The
Italian industrial medicine was born at the beginning of this century as
a clinical doctrine and focussed particularly on the typical pathologies
concerning work. With the 1988 Financial Law the task to give workers medical
and legal services was assigned to the National Insurance Institute for
Industrial Accidents (INAIL) again. The need to create increasingly satisfactory
work conditions in terms of safety entailed the recognition of the need
of a controlled workplace, biological monitoring and sanitary surveillance.
Such needs gave rise to
the legislative decree 626/94 that includes the outline rule 83/391/EEC
and the rules linked to it. Among the points deserving particular attention
are:
- the application of the
decree's rules to all workplaces, and consequently to every worker;
- the ascertainment of prospective
risks workers may run through the same procedure;
- the integration of individual
skills with corporate issues;
The regulations pertaining
safety and industrial hygiene underscored once again that the preliminary
phase to start proper prevention measures at the workplace consists in
ascertaining risks, thus allowing a safety scheme to be worked out. More
specifically, such phase consists in an analysis of the manufacturing cycle,
of the materials used, of machines' working, of the intermediate and end-products,
as well as of the working management (shifts, personnel turnover) and of
the safety devices or of the measures already been taken to keep dangers
in check.
Sanitary surveillance's
specific task, according to the current provisions, should be assigned
to a medicine graduate specialised in preventive medicine of workers and
in industrial psychology, industrial toxicology or an equivalent specialisation.
According to article 16
of the Legislative Decree 626/94, sanitary surveillance includes preventive
controls (clinical, biological examinations and instrumental surveys) carried
out in order to determine the absence of contraindications to work for
workers, and ultimately to ascertain their health conditions with respect
to the risks they may incur. Article 17 of the same legislative decree
vests physicians with some particular functions:
- carrying out an updated
risk health record for every worker submitted to sanitary surveillance
to be kept by the employer, with the protection of the professional secrecy;
- carrying out medical examinations
asked by the worker (besides those laid down by article 16) in case such
request is linked to professional risks;
- co-operating with the
employer and with the prevention and protection services to develop and
carry out measures to protect the workers' health and psychophysical safety;
- co-operating to the training
and information activities of the workers;
- visiting the workplaces
at least twice a year and participating in planning the controls of the
workers' contact with particular agents, whose results must be communicated
timely in order to take the proper measures;
- co-operating with the
worker to set up a first-aid service;
- informing the workers
about the sanitary controls they underwent and, in case of contact with
agents having long-term effects, about the need to carry out controls even
when they stop doing the work which entailed the contact to such agents;
- informing workers who
want to know about the results of their sanitary controls and, upon request,
giving them a copy of the sanitary documents;
- communicating the representatives
in charge of the safety the anonymous and collective results of the clinical
and instrumental controls which were carried out as well as explaining
their meaning.
The Legislative Decree 626/94
shocked the work environment that had often paid little attention to the
development and the evolution of the regulations – both medical and otherwise
– whose goals were safer workplaces and the protection of the workers'
health. This decree made the previous regulations concerning safety and
prevention adapt to technological advances; furthermore, new professionals
that should carry out such rules have been established. Some measures were
fully approved by industrial physicians, mainly by those who often underscored
the professionalism of physicians, charging them with responsibilities
and operative autonomy in complete compliance with the regulations.
As far as the compulsoriness
of sanitary surveillance is concerned, the Legislative Decree 626/94 refers
to the currents provisions, but it is impossible to overlook the obsolescence
of the Presidential Decree 305/56 in various aspects. In the space of forty
years, in fact, industries, technologies, materials and working itself
have evolved and this should not be ignored by the law.
Such considerations make
it essential to resort to the physician's opinions in case of a potentially
dangerous working situation. It would be a more modern and realistic way
to carry out preventive measures in the citizens' prior interest, the protection
of their health being a right sanctioned by the Court of Cassation.
The Legislative Decree dated
19th September 1994, n. 626, was changed and integrated into the legislative
decree dated 19th March 1996, n. 242, that considerably changed the provisions
pertaining safety.
It is a question of working
with specific tasks as far as safety and health at the workplace are concerned.
Within this context the bodies or individuals mostly involved are:
a) the prevention and protection
from risks service, considered as “a group of people, systems and means
inside or outside the company aimed at preventing and protecting workers
from work-related risks inside the company or production unit” (article
2, section 1, letter c).
b) the workers' representative
in charge of safety laid down by article 2, section 1, letter f;
c) the physician in charge
who carries out a compulsory sanitary surveillance in some sectors where
workers are more likely to find risk factors for their health and safety
as, for instance, when they have to handle manually materials or use equipment
controlled by computer screens emitting carcinogenic substances, biological
or physical agents, chemicals. (Legislative Decree August 15, 1991, n.
277).
Sanitary surveillance: preventive
and periodical controls. Biological monitoring
The words sanitary surveillance
referred to work environments were used for the first time in the mid-seventies.
A NIOSH manual published in 1973 reported two chapters devoted to sanitary
surveillance; subsequently, in 1980, the OSHA published a series of warnings
as for sanitary surveillance at the workplace.
Sanitary surveillance is
made up by controls to be carried out when hiring people (preventive controls)
and subsequently during their working activities (periodical controls).
In the first place they can determine an individual's fitness for the work
he/she is going to do, controlling, among the other things, the functionality
of his/her organs and apparatuses with specific attention to noxious agents'
potential targets. They can give a closely individual reference record
that would make it possible to correctly decide future changes. They can
suggest a specific surveillance for individuals whose situation may theoretically
entail higher risks.
During the periodical controls
it is necessary to evaluate carefully the changes of the record existing
when the preventive control was made. The data pertaining the biological
and environmental monitoring (the concentration levels of pollutants in
the workplace) must be considered too. The biological monitoring
programmed according to the risks related to a “controlled” work consists
in determining the exposure to agents present in the work environment by
measuring certain substances in biological samples taken from the exposed
people according to specific methods. Such substances may be represented
by a chemical, by one of its metabolites, by a reversible biochemical change
triggered by the exposure to noxious agents.
The case of infectious diseases
is in disagreement with these provisions, in particular as far as the restrictions
physicians have to cope with in case of the AIDS virus are concerned, an
issue where opinions and positions are conflicting. On the one hand a person
having pulmonary tuberculosis can be submitted to the necessary clinical
analyses, on the other a person who has AIDS must give his approval to
be tested.
(to be continued)
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