 )7 76+HVDPH GHOOH XULQH HFRJUD¿D WLURLGHD
YLVLWDRFXOLVWLFD(&*
Accertamenti per visita preventiva da effettuare caso per caso sulla base di valuta-­
zioni anamnestico-­cliniche: screening onco-­preventivo in relazione a predisposizione, UDGLRVHQVLELOLWjLQGLYLGXDOHFULWHULGLGLDJQRVWLFDSUHFRFHGDWLGRVLPHWULFi:
6DQJXH RFFXOWR QHOOH IHFL ! DQQL 36$ WRWDOH H IUHH ! DQQL HFRJUD¿D
SHOYLFDRYDLRHFRJUD¿DYHVFLFDOHHUHQDOHFRQVXOHQ]DVHQRORJLFDFRQVXOHQ]DJD-­
VWURHQWHURORJLD FRQVXOHQ]D GHUPDWRORJLFD FRQVXOHQ]D QHXURSVLRFKLDWULFD HVDPL GL
IXQ]LRQDOLWjUHVSLUDWRULDLQFDVRGLXVRGL'3,SHUOHYLHUHVSLUDWRULH
48
SORVEGLIANZA SANITARIA
IN AMBITO OSPEDALIERO
Accertamenti consigliati per visite periodiche:
(PRFURPRFRPSOHWRHOHWWURIRUHVLFUHDWLQLQHPLDWUDQVDPLQDVL
HJDPPD*7ELOLUXELQDWRWDOH
HIUD]LRQDWDSUR¿ORWLURLGHR
$QQXDOH
*OLFHPLD
&ROHVWHURORWRWDOHH+'/
7ULJOLFHULGL (&*
7ULHQQDOH
%LHQQDOH
$QQXDOH
7ULHQQDOH
%LHQQDOH
$QQXDOH
7ULHQQDOH
%LHQQDOH
$QQXDOH
7ULHQQDOH
!
!
!
!
DQQL
DQQL
DQQL
DQQL
DQQL
DQQL
DQQL
DQQL
DQQL
DQQL
Accertamenti da effettuare per visite periodiche caso per caso sulla base di va-­
lutazioni anamnestico-­cliniche: screening onco-­preventivo in relazione a predisposi-­
]LRQHUDGLRVHQVLELOLWjLQGLYLGXDOHFULWHULGLGLDJQRVWLFDSUHFRFHGDWLGRVLPHWULFL
‡6DQJXHRFFXOWRQHOOHIHFL
$QQXDOH!DQQL
‡(FRJUD¿DWLURLGHD 7ULHQQDOH
‡36$WRWDOHHIUHH $QQXDOH!DQQL
‡(FRJUD¿DSHOYLFDRYDLR
%LHQQDOHDQQL?$QQXDOH!DQQL
‡(FRJUD¿DYHVFLFDOHHUHQDOH %LHQQDOHDQQL?$QQXDOH!DQQL
‡&RQVXOHQ]DVHQRORJLFD
%LHQQDOHDQQL?$QQXDOH!DQQL
‡&RQVXOHQ]DJDVWURHQWHURORJLD 4XLQTXHQQDOH!DQQL
‡&RQVXOHQ]DGHUPDWRORJLFD 6XLQGLFD]LRQHFOLQLFD
‡&RQVXOHQ]DRFXOLVWLFD
%LHQQDOH
‡&RQVXOHQ]DHPDWRORJLFD
6XLQGLFD]LRQHFOLQLFD
‡&RQVXOHQ]DXURORJLFD
6XLQGLFD]LRQHFOLQLFD
‡&RQVXOHQ]DQHXURSVLFKLDWULFD 6XLQGLFD]LRQHFOLQLFD
‡(VDPLGLIXQ]LRQDOLWjUHVSLUDWRULD
6XLQGLFD]LRQHFOLQLFD
49
Radiazioni ottiche artificiali (roa)
,O$SULOHqHQWUDWRLQYLJRUHO¶DUWGHO'/JVFKHVDQFLVFHO¶RE-­
EOLJRGLYDOXWDUHLULVFKLGDHVSRVL]LRQHDUDGLD]LRQLRWWLFKHDUWL¿FLDOL52$HOHFRQ-­
VHJXHQWLPLVXUHGLSURWH]LRQHGHLODYRUDWRUL/HUDGLD]LRQLFRLQYROWHVRQRWXWWHTXHOOH
DYHQWLXQJDPPDGLOXQJKH]]DG¶RQGDFKHYDGDQPDPPGLVWLQJXHQGROHcin LQFRHUHQWLUDGLD]LRQLLQIUDURVVH,5HVULVFDOGDWRULUDGLDQWLYLVLELOLHVIRWRWHUDSLD
QHRQDWDOHHGHUPDWRORJLFDHGXOWUDYLROHWWH89HVVWHULOL]]D]LRQHIRWRWHUDSLDGHU-­
PDWRORJLFDHFRHUHQWLODVHUXVLLQRIWDOPRORJLDFKLUXUJLDHWF,OGDWRUHGLODYRUR
GRYUjYDOXWDUHHPLVXUDUHLOLYHOOLGLUDGLD]LRQLRWWLFKHFXLYHQJRQRHVSRVWLLODYRUDWRUL
VWDELOLUHLVLVWHPLSLDGHJXDWLSHUULGXUUHWDOLHVSRVL]LRQLLQIRUPDUHLGLSHQGHQWLHG
DWWXDUHXQSLDQRGLSUHYHQ]LRQH
,ULVFKLPDJJLRULGHULYDQWLGDOO¶HVSRVL]LRQHDUDGLD]LRQLRWWLFKHDUWL¿FLDOLULJXDUGD-­
QRDSSDUDWRYLVLYRHFXWDQHR6XOODEDVHGHOODYDOXWD]LRQHGHOULVFKLRVDUjRSSRUWXQR
DWWLYDUHODVRUYHJOLDQ]DVDQLWDULDSHULODYRUDWRULGHOODVDQLWjFKHGHEEDQRLQGRVVDUH
'3,VHQ]DLTXDOLVDUHEEHSUHVXPLELOHXQDHVSRVL]LRQHVXSHULRUHDLOLPLWLGLOHJJHH
SHULTXDOLO¶HVSRVL]LRQHVLSXzSURWUDUUHQHOWHPSRPHVLDQQL
7UDLVRJJHWWLSDUWLFRODUPHQWHVHQVLELOLDOULVFKLRVRQRLQFOXVLLQGLYLGXLGLIRWRWLSR
DOELQLHVRJJHWWLDIIHWWLGDPDODWWLHGHOFROODJHQHSHUHVSRVL]LRQHDG89VRJJHWWLLQ
WUDWWDPHQWRFURQLFRRFLFOLFRFRQIDUPDFLIRWRVHQVLELOL]]DQWLHVDQWLELRWLFLWHWUDFLFOL-­
QHDQWLDULWPLFLDPLRGDURQHGLXUHWLFLWLD]LGLFLHWFVRJJHWWLFRQDOWHUD]LRQLGHOO¶LULGH
RGHOODSXSLOODRFRQUHFHQWHLPSLDQWRGLFULVWDOOLQRDUWL¿FLDOHODYRUDWRULFRQOHVLRQL
FXWDQHHPDOLJQHRSUHPDOLJQHGRQQHLQJUDYLGDQ]D
Profili di rischio e periodicità
,OSURJUDPPDGLVRUYHJOLDQ]DVDQLWDULDYLHQHUHGDWWRGRSRO¶DQDOLVLGHOOHPRGDOLWj
GLHVSRVL]LRQHHGHLULVFKLODYRUDWLYLYDOXWDWLQHOGRFXPHQWRGLYDOXWD]LRQHGHLULVFKL
'95/DSHULRGLFLWjGHLFRQWUROOLVDUjVWDELOLWDGDOPHGLFRFRPSHWHQWHLQEDVHDJOL
HVLWLGHOODYDOXWD]LRQHGHOULVFKLRHGHOOHFRQVHJXHQWLPLVXUHGLSUHYHQ]LRQHDGRWWDWH
,SURWRFROOLVDQLWDULVDUDQQRVRWWRSRVWLDYHUL¿FDHFRQWLQXRDJJLRUQDPHQWRDVHJXLWR
GLUHYLVLRQLGHOODYDOXWD]LRQHGHOULVFKLRGHLULVXOWDWLGHOODVRUYHJOLDQ]DVDQLWDULDGHL
ULVXOWDWL GHO PRQLWRUDJJLR ELRORJLFR GL FULWLFLWj HYLGHQ]LDWH GXUDQWH FROORTXL FRQ L
SUHSRVWLRLODYRUDWRUL
8QDPRWLYDWDÀHVVLELOLWjJHVWLRQDOHSXzFRUULVSRQGHUHDGXQDSXQWXDOHYDOXWD]LRQH
GHOULVFKLRGRSRDGHJXDWDFRQVLGHUD]LRQHGLWXWWHOHYDULDELOLLQWHUIHUHQWLGLVSRQLEL-­
OLWjXWLOL]]RFRUUHWWRHYHUL¿FDWRGLLGRQHL'3,GLVSRVLWLYLPHGLFLSHUODSUHYHQ]LRQH
50
SORVEGLIANZA SANITARIA
IN AMBITO OSPEDALIERO
GHOOHSXQWXUHDFFLGHQWDOLHGHOOHSUHFDX]LRQLVWDQGDUGGRFXPHQWDWDIRUPD]LRQHDQ-­
GDPHQWRGHJOLLQIRUWXQLHFF9HQJRQRGLVHJXLWRULSRUWDWLLSULQFLSDOLSUR¿OLGLULVFKLR
FRQLULIHULPHQWLQRUPDWLYLSLUHFHQWLLULIHULPHQWLDO'/YRQVRQR
GDLQWHQGHUHLQWHJUDWLGDO'/YRQHGLQROWUHSHULRGLFLWjHSURWRFROOL
PLQLPLVXJJHULWLSHUYLVLWDPHGLFDHGDFFHUWDPHQWLVDQLWDUL/HOLQHHGLLQGLUL]]RQRQ
SRVVRQRUDSSUHVHQWDUHXQXQLYHUVDOHSHUFRUVRREEOLJDWRULRPDXQDPHUDUDFFRPDQ-­
GD]LRQHDSSUH]]DELOHGLYROWDLQYROWDGDOPHGLFRUHVSRQVDELOH
51
DIVISIONE/AMBULATORIO/SERVIZIO: SALA OPERATORIA-­CHIRURGICI 1.1 MANSIONE:MEDICO ANESTESISTA-­RIANIMATORE-­CHIRURGO GENER
ALE,TORACICO,ORTOPEDICO,ORL,UROLOGO,GINECOLOGO, OCULISTA, PLASTICO, CARDIOVASCOLARE, UTIR 5LVFKLSHUODVDOXWH
$WWLYLWjFKHSXz
GHWHUPLQDUHLOULVFKLR
Radiazioni 'LDJQRVWLFDLQWUDRSHUDWRULD
LRQL]]DQWLODVHU89LQIUDURVVL
Riferimenti normativi per la sorveglianza sanitaria
LULIHULPDO'/YR
sono da intendere integrati GDO/YR
'/JVQ
'/JV?7LWROR9,,,
&DSR9
$JHQWLELRORJLFL
&RQWDWWRFRQLOSD]LHQWH
chirurgico
'/JV7LWROR;
Gas anestetici
,PSLHJRGLJDVDQHVWHWLFL
'/JV±7LWROR,;
&LUF0LQ6DQQ
1RWD,OULVFKLRUDGLRORJLFR&DW$qDFXUDGHO0HGLFR$XWRUL]]DWR
Tipologia degli Accertamenti Sanitari
Visite successive o Prima Visita 3HULRGLFKH
Visita medica
Visita medica
(PRFURPRFRPSOHWR
5HWLFRORFLWL
*OLFHPLD&UHDWLQLQHPLD
*27*37J*7
%LOLUXELQHPLD',
3URWLGRJUDPPD(VXULQH
,QGLFDWRULELRORJLFLGL
HVSRVL]LRQHDJDVDQHVWHWLFL
*OLFHPLD&UHDWLQLQHPLD
(PRFURPRFRPSOHWR
5HWLFRORFLWL*27*37
J*7%LOLUXELQHPLD',
3URWLGRJUDPPD(VXULQH
,QGLFDWRULELRORJLFLGL
HVSRVL]LRQHDJDVDQHVWHWLFL
(&*
Eventuali altri accertamenti LQEDVHDOOHFRQGL]LRQL
individuali e ai rischi
Eventuali altri accertamenti LQEDVHDOOHFRQGL]LRQL
individuali e ai rischi
52
Periodicità
%LHQQDOH
$QQXDOHVHHVSRVWRD5,
gas anestetici)
%LHQQDOH
$QQXDOHVHHVSRVWRD5,
gas anestetici)
'DGH¿QLUH
SORVEGLIANZA SANITARIA
IN AMBITO OSPEDALIERO
DIVISIONE/AMBULATORIO/SERVIZIO: SALA OPERATORIA-­CHIRURGICI
1.2 MANSIONE:CAPOSALA , INFERMIERE, AUSILIARIO-­OTA-­OSS
5LVFKLSHUODVDOXWH
Radiazioni ionizzanti
Riferimenti normativi per $WWLYLWjFKHSXzGHWHUPLQDUH la sorveglianza sanitaria
LOULVFKLR
'/YRLQWHJUDWR
GD'/YR
Strumentisti
'/JVQ
$JHQWLELRORJLFL
&RQWDWWRFRQLOSD]LHQWH
FKLUXUJLFRHPDQLSROD]LRQH
effetti dei malati
'/JV7LWROR;
Gas anastetici
,PSLHJRGLJDVDQHVWHWLFL
&LUF0LQ6DQQ'/JV
±7LWROR,;
Agenti chimici
,PSLHJRGLSURGRWWLSHU
GLVLQIH]LRQHHSXOL]LD
'/JV±7LWROR,;
Movimentazione manuale di carichi
0RYLPHQWD]LRQHSD]LHQWL
materiali
'/JV7LWROR9,
1RWD,OULVFKLRUDGLRORJLFR&DW$qDFXUDGHO0HGLFR$XWRUL]]DWR
Tipologia degli Accertamenti Sanitari
Periodicità
Prima Visita 9LVLWHVXFFHVVLYHR3HULRGLFKH
Visita medica
Visita medica
Esame clinico-­funzionale del rachide
Esame clinico-­funzionale del rachide
(PRFURPRFRPSOHWR
5HWLFRORFLWL
,QGLFDWRULELRORJLFLGL
HVSRVL]LRQHDJDVDQHVWHWLFL
*OLFHPLD*27*37
J*7%LOLUXELQHPLD
',3URWLGRJUDPPD
&UHDWLQLQHPLD
(VXULQH
(PRFURPR5HWLFRORFLWL
*OLFHPLD&UHDWLQLQHPLD*27 Biennale
*37J*7%LOLUXELQHPLD
$QQXDOHVHHVSRVWRD5,
',3URWLGRJUDPPD(V
gas anestetici)
XULQH,QGLFDWRULELRORJLFLGL
HVSRVL]LRQHDJDVDQHVWHWLFL
Biennale
$QQXDOHVHHVSRVWRD5,
gas anestetici)
%LHQQDOH
(&*
Eventuali altri accertamenti Eventuali altri accertamenti in 'DGH¿QLUH
LQEDVHDOOHFRQGL]LRQL
EDVHDOOHFRQGL]LRQLLQGLYLGXDOL
individuali
53
DIVISIONE/AMBULATORIO/SERVIZIO:PRONTO ( e PUNTO DI PRIMO) SOCCORSO
1.3 MANSIONE: MEDICO,CAPOSALA, INFERMIERE, AUSILIARIO-­OTA-­OSS
5LVFKLSHUODVDOXWH
$WWLYLWjFKHSXz
GHWHUPLQDUHLOULVFKLR
Riferimenti normativi per la sorveglianza sanitaria
'/YRLQWHJUDWR
GD'/YR
$JHQWLELRORJLFL
Contatto conmalato
'/JV7LWROR;
Agenti chimici
,PSLHJRGLSURGRWWLSHU
GLVLQIH]LRQHHSXOL]LD
'/JV±7LWROR,;
Movimentazione manuale di carichi
0RYLPHQWD]LRQHSD]LHQWLH
'/JV7LWROR9,
materiali
Tipologia degli Accertamenti Sanitari
Prima Visita Visite successive o 3HULRGLFKH
Visita medica
Visita medica
Esame clinico-­funzionale del rachide
Esame clinico-­funzionale del rachide
(PRFURPRFRPSOHWR*OLFHPLD
&UHDWLQLQHPLD*27*37
J*7%LOLUXELQHPLD',
3URWLGRJUDPPD(VXULQH
(PRFURPRFRPSOHWR
*OLFHPLD&UHDWLQLQHPLD
*27*37J*7
%LOLUXELQD'
,3URWLGRJUDPPD(VXULQH
Periodicità
%LHQQDOH
%LHQQDOH
Biennale
(&*
Eventuali altri accertamenti in EDVHDOOHFRQGL]LRQLLQGLYLGXDOL
54
Eventuali altri accertamenti LQEDVHDOOHFRQGL]LRQL
'DGH¿QLUH
individuali
SORVEGLIANZA SANITARIA
IN AMBITO OSPEDALIERO
SERVIZIO: VARI
1.4 MANSIONE: AUTISTA
5LVFKLSHUODVDOXWH
$WWLYLWjFKHSXzGHWHUPLQDUHLO
ULVFKLR
Riferimenti normativi per la sorveglianza sanitaria
'/YR
LQWHJUDWRGD'/YR
$JHQWLELRORJLFL
0DQLSROD]LRQHHIIHWWLGHOSD]LHQWH
HUL¿XWL
'/JV?±7LWROR;
Movimentazione manuale '/JV?±7LWROR
0RYLPHQWD]LRQHSD]LHQWLHPDWHULDOL
di carichi
VI
$FFHUWDPHQWRGLDVVHQ]DGLFRQGL]LRQLGLDOFROGLSHQGHQ]DSHUPDQVLRQHDULVFKLR
LGHQWL¿FDWDGDOODQRUPDWLYD$UWGHOOD/3URYYHGLPHQWRGHOOD
&RQIHUHQ]D6WDWR5HJLRQLDUWFGHO'/JVHVP
Tipologia degli Accertamenti Sanitari
Prima Visita 9LVLWHVXFFHVVLYHR3HULRGLFKH
Visita medica
Visita medica
Esame clinico-­funzionale Esame clinico-­funzionale del del rachide
rachide
Periodicità
%LHQQDOH
%LHQQDOH
(PRFURPRFRPSOHWR
*OLFHPLD*27*37
J*7%LOLUXELQHPLD',
3URWLGRJUDPPD
&UHDWLQLQHPLD
(VXULQH
(PRFURPRFRPSOHWR*OLFHPLD
*27*37J*7%LOLUXELQHPLD',
%LHQQDOH
3URWLGRJUDPPD&UHDWLQLQHPLD(V
urine
(&*
(&*
Eventuali altri DFFHUWDPHQWLLQEDVHDOOH
condizioni individuali
(YHQWXDOLDOWULDFFHUWDPHQWLLQEDVH
'DGH¿QLUH
alle condizioni individuali
Quadriennale
55
SERVIZIO:CAMERA IPERBARICA
MANSIONE: MEDICO, INFERMIERE, AUSILIARIO-­OTA-­OSS
5LVFKLSHUODVDOXWH
$JHQWLELRORJLFL
$WWLYLWjFKHSXzGHWHUPLQDUH
LOULVFKLR
Riferimenti normativi per la sorveglianza sanitaria
( D. L.vo 81/2008integrato
da D. L.vo 106/2009)
&RQWDWWRFRQLOSD]LHQWH
FKLUXUJLFRHPDQLSROD]LRQH
effetti dei malati
'/JV±7LWROR;
Agenti chimici
,PSLHJRGLSURGRWWLSHU
GLVLQIH]LRQHHSXOL]LD
Pressione Atmosferica
3UHVHQ]DLQFDPHUDLSHUEDULFD
'/JV±7LWROR,;
Movimentazione manuale 0RYLPHQWD]LRQHSD]LHQWLH
di carichi
materiali
'/JV7LWROR9,
Tipologia degli Accertamenti Sanitari
Periodicità
Prima Visita 9LVLWHVXFFHVVLYHR3HULRGLFKH
Visita medica
Visita medica
Annuale
Esame clinico-­funzionale del rachide
Esame clinico-­funzionale del rachide
%LHQQDOH
(PRFURPRFRPSOHWR
5HWLFRORFLWL
9(6aaK*OLFHPLD
*27*37J*7
%LOLUXELQHPLD',
3URWLGRJUDPPD
&UHDWLQLQHPLD
(VXULQH,QGLFDWRUL
ELRORJLFLGLHVSRVL]LRQHD
JDVDQHVWHWLFL
(PRFURPR5HWLFRORFLWL
*OLFHPLD&UHDWLQLQHPLD*27
*37J*7%LOLUXELQHPLD',
3URWLGRJUDPPD(VXULQH
(&*
Eventuali altri DFFHUWDPHQWLLQEDVHDOOH
condizioni individuali
56
Annuale
(&*
Annuale
Eventuali altri accertamenti in EDVHDOOHFRQGL]LRQLLQGLYLGXDOL
'DGH¿QLUH
SORVEGLIANZA SANITARIA
IN AMBITO OSPEDALIERO
DIVISIONE/AMBULATORIO/SERVIZIO:DIALISI
MANSIONE: MEDICO, CAPOSALA, INFERMIERE, TECNICO DI DIALISI, AUSILIARIO-­OTA-­OSS
5LVFKLSHUODVDOXWH
Riferimenti normativi per la $WWLYLWjFKHSXzGHWHUPLQDUH sorveglianza sanitaria
LOULVFKLR
'/YR
LQWHJUDWRGD'/YR
$JHQWLELRORJLFL
&RQWDWWRFRQSD]LHQWH
Agenti chimici
,PSLHJRGLSURGRWWLSHU
'/JV±7LWROR
VWHULOL]]D]LRQHDSSDUHFFKLDWXUH
,;
GLGLDOLVLGLVLQIHWDQWLGHWHUJHQWL
Movimentazione manuale di carichi
0RYLPHQWD]LRQHSD]LHQWLH
materiali
Tipologia degli Accertamenti Sanitari
'/JV±7LWROR
;
'/JV7LWROR
VI
Periodicità
Prima Visita 9LVLWHVXFFHVVLYHR3HULRGLFKH
Visita medica
Visita medica
%LHQQDOH
Esame clinico-­funzionale arti VXSHULRULHUDFKLGH
Esame clinico-­funzionale arti VXSHULRULHUDFKLGH
%LHQQDOH
(PRFURPRFRPSOHWR*OLFHPLD
&UHDWLQLQHPLD
*27*37J*7%LOLUXELQHPLD
',3URWLGRJUDPPD(VXULQH
(&*
Eventuali altri accertamenti in EDVHDOOHFRQGL]LRQLLQGLYLGXDOL
(PRFURPRFRPSOHWR*OLFHPLD
&UHDWLQLQHPLD*27*37J*7
%LHQQDOH
%LOLUXELQD',3URWLGRJUDPPD
(VXULQH
Eventuali altri accertamenti in EDVHDOOHFRQGL]LRQLLQGLYLGXDOL
'DGH¿QLUH
57
DIVISIONE/AMBULATORIO/SERVIZIO: CHIRURGICI NON ADDETTI ALLA SALA OPERATORIA
MANSIONE: MEDICO,CAPOSALA, INFERMIERE, AUSILIARIO-­OTA-­OSS
5LVFKLSHUODVDOXWH
Riferimenti normativi per la sorveglianza $WWLYLWjFKHSXzGHWHUPLQDUH sanitaria
LOULVFKLR
'/YR
LQWHJUDWRGD'/YR
$JHQWLELRORJLFL
Contatto con il malato
'/JV±7LWROR
;
Agenti chimici
,PSLHJRGLGLVLQIHWWDQWLH
detergenti
'/JV±7LWROR,;
Movimentazione manuale di carichi
0RYLPHQWD]LRQHSD]LHQWLH
materiali
'/JV7LWROR
VI
Tipologia degli Accertamenti Sanitari
Periodicità
Prima visita
9LVLWHVXFFHVVLYHR3HULRGLFKH
Visita medica
Visita medica
%LHQQDOH
Esame clinico-­funzionale del rachide
Esame clinico-­funzionale del rachide
%LHQQDOH
(PRFURPRFRPSOHWR*OLFHPLD
&UHDWLQLQHPLD
*27*37J*7%LOLUXELQHPLD
',3URWLGRJUDPPD(VXULQH
(PRFURPRFRPSOHWR
*OLFHPLD&UHDWLQLQHPLD
*27*37J*7%LOLUXELQD'
,3URWLGRJUDPPD
(VXULQH
%LHQQDOH
Eventuali altri accertamenti LQEDVHDOOHFRQGL]LRQL
individuali
'DGH¿QLUH
(&*
Eventuali altri accertamenti in EDVHDOOHFRQGL]LRQLLQGLYLGXDOL
58
SORVEGLIANZA SANITARIA
IN AMBITO OSPEDALIERO
DIVISIONE/SERVIZIO:MEDICI 0HGLFLQD*HQHUDOH0DODWWLH,QIHWWLYH*DVWURHQWHURORJLD)LVLRFKLQHVLWHUDSLD
/XQJRGHJHQ]D3QHXPRORJLD3VLFKLDWULD&DUGLRORJLD'HUPDWRORJLD1HIURORJLD
Reumatologia, Neurologia, Pediatria) MANSIONE: MEDICO,CAPOSALA, INFERMIERE, AUSILIARIO-­OTA-­OSS, PUERICULTRICE 5LVFKLSHUODVDOXWH
Riferimenti normativi per la sorveglianza $WWLYLWjFKHSXzGHWHUPLQDUH
sanitaria
LOULVFKLR
'/YR
LQWHJUDWRGD'/YR
$JHQWLELRORJLFL
Contatto con il malato
'/JV±
7LWROR;
Agenti chimici
,PSLHJRGLGLVLQIHWWDQWLH
detergenti
'/JV±7LWROR
,;
Movimentazione manuale di carichi
0RYLPHQWD]LRQHSD]LHQWLH
materiali
'/JV7LWROR
VI
Tipologia degli Accertamenti Sanitari
Periodicità
Prima Visita 9LVLWHVXFFHVVLYHR3HULRGLFKH
Visita medica
Visita medica
%LHQQDOH
Esame clinico-­funzionale del rachide
Esame clinico-­funzionale del rachide
%LHQQDOH
(PRFURPRFRPSOHWR*OLFHPLD
&UHDWLQLQHPLD
*27*37J*7%LOLUXELQHPLD
',3URWLGRJUDPPD(VXULQH
(PRFURPRFRPSOHWR
*OLFHPLD&UHDWLQLQHPLD*27
*37J*7
%LHQQDOH
%LOLUXELQD',3URWLGRJUDPPD
(VXULQH
(&*
Eventuali altri accertamenti in EDVHDOOHFRQGL]LRQLLQGLYLGXDOL
Eventuali altri accertamenti in 'DGH¿QLUH
EDVHDOOHFRQGL]LRQLLQGLYLGXDOL
59
AMBULATORI:MEDICI 0HGLFLQD*HQHUDOH0DODWWLH,QIHWWLYH*DVWURHQWHURORJLD)LVLRFKLQHVLWHUDSLD
/XQJRGHJHQ]D3QHXPRORJLD3VLFKLDWULD&DUGLRORJLD'HUPDWRORJLD1HIURORJLD
Reumatologia, Neurologia, Pediatria)
MANSIONE:MEDICO, CAPOSALA, INFERMIERE, AUSILIARIO-­OTA-­OSS, PUERICULTRICE 5LVFKLSHUODVDOXWH
$WWLYLWjFKHSXzGHWHUPLQDUH
LOULVFKLR
Riferimenti normativi per la sorveglianza sanitaria
'/YR
LQWHJUDWRGD'/YR
$JHQWLELRORJLFL
Contatto con il malato
'/JV±
7LWROR;
Agenti chimici
,PSLHJRGLGLVLQIHWWDQWLH
detergenti
'/JV±
7LWROR,;
Movimentazione manuale di carichi
0RYLPHQWD]LRQHSD]LHQWLH
materiali
'/JV
Titolo VI
Tipologia degli Accertamenti Sanitari
Periodicità
Prima Visita 9LVLWHVXFFHVVLYHR3HULRGLFKH
Visita medica
Visita medica
Triennale
Esame clinico-­funzionale del rachide
Esame clinico-­funzionale del rachide
Triennale
(PRFURPRFRPSOHWR*OLFHPLD
&UHDWLQLQHPLD
*27*37J*7%LOLUXELQHPLD
',3URWLGRJUDPPD(VXULQH
(PRFURPRFRPSOHWR*OLFHPLD
&UHDWLQLQHPLD*27*37J*7
Triennale
%LOLUXELQD',3URWLGRJUDPPD
(VXULQH
(&*
(YHQWXDOLDOWULDFFHUWDPHQWLLQEDVH Eventuali altri accertamenti in alle condizioni individuali
EDVHDOOHFRQGL]LRQLLQGLYLGXDOL
60
'DGH¿QLUH
SORVEGLIANZA SANITARIA
IN AMBITO OSPEDALIERO
DIVISIONE/AMBULATORIO/SERVIZIO ONCOLOGIA
MANSIONE: MEDICO, CAPOSALA, INFERMIERE, AUSILIARIO-­OTA-­OSS
5LVFKLSHUODVDOXWH
$JHQWLELRORJLFL
Agenti chimici
$WWLYLWjFKHSXzGHWHUPLQDUH
LOULVFKLR
&RQWDWWRFRQSD]LHQWH
'/JV±7LWROR;
3UHSDUD]LRQHHRVRPPLQLVWUD]LRQH
di farmaci antitumorali '/JV±7LWROR
,PSLHJRGLSURGRWWLSHUGLVLQIH]LRQH ,;&DSR,H,,
HSXOL]LD
Movimentazione manuale 0RYLPHQWD]LRQHSD]LHQWL
di carichi
7LSRORJLDGHJOL$FFHUWDPHQWL6DQLWDUL
Prima Visita Riferimenti normativi per la sorveglianza sanitaria
'/YR
LQWHJUDWRGD'/YR
'/JV7LWROR
VI
3HULRGLFLWj
Visite successive o Periodiche Visita medica
Visita medica
%LHQQDOH
$QQXDOHSHUDGGHWWL
SUHSDUD]LRQH
FKHPLRWHUDSLFL
DQWLEODVWLFL
Esame clinico-­funzionale del rachide
Esame clinico-­funzionale del rachide
%LHQQDOH
(PRFURPRFRPSOHWR
5HWLFRORFLWL
*3'*OLFHPLD
&UHDWLQLQHPLD*27*37
J*7%LOLUXELQHPLD',
3URWLGRJUDPPD(VXULQH
(PRFURPRFRPSOHWR
5HWLFRORFLWL*OLFHPLD
&UHDWLQLQHPLD*27*37
J*7%LOLUXELQHPLD',
3URWLGRJUDPPD(VXULQH
%LHQQDOH
$QQXDOHSHUDGGHWWL
SUHSDUD]LRQH
FKHPLRWHUDSLFL
DQWLEODVWLFL
(&*
Eventuali altri accertamenti (YHQWXDOLDOWULDFFHUWDPHQWLLQEDVH
LQEDVHDOOHFRQGL]LRQL
'DGH¿QLUH
alle condizioni individuali
individuali
61
SERVIZIO: LABORATORIO ANALISI CLINICHE, MICROBIOLOGICHE, BANCA DEL SANGUE MANSIONE: MEDICO, BIOLOGO, CHIMICO, INFERMIERE,
TECNICO DI LABORATORIO, AUSILIARIO-­OTA-­OSS
Riferimenti normativi per la sorveglianza $WWLYLWjFKHSXzGHWHUPLQDUH
5LVFKLSHUODVDOXWH
sanitaria
LOULVFKLR
'/YRLQWHJUDWR
GD'/YR
Contatto con sangue e altri $JHQWLELRORJLFL
'/JV±7LWROR;
OLTXLGLELRORJLFL
Radiazioni ionizzanti
Diagnostica
Agenti chimici
,PSLHJRGLSURGRWWLSHUDQDOLVLGL '/JV±7LWROR
ODERUDWRULR
,;&DSR,
$IIDWLFDPHQWRSRVWXUDOHH
visivo
8VRGL9'7SHUDOPHQRKVHWW '/JV±7LWROR9,,
Movimentazione manuale di carichi
Movimentazione materiali
Tipologia degli Accertamenti Sanitari
Prima Visita '/JV
'/JV7LWROR9,
Periodicità
9LVLWHVXFFHVVLYHR3HULRGLFKH
Visita medica
Visita medica
Visita oculistica
Visita oculistica
(PRFURPRFRPSOHWR
5HWLFRORFLWL*OLFHPLD
&UHDWLQLQHPLD*27*37
J*7%LOLUXELQHPLD',
3URWLGRJUDPPD(VXULQH
*OLFHPLD&UHDWLQLQHPLD
(PRFURPRFRPSOHWR
5HWLFRORFLWL
*27*37J*7%LOLUXELQHPLD
',3URWLGRJUDPPD(VXULQH
%LHQQDOH
$QQXDOH/DERUDWRULRD
ULVFKLRELRORJLFRDJHQWL
%LHQQDOHQHJOLLGRQHL!
anni
4XLQTXHQQDOHQHJOLLGRQHL
DQQL
%LHQQDOH
$QQXDOH/DERUDWRULRD
ULVFKLRELRORJLFRDJHQWL
(&*
Eventuali altri accertamenti Eventuali altri accertamenti in LQEDVHDOOHFRQGL]LRQL
EDVHDOOHFRQGL]LRQLLQGLYLGXDOL
individuali
62
'DGH¿QLUH
SORVEGLIANZA SANITARIA
IN AMBITO OSPEDALIERO
SERVIZIO: ANATOMIA PATOLOGICA
MANSIONE: MEDICO, BIOLOGO, INFERMIERE, TECNICO, AUSILIARIO-­OTA-­OSS
5LVFKLSHUODVDOXWH
$WWLYLWjFKHSXzGHWHUPLQDUHLO
ULVFKLR
Riferimenti normativi per la sorveglianza sanitaria
ULIHULP'/YR
integrato
'/YR
$JHQWLELRORJLFL
Contatto con sangue e altri OLTXLGLPDWHULDOLELRORJLFL
'/JV±7LWROR;
Agenti chimici
,PSLHJRGLSURGRWWLSHUDQDOLVLGL
ODERUDWRULR
'/JV±7LWROR
,;&DSR,
$IIDWLFDPHQWRSRVWXUDOH
e visivo
8VRGL9'7SHUDOPHQRKVHWW
'/JV±7LWROR9,,
Movimentazione manuale Movimentazione materiali
di carichi
'/JV7LWROR9,
Tipologia degli Accertamenti Sanitari
Periodicità
Prima Visita 9LVLWHVXFFHVVLYHR3HULRGLFKH
Visita medica
Visita medica
Visita oculistica
Emocromo FRPSOHWR*OLFHPLD
&UHDWLQLQHPLD*27
*37J*7%LOLUXELQHPLD
',3URWLGRJUDPPD
(VXULQH
(&*
Eventuali altri DFFHUWDPHQWLLQEDVHDOOH
condizioni individuali
Visita oculistica
Annuale %LHQQDOHQHJOLLGRQHL!
anni
4XLQTXHQQDOHQHJOLLGRQHL
DQQL
(PRFURPRFRPSOHWR*OLFHPLD
&UHDWLQLQHPLD*27*37
Annuale J*7%LOLUXELQHPLD',
3URWLGRJUDPPD(VXULQH
,QGLFDWRULELRORJLFLGLHVSRVL]LRQH
Eventuali altri accertamenti in EDVHDOOHFRQGL]LRQLLQGLYLGXDOL
'DGH¿QLUH
63
AMBULATORIO/SERVIZIO: RADIOLOGI
MANSIONE: MEDICO,TECNICO RADIOLOGO, INFERMIERE, AUSILIARIO-­OTA-­OSS
Riferimenti normativi per la sorveglianza $WWLYLWjFKHSXzGHWHUPLQDUHLO sanitaria
5LVFKLSHUODVDOXWH
ULVFKLR
'/YR
integrato
GD'/YR
Radiazioni ionizzanti
Diagnostica
'/JV
'OJV?7LWROR9,,,
&DPSLHOHWWURPDJQHWLFL
Diagnostica
&DSR,9
'/JV±7LWROR
$JHQWLELRORJLFL
&RQWDWWRFRQSD]LHQWH
;
,PSLHJRGLSURGRWWLSHU
'/JV±7LWROR
Agenti chimici
GLVLQIH]LRQHHSXOL]LD
,;&DSR,
Movimentazione manuale di 0RYLPHQWD]LRQHSD]LHQWL
'/JV7LWROR9,
carichi
$IIDWLFDPHQWRSRVWXUDOHH
'/JV±7LWROR
8VRGL9'7SHUDOPHQRKVHWW
visivo
VII
1RWD,SURWRFROOLSHUULVFKLRUDGLRORJLFRFDW$VRQRDFXUDGHO0HGLFR$XWRUL]]DWRVHF/*$,50
Tipologia degli Accertamenti Sanitari
Prima Visita 9LVLWHVXFFHVVLYHR3HULRGLFKH
Visita medica
Visita medica
Esame clinico-­funzionale del Esame clinico-­funzionale del rachide
rachide
(PRFURPRFRPSOHWR
5HWLFRORFLWL*OLFHPLD
&UHDWLQLQHPLD*27*37
J*7%LOLUXELQHPLD',
3URWLGRJUDPPD)7)7
76+(VXULQH
Periodicità
$QQXDOHFDW%
%LHQQDOH
%LHQQDOH
(PRFURPRFRPSOHWR
5HWLFRORFLWL*OLFHPLD
&UHDWLQLQHPLD*27*37
J*7%LOLUXELQHPLD',
3URWLGRJUDPPDHVXULQH
$QQXDOHFDW%
%LHQQDOH
)7)776+
%LHQQDOHFDW%
(&*
(FRJUD¿D7LURLGHD
(FRJUD¿D7LURLGHD
Visita oculistica Visita oculistica ((*YLVLWD25/H
DXGLRPHWULDSHUJOLDGGHWWLDG
LPSLDQWL501
Eventuali altri accertamenti Eventuali altri accertamenti in LQEDVHDOOHFRQGL]LRQL
EDVHDOOHFRQGL]LRQLLQGLYLGXDOL
individuali
64
%LHQQDOHVDOYRGLYHUVD
indicazione
%LHQQDOHVDOYRGLYHUVD
indicazione
'DGH¿QLUH
SORVEGLIANZA SANITARIA
IN AMBITO OSPEDALIERO
SERVIZIO: FARMACIA OSPEDALIERA E TERRITORIALE
MANSIONE: FARMACISTA,INFERMIERE
5LVFKLSHUODVDOXWH
$WWLYLWjFKHSXz
GHWHUPLQDUHLOULVFKLR
Riferimenti normativi per la sorveglianza sanitaria
'/YRLQWHJUDWR
GD'/YR
Agenti chimici
0DQLSROD]LRQHR
SUHSDUD]LRQHGLIDUPDFL
antitumorali '/JV?7LWROR,;
&DSR,
Agenti chimici
$OOHVWLPHQWRSUHSDUDWL
'/JV?7LWROR,;
galenici
&DSR,,
,PSLHJRGLSURGRWWLFKLPLFL
Tipologia degli Accertamenti Sanitari
Prima Visita Periodicità
Visite successive o 3HULRGLFKH
Triennale
Visita medica
Visita medica
Emocromo FRPSOHWR5HWLFRORFLWL*3'+
*OLFHPLD&UHDWLQLQHPLD
*27*37J*7%LOLUXELQHPLD
',3URWLGRJUDPPD(VXULQH
(PRFURPRFRPSOHWR
5HWLFRORFLWL*OLFHPLD
*27*37J*7
%LOLUXELQHPLD',
3URWLGRJUDPPD
&UHDWLQLQHPLD(VXULQH
$QQXDOHVHSUHSDUD]LRQH
FKHPLRWHUDSLFLDQWLEODVWLFL
Triennale
$QQXDOHVHSUHSDUD]LRQH
FKHPLRWHUDSLFLDQWLEODVWLFL
(&*
Eventuali altri accertamenti Eventuali altri accertamenti in LQEDVHDOOHFRQGL]LRQL
'DGH¿QLUH
EDVHDOOHFRQGL]LRQLLQGLYLGXDOL
individuali
65
SERVIZIO: UFFICIO TECNICO
MANSIONE: MURATORE, CARPENTIERE, FALEGNAME, ELETTRICISTA, IDRAULICO, CONDUTTORI CALDAIE, MECCANICI
5LVFKLSHUODVDOXWH
$WWLYLWjFKHSXz
GHWHUPLQDUHLOULVFKLR
Riferimenti normativi per la sorveglianza sanitaria
'/YRLQWHJUDWR
GD'/YR
$JHQWLFKLPLFLFHPHQWR
GLVDUPDQWLIXPLJDVVDOGDWXUH
FROOHYHUQLFLVROYHQWLSROYHUL
inorganiche e del legno)
/DYRUD]LRQLSURSULHGHOOD
mansione
'/JV?7LWROR,;
&DSR,
$JHQWL¿VLFL
UXPRUHYLEUD]LRQL
/DYRUD]LRQLSURSULHGHOOD
mansione
'/JV?7LWROR9,,,
&DSR,,,H,,,
Movimentazione manuale carichi Movimentazione materiali
'/JV±7LWROR9,
$FFHUWDPHQWRGLDVVHQ]DGLWRVVLFRGLSHQGHQ]DSURYYFRQIXQL¿FDWD??H??SHU
PDQVLRQLFKHSUHYHGRQRULODVFLRSDWHQWHGLFRQGXWWRUHGLFDOGDLHDYDSRUH
Agenti biologici
Riparazione condotte fognarie
Tipologia degli Accertamenti Sanitari
Visite successive o Prima Visita 3HULRGLFKH
Periodicità
Visita medica
Biennale
Visita medica
(PRFURPRFRPSOHWR*OLFHPLD (PRFURPRFRPSOHWR
*27*37J*7&UHDWLQLQHPLD *OLFHPLD*27*37J*7 %LHQQDOH
(VXULQH
&UHDWLQLQHPLD(VXULQH
Audiometria
6HFRQGRLO/H[KR
/H[Z:
!G%$DQQXDOH
ñG%$ELHQQDOH
G%$WULHQQDOH
6SLURPHWULD
6SLURPHWULD
%LHQQDOH
6HHVSRVWLDGLUULWDQWL
UHVSLUDWRULDJHQWLFKLPLFL
Eventuali altri accertamenti in EDVHDOOHFRQGL]LRQLLQGLYLGXDOL
Eventuali altri accertamenti LQEDVHDOOHFRQGL]LRQL
'DGH¿QLUH
individuali
Audiometria
(&*
66
SORVEGLIANZA SANITARIA
IN AMBITO OSPEDALIERO
SERVIZIO: VARI MANSIONE:DISINFETTORI, NECROFORI, ADDETTI LAVANDERIA 5LVFKLSHUODVDOXWH
$WWLYLWjFKHSXz
GHWHUPLQDUHLOULVFKLR
Riferimenti normativi per la sorveglianza sanitaria
'/YRLQWHJUDWR
GD'/YR
$JHQWLELRORJLFL
&RQWDWWRFRQOLTXLGL
ELRORJLFLELDQFKHULD
'/JV±7LWROR;
Agenti chimici
(VSRVL]LRQHRFRQWDWWRD
'/JV?7LWROR,;
SURGRWWLRVRVWDQ]HGLYDULD
&DSR,
natura Movimentazione manuale carichi
Movimentazione materiali
'/JV?±7LWROR9,
$FFHUWDPHQWRGLDVVHQ]DGLWRVVLFRGLSHQGHQ]DSURYYFRQIXQL¿FDWD??H??SHU
XVRVRVWDQ]HFKHSUHYHGRQRULODVFLRSDWHQWHVSHFLDOH
Tipologia degli Accertamenti Sanitari
Periodicità
Prima Visita Visite successive o 3HULRGLFKH
Visita medica
Visita medica
Biennale
(PRFURPRFRPSOHWR*OLFHPLD
*27*37J*7%LOLUXELQHPLD
',3URWLGRJUDPPD
&UHDWLQLQHPLD
(VXULQH
Emocromo FRPSOHWR*OLFHPLD
*27*37J*7
%LOLUXELQHPLD',
3URWLGRJUDPPD
&UHDWLQLQHPLD(VXULQH
%LHQQDOH
(&*
Eventuali altri accertamenti in EDVHDOOHFRQGL]LRQLLQGLYLGXDOL
Eventuali altri accertamenti LQEDVHDOOHFRQGL]LRQL
'DGH¿QLUH
individuali
67
SERVIZIO:UFFICI AMMINISTRATIVI MANSIONE:OPERATORE AL VDT 5LVFKLSHUODVDOXWH
Riferimenti normativi per la sorveglianza $WWLYLWjFKHSXzGHWHUPLQDUHLO sanitaria
ULVFKLR
'/YR
integrato
GD'/YR
$IIDWLFDPHQWRSRVWXUDOHH
visivo
$WWLYLWjDO9'7!RUH
settimana
Tipologia degli Accertamenti Sanitari
Prima Visita '/JV±7LWROR9,,
Periodicità
9LVLWHVXFFHVVLYHR3HULRGLFKH
Quinquennale negli idonei <50 anni
Visita medica
Visita medica
Biennale negli idonei >50 anni
Esame clinico-­
Esame clinico-­funzionaledel funzionaledel rachide e arti UDFKLGHHDUWLVXSHULRUL
VXSHULRUL
,QFDVRGLGLVWXUELFRUUHODWL
DOODSRVWXUDTXHVWLRQDULR
Visita oculistica
4XLQTXHQQDOHQHJOLLGRQHL
DQQLRFRPHGD
SUHVFUL]LRQHRFXOLVWLFD
%LHQQDOHQHJOLLGRQHL!
anni
(PRFURPRFRPSOHWR
*OLFHPLD*27*37J*7
&UHDWLQLQHPLD
(VXULQH
68
Visita oculistica
SORVEGLIANZA SANITARIA
IN AMBITO OSPEDALIERO
SERVIZIO: VARI
MANSIONE:MAGAZZINIERE
5LVFKLSHUODVDOXWH
Riferimenti normativi per la sorveglianza $WWLYLWjFKHSXzGHWHUPLQDUH sanitaria
LOULVFKLR
'/YR
integrato
GD'/YR
Movimentazione manuale di FDULFKL
VIRU]LULSHWXWLDUWRVXSHULRUH
Movimentazione materiali
Tipologia degli Accertamenti Sanitari
Prima Visita 9LVLWHVXFFHVVLYHR3HULRGLFKH
Visita medica
Visita medica
Esame clinico-­funzionale del Esame clinico-­funzionale del UDFKLGHHDUWLVXSHULRUL
UDFKLGHHDUWLVXSHULRUL
(PRFURPRFRPSOHWR
*OLFHPLD*27*37
J*7%LOLUXELQHPLD
',3URWLGRJUDPPD
&UHDWLQLQHPLD(VXULQH
'/JV?±7LWROR9,
Periodicità
%LHQQDOH
%LHQQDOH
(PRFURPRFRPSOHWR*OLFHPLD
*27*37J*7%LOLUXELQHPLD
%LHQQDOH
',3URWLGRJUDPPD
&UHDWLQLQHPLD(VXULQH
(&*
Eventuali altri accertamenti LQEDVHDOOHFRQGL]LRQL
individuali
Eventuali altri accertamenti in 'DGH¿QLUH
EDVHDOOHFRQGL]LRQLLQGLYLGXDOL
69
AMBULATORIO/SERVIZIO: DIP. DIPENDENZE PATOLOGICHE, SALUTE MENTALE, PREVENZIONE, DISTRETTO SOCIO-­SANITARIO MANSIONE: VETERINARIO DI SANITA’ ANIMALE, FISIOTERAPISTA, ADDETTI ALL’ ASSISTENZA SANITARIA DOMICILIARE
5LVFKLSHUODVDOXWH
$WWLYLWjFKHSXzGHWHUPLQDUHLO
ULVFKLR
Riferimenti normativi per la sorveglianza sanitaria
'/YR
integrato
GD'/YR
5DGLD]LRQLODVHU89LQIUDURVVL 7UDWWDPHQWL¿VLRWHUDSLFL
'/JV?7LWROR
VIII
&DSR9
$JHQWLELRORJLFL
&RQWDWWRFRQLSD]LHQWLHDQLPDOL
'/JV7LWROR
;
Agenti chimici
,PSLHJRGLYDULHVRVWDQ]HSHU
GLVLQIH]LRQHHSXOL]LD
&LUF0LQ
6DQQ'/JV
±7LWROR,;
Movimentazione manuale 0RYLPHQWD]LRQHSD]LHQWLH
FDULFKLHVIRU]LPRYLPHQWL
PDWHULDOLWUDWWDPHQWRSD]LHQWL
ULSHWXWLDUWLVXSHULRUL
¿VLRWHUDSLVWL
Tipologia degli Accertamenti Sanitari
Prima Visita 9LVLWHVXFFHVVLYHR3HULRGLFKH
Visita medica
Esame clinico-­funzionale UDFKLGHHDUWLVXSHULRUL
(PRFURPRFRPSOHWR
*OLFHPLD
&UHDWLQLQHPLD*27*37
J*7%LOLUXELQHPLD',
3URWLGRJUDPPD(VXULQH
'/JV?±7LWROR
VI
Periodicità
Biennale
,QFDVRGLGLVWXUEL
Esame clinico-­funzionalerachide e correlati DUWLVXSHULRUL
TXHVWLRQDULR
Visita medica
(PRFURPRFRPSOHWR*OLFHPLD
&UHDWLQLQHPLD*27*37J*7
%LOLUXELQHPLD',3URWLGRJUDPPD %LHQQDOH
(VXULQH
(&*
Eventuali altri accertamenti LQEDVHDOOHFRQGL]LRQL
individuali e ai rischi
70
Eventuali altri accertamenti in EDVHDOOHFRQGL]LRQLLQGLYLGXDOLH
ai rischi
'DGH¿QLUH
SORVEGLIANZA SANITARIA
IN AMBITO OSPEDALIERO
SERVIZIO: DIP. DIPENDENZE PATOLOGICHE, SALUTE MENTALE ,PREVENZIONE, DISTRETTO SOCIO-­SANITARIO MANSIONE:MEDICO, INFERMIERE, PSICOLOGO, OPERATORE TECNICO PREVENZIONE, EDUCATORE, ASSISTENTE SOCIALE, ASSISTENTE SANITARIO
$WWLYLWjFKHSXzGHWHUPLQDUH
5LVFKLSHUODVDOXWH
LOULVFKLR
Riferimenti normativi per la sorveglianza sanitaria
'/YRLQWHJUDWR
GD'/YR
$JHQWLELRORJLFL
&RQWDWWRFRQSD]LHQWLLQTXLQDQWL
'/JV7LWROR;
DPELHQWLHFLEL
Agenti chimici
&RQWDWWRFRQYDULHVRVWDQ]HSHU
GLVLQIH]LRQHHSXOL]LDLQTXLQDQWL '/JV±7LWROR,;
DPELHQWDOL
Movimentazione manuale carichi
Movimentazionemateriali
Tipologia degli Accertamenti Sanitari
Prima Visita 9LVLWHVXFFHVVLYHR3HULRGLFKH
Visita medica
Visita medica
Emocromo FRPSOHWR*OLFHPLD
&UHDWLQLQHPLD
*27*37J*7
%LOLUXELQHPLD',
3URWLGRJUDPPD(V
urine (PRFURPRFRPSOHWR
*OLFHPLD&UHDWLQLQHPLD*27
*37J*7%LOLUXELQHPLD',
3URWLGRJUDPPD(VXULQH
'/JV?±7LWROR9,
Periodicità
Triennale
Quinquennale (psicologo, educatore, assist. sanit.)
Triennale
4XLQTXHQQDOHSVLFRORJR
HGXFDWRUHDVVLVWVDQLW
(&*
Eventuali altri accertamenti in Eventuali altri accertamenti in EDVHDOOHFRQGL]LRQL EDVHDOOHFRQGL]LRQLLQGLYLGXDOL 'DGH¿QLUH
individuali e ai e ai rischi
rischi
71
RIFERIMENTI BIBLIOGRAFICI
$&2(0 2FFXSDWLRQDO 0HGLFLQH 3UDFWLFH *XLGHOLQHV (YDOXDWLRQ DQG PDQDJHPHQW RI
FRPPRQKHDOWKSUREOHPVDQGIXQFWLRQDOUHFRYHU\RIZRUNHUVQG(G&DS,Q*ODVV/6
%HYHUO\)DUPV0$2(03UHVV
$OHVVLR / 3RUUX 6 /RQJR ) HW DO /LQHH *XLGD 6,0/,, SHU OD VRUYHJOLDQ]D VDQLWDULD GHL
ODYRUDWRULGHOODVDQLWjHVSRVWLDULVFKLRELRORJLFR3,0((G3DYLD
$VV,WDO0HG3UHY/DYRU6DQLWj 6LQWHVLGHOOHLQGLFD]LRQLSHUXQDUD]LRQDOHDSSOLFD]LRQH
GHOOH/LQHH*XLGD0LQLVWHULDOLVXOODSUHYHQ]LRQHGHLULVFKLRFFXSD]LRQDOLQHOODPDQLSROD]LRQH
GHL&KHPLRWHUDSLFL$QWLEODVWLFL0HG/DY
%DWWHYL 1 0HQRQL 2 5LFFL 0* &DLUROL 60$32 LQGH[ IRU ULVN DVVHVVPHQW RI SDWLHQW
PDQXDOKDQGOLQJLQKRVSLWDOZDUGVDYDOLGDWLRQVWXG\(UJRQRPLFV
%RQDPRQWH'&DULQR0HWDO2FFXSDWLRQDO$LUERUQH$OOHUJ\IURP$PLQRWKLRSKHQRO(XU
-'HUPDWRO
&HVDQD*&&RVWD*2FFXSDWLRQDOVWUHVVULVNDVVHVVPHQWDQG¿WQHVVIRUZRUN0HG/DY
&RORPELQL ' 2FFKLSLQWL ( HW DO /LQHH *XLGD SHU OD SUHYHQ]LRQH GHL GLVWXUEL H GHOOH
SDWRORJLHPXVFRORVFKHOHWULFKHGHOUDFKLGHGDPRYLPHQWD]LRQHPDQXDOHGLFDULFKL3,
0((G3DYLD
&RQZD\ 30 &DPSDQLQL 3 6DUWRUL 6 'RWWL 5 &RVWD * 0DLQ DQG LQWHUDFWLYH HIIHFWV RI
VKLIWZRUNDJHDQGZRUNVWUHVVRQKHDOWKLQDQ,WDOLDQVDPSOHRIKHDOWKFDUHZRUNHUV$SSOLHG
(UJRQRPLFV±
&RRUGLQDPHQWR7HFQLFR,QWHUUHJLRQDOHSHUOD3UHYHQ]LRQHQHLOXRJKLGLODYRUR,QGLFD]LRQL
RSHUDWLYHVXOO¶HVSRVL]LRQHDGDJHQWL¿VLFLFRQDJJLRUQDPHQWRUHODWLYRDO&DSR9'RFXPHQWR
&ULSSD0%HOOHUL/0LVWUHOOR*HWDO3UHYHQWLRQRIODWH[DOOHUJ\DPRQJKHDOWKFDUHZRUNHUV
DQGLQWKHJHQHUDOSRSXODWLRQODWH[SURWHLQFRQWHQWLQGHYLFHVFRPPRQO\XVHGLQKRVSLWDOVDQG
JHQHUDOSUDFWLFH,QW$UFK2FFXS(QYLURQ+HDOWK
De Perio MA Tsevat J HW DO &RVWHIIHFWLYHQHVV RI LQWHUIHURQ JDPPD UHOHDVH DVVD\V YV
WXEHUFXOLQVNLQWHVWVLQKHDOWKFDUHZRUNHUV$UFK,QWHUQ0HG
72
SORVEGLIANZA SANITARIA
IN AMBITO OSPEDALIERO
)UDQFKL $ 'LDQD 2 )UDQFR * -REUHODWHG ULVN RI ODWHQW WXEHUFXORVLV LQIHFWLRQ LQ D
KRPRJHQHRXV SRSXODWLRQ RI KRVSLWDO ZRUNHUV LQ D ORZ LQFLGHQFH DUHD $P - ,QG 0HG
.DXSSLQHQ..XPSXODLQHQ5+RXWPDQ,*HQGHULVVXHVLQVDIHW\DQGKHDOWKDWZRUN$
UHYLHZ(XURSHDQ$JHQF\IRU6DIHW\DQG+HDOWKDW:RUN
,DYLFROL 6,63(6/¶V FRPPLWPHQW WR PDQDJH DQG DVVHVV ZRUNUHODWHG VWUHVV ,Q %RRN RI
3URFHHGLQJRIWKH,;&RQIHUHQFHRIWKH(XURSHDQ$FDGHP\RI2FFXSDWLRQDO+HDOWK3V\FKRORJ\
($2+30DU5RPH,WDO\
/HJJH GHO PDU]R Q /HJJH TXDGUR LQ PDWHULDGL DOFRO H GL SUREOHPL DOFRO
FRUUHODWLHUHODWLYRSURYYHGLPHQWRGHOOD&RQIHUHQ]DSHUPDQHQWHSHULUDSSRUWLWUDOR6WDWROH
5HJLRQLHOH3URYLQFHDXWRQRPHGL7UHQWRH%RO]DQRQHOODVHGXWDGHOPDU]R
/RUXVVR$%UXQR6/¶$EEDWH1$UHYLHZRIORZEDFNSDLQDQGPXVFXORVNHOHWDOGLVRUGHUV
DPRQJ,WDOLDQQXUVLQJSHUVRQQHO,QG+HDOWK
/XFFKLQL5)DFFR37URPELQL()UDQFHVFKLQL57DFFLD5$OHVVLR//RµVWUHVVLQGH[¶
SURSRVWDGLXQPHWRGRSHUODYDOXWD]LRQHGDVWUHVVHEXUQRXWLQDPELHQWLVDQLWDUL*,WDO0HG/DY
(UJRQ6XSSO
0D]XUHN*+-HUHE-/R%OXH3HWDO*XLGHOLQHVIRUXVLQJWKH4XDQWLIHURQ7%*ROGWHVWIRU
GHWHFWLQJ0\FREDFWHULXPWXEHUFXORVLVLQIHFWLRQ00:555
0RODULXV$%HUJOXQG.(ULNVVRQ&HWDO6RFLRHFRQRPLFFRQGLWLRQVOLIHVW\OHIDFWRUVDQG
VHOIUDWHGKHDOWKDPRQJPHQDQGZRPHQLQ6ZHGHQ(XU-3XEOLF+HDOWK
0XUDWRUH 0 %XMD * )D]LR ) 0XLD 5 3HOOHJULQR * ,QFLGHQWL RFFXSD]LRQDOL D ULVFKLR
ELRORJLFR*,WDO0HG/DY(UJRQ6XSSO
1HWWLV($VVHQQDWR*)HUUDQLQL$7XUVL$7\SH,DOOHUJ\WRQDWXUDOUXEEHUODWH[DQGW\SH
,9DOOHUJ\WRUXEEHUFKHPLFDOVLQKHDOWKFDUHZRUNHUVZLWKJORYHUHODWHGVNLQV\PSWRPV&OLQ
([S$OOHUJ\
3DOPHU .7 &R[ 5 %URZQ , )LWQHVV IRU ZRUN WKH PHGLFDO DVSHFWV 2[IRUG 8QLYHUVLW\
3UHVV
3XQQHWW/3UXVV8WXQ$1HOVRQ',HWDO(VWLPDWLQJWKHJOREDOEXUGHQRIORZEDFNSDLQ
DWWULEXWDEOHWRFRPELQHGRFFXSDWLRQDOH[SRVXUHV$P-,QG0HG
5XRWVDODLQHQ-HWDO“6\VWHPDWLFUHYLHZRILQWHUYHQWLRQVIRUUHGXFLQJRFFXSDWLRQDOVWUHVV
LQKHDOWKFDUHZRUNHUV´ 6FDQG-:RUN(QYLURQ+HDOWK
73
Romano C , Baracco A , Frigeri G et al Tutela della salute e sicurezza nei luoghi di lavoro GDO'OJVDO'OJVHVPL5LYLVWDLQIRUWXQLHPDODWWLHSURIHVVLRQDOL9RO
6ROHR/5RPDQR&$EEULWWL*HWDO/LQHH*XLGD6,0/,,SHUODVRUYHJOLDQ]DVDQLWDULD
3,0((G3DYLD9RO
6WDDO-%+ORELO+YDQ7XOGHU0:HWDO2FFXSDWLRQDOKHDOWKJXLGHOLQHVIRUWKHPDQDJHPHQW
RIORZEDFNSDLQDQLQWHUQDWLRQDOFRPSDULVRQ2FFXS(QYLURQ0HG
7RPDR30DUWLQL$'L5HQ]L6HWDO3UHYDOHQFHRIODWHQWWXEHUFRORVLVLQIHFWLRQLQ+&:V
DVVHVVHGE\4XDQWL)(5217%*ROGDQGWXEHUFROLQVNLQWHVWSUHOLPLQDU\UHVXOWV*,WDO0HG
/DY(UJ6XSSO
9LRODQWH)6)LRUL0)LRUHQWLQL&HWDO$VVRFLDWLRQVRI3V\FKRVRFLDODQG,QGLYLGXDO)DFWRUV
ZLWKWKUHHGLIIHUHQWFDWHJRULHVRIEDFNGLVRUGHUVDPRQJQXUVLQJVWDII-2FFXS+HDOWK
74
Fly UP