RESUMO
The incorporation into Italian legislation of the European Community directives on the improvement of health and safety at work has promoted a vast effort in order to revise the surveillance approach in many facilities, including hospitals. At the S. Gerardo Hospital in Monza, the required risk evaluation was performed in 1995. The paper here reports the results of environmental and work organization inspection, literature review and the proposal of a surveillance program. S. Gerardo Hospital is a large facility with 2,547 employees. Major structural problems are associated with fire prevention and the continuous change required for the development of a modern hospital. Relevant risk in health care are: biological risk, in particular hepatitis B and AIDS virus, teratogenic viruses (rubella, cytomegalovirus and varicella-zoster) and the renewed possibility of tuberculosis infection, often multi-drug resistant; chemical hazards, in particular use and exposure to antineoplastic and antiviral agents, sterilants like ethylene oxide and formaldheyde; physical risk, well-known for ionizing radiations, but important also for non-ionizing radiations; manual lifting (patients in particular) which makes nurses one of the occupations most affected by low back pain; psycho-social risk, with particular reference to stress in emergency departments and everywhere a strong psychological engagement is required. Also the risk of non-health personnel, office areas, food preparation, housekeeping, maintenance, central supplies and laundry was assessed. Health surveillance programs for the exposed and preventive medicine programs according international standards for all workers are presented.