Risks of manual movement of patients.

The paper is a survey about Italian new rules and critical issues relative to health care manual material handling risk management. The Legislative Decree 81/2008 introduced the definition of "pathologies due to biomechanical overload". This definition is more consistent and broad than the previous one that was mainly related to spine pathologies. Furthermore the new Decree addresses the importance of a dedicated staff to train workers in lifting and moving patients. This training is now mandatory. Regarding to risk assessment, the new rule suggests to use, as a main tool, the ISO standard 11228. The different risk assessment approaches are discussed according to the Italian Society of Occupational Medicine and Industrial Hygiene Guidelines. Medical surveillance, based on the bio psychosocial model, has to be measured in terms of efficacy and should targeted not only to lumbar spine but also to shoulder and other musculoskeletal localizations. It is important to note that even if patients do not fully recover from sickness the return to work has to be encouraged assigning them tasks tailored to the residual capacities. Finally the authors discuss the relative efficacy of the different preventive interventions (information and training, aids and physical exercise) suggesting that a multifactorial approach is the only strategy to pursue to get positive results.