[Restrictions on night work: analysis of case studies in a large Lombardy Hospital]. / Limitazioni al lavoro notturno; analisi della casisitica in un ospedale lombardo di grandi dimensioni.

A high percentage of the division's doctors and employees work at night to guarantee urgent assistance and diagnostic services to patients. Night work is not recommended for persons with rather serious case histories due to the disruption of circadian rhythms or the increased workload required of certain operators during nighttime hours. All of the evaluations of health operators with a limited capacity to work on the night shift in our hospital were analysed, except for female workers restricted from night work during pregnancy or puerperium, as provisioned by the regulation that protects working mothers. Forty-two cases were considered (six physicians and 36 operators in the division) out of a total of 2676 employees assigned to night work and the conditions that led to the formulation of the decision are divided as follows: 16 Mental disturbances currently subject to treatment (depression, post-traumatic anxiety disorder, primary insomnia...), 8 Tumours (breast, colon, Ewing Sarcoma), 7 Neurological disorders (multiple sclerosis, myasthenia), 6 Cardiovascular disease (previous IMA; arrhythmias, arterial hypertension not controlled by theraphy) and 5 others patologies (total 45). The cases will be analysed in detail with an analysis of the characteristics of the exempt group of workers and with reference to the temporary or indefinite nature of the exemption.

[Measles, mumps, rubella and varicella: antibody titration and vaccinations in a large hospital]. / Morbillo, parotite, rosolia e varicella: titolazione anticorpale e vaccinazioni in un ospedale di grandi dimensioni.

The occurrence contagious diseases such as measles, varicella, mumps and rubella in the hospital open creates situations of alarm, due to the potential involvement of workers, but most importantly for the oftentimes harmful consequences for critical patients, such as pregnant women or immunocompromised individuals. In 2007 antibody titration was initiated in our hospital for four infectious diseases, also pursuant to the Lombardy Region Resolution N. VIII/1587 of 22-12-2005 "Decisions regarding vaccinations in children and adults in the Lombardy Region" which indicate the departments in which a priority exists: maternity-neonatal and infectious illnesses. In 2011 a vaccination campaign was launched for unprotected operators in the Health and Medical Management departments: after an interview with the competent physician of reference, the subjects voluntary submitted themselves to vaccination. The protective antibody data encountered over the years are similar to that reported in the literature, with coverage percentages greater than 93% for varicella and rubella, over 89% for measles and over 85% for mumps. Approximately 80% of the operators are protected against all four diseases. However, the dramatic consequences of potential contagion lead us to strongly recommend vaccinations for non-protected subjects. At present 37 operators have been vaccinated with the trivalent MMR vaccine (Measles, Mumps and Rubella) and 14 for Varicella. The antibody response was verified in all cases.

[Focus on risk assessment in health environments: results and perspectives of a multicenter working group]. / Focus sulla valutazione del rischio negli ambienti sanitari: risultati e prospettive di un gruppo di lavoro multicentrico.

The hospital risk assessment (VdR) is certainly a relevant issue concerning the activities of prevention for the health of healthcare workers in relation to biological risk. The aim of this paper is to provide an up-date of the issue, based on the suggestions of recent literature about the rules ratified by the new legislative decree and data supplied by the Group of 10 Hospitals participated in this multicenter study. From the analysis of data on healthcare settings (HCS) participating in the project the following considerations can be formulated: i) All HCS considered VdR from biological agents. The method recommended in the Guidelines SIMLII 2005 is the most followed ii) To grading the risk, the use of invasive procedures for carrying out the analysis results is a necessary element iii) the operators classified as exposed to biological risk, and therefore subject to health surveillance, represent almost all of workforce in 7 out of 10 HCS. The subgroup believes that VdR must be conducted in close collaboration with the occupational physician and should represent a worthwhile investment with spin-off character on prevention, decision making, empowering. The presence of environmental requirements and organizational procedures should be considered, so that HCS is enabled for an effective risk management, without which risk assessments cannot be performed. The method of VdR mentioned in the guidelines MLIS 2005, besides being the most widely used by the company participating in the study, still has practical reasons and opportunities to justify its use. The HCS group felt the need to propose an implementation of the definition of invasive procedures and EPP, together with individual assessment. Flexibility was suggested in identifying different levels of risk with the involvement of occupational physicians, especially in the presence of EPP, also in order to plan content and frequency of health surveillance.

[Focus on health surveillance of health workers exposed to blood-transmissible biological agents: results and perspectives of a multicenter working group]. / Focus sulla sorveglianza sanitaria dei lavoratori della sanità esposti ad agenti biologici trasmissibili per via ematogena: risultati e prospettive di un gruppo di lavoro multicentrico.

The biological risk from exposure to bloodborne pathogens in health care environments represents a frequent and widespread risk, involving a large number of exposed workers. On the basis of the available scientific innovations, the recent legislation regarding health and safety of workers and the experiences of SIMLII guidelines on health surveillance (HS) workers exposed to biological risk, a multicenter study was carried out, involving nine relevant hospitals and about 32 000 healthcare workers (HCW). A review of the literature was performed, with particular reference to the last 10 years. For each hospital, protocols of HS have been examined according to tasks and biological risk from bloodborne viruses (HBV, HDV, HCV, HIV) as well as management of HCW infected with this pathogens. Differences of risk management in the hospitals, in relationship also with recommendations of the literature have been evaluated. The literature supplies important indications for HS management of HCW exposed to bloodborne pathogens, with relevant information also for patient safety. Preventive examinations are in line with the recommendations of literature and similar across the hospitals for HCV and HIV, while they are different for HBV. Periodic surveillance was different for the frequency, among the hospitals and also as compared to national SIMLII guidelines. As for management, no differentiation among the hospitals was detected as referred to different risk of exposure, while differences were observed around definitions of restrictions. Finally, good medical practices to support occupational physicians in the prevention and management of HCWs' exposed to biological risks are suggested.

[Tuberculosis. Focus on risk assessment and health surveillance in health workers: results and perspectives of a multicenter working group]. / La tubercolosi. Focus sulla valutazione del rischio e la sorveglianza sanitaria dei lavoratori della sanità: risultati e prospettive di un gruppo di lavoro multicentrico.

INTRODUCTION: Tuberculosis (TB) is still a threat for healthcare workers (HCW), due to the non decreasing incidence, the spread of drug-resistance, the introduction of new tests for the screening, the relevant costs of surveillance of exposed subjects. These issues implicate a revision of activities to prevent TB in health-care settings. METHODS: A multidisciplinary working group, led by occupational physicians, examined the activities to prevent TB performed in 9 Italian hospitals and reviewed the literature, with the aim to formulate evidence-based procedures. RESULTS: In the considered hospitals, 23.000 HCW are classified as exposed to TB, out of 32.000 HCW exposed to biological risks; yearly, about 6000 subjects are screened for preventive, periodical or post-exposure surveillance and 110-130 chemoprophylaxis are prescribed. A high proportion of HCW (54-75%) refused or interrupt to assume the drugs. In the period 2004-2008, 14 occupational TB were diagnosed (9/100.000 HCW exposed to biological risks). DISCUSSION: Critical issues are the availability of a specific, written TB control plan, including risk assessment, protocols for identifying, evaluating, managing infectious TB patients, health surveillance, education programs, specifically addressed to increase Standard Precaution adoption and compliance to the screening and to adequate risk perception. Risk assessment identify HCW to be included in TB testing (characterized by low positive predictive value), unrecognized TB and environmental control needed; TB risk classification should include no more than 3 or 4 classes and performed by assessing the issues suggested in the Italian guideline. Tubercolin skin test should be used for HCW screening, adding in vitro test in specific circumstances (for example, skin test positivity in BCG vaccinated HCW); the frequency of the screening should not exceed 2 years. Periodical revision of preventive activities should follow up to date scientific literature and need appropriate data computing.

[Exanthemic diseases (measles, chickenpox, rubella and parotitis). Focus on screening and health surveillance of health workers: results and perspectives of a multicenter working group]. / Le malattie esantematiche (Morbillo, Varicella, Rosolia e Parotite). Focus su screening e sorveglianza sanitaria dei lavoratori della sanità: risultati e prospettive di un gruppo di lavoro multicentrico.

BACKGROUND: Nosocomial transmission of varicella-zoster virus, certain paramixovirus and rubivirus might pose a risk of morbidity for varicella (V), rubella (R), mumps (Mu) and measles (Me) in health care workers (HCW), patients and coworkers. International literature and European legislation recommend preventive interventions to minimize the risk. METHODS: A literature review and a seroprevalence study were carried out in 9 hospitals located in north and central Italy, in order to evaluate risk assessment, health surveillance and fitness for work of HCW exposed to V, R, Mu and Me. Antibodies (Ab) against V, R, Mu and Me were determined. For a subgroup of 4 hospitals; sociodemographic, occupational data and sera were collected and analyzed. RESULTS: About 36000 tests on about 9000 HCW were analyzed. Differences in seroprevalence ratios (V 85.7-95.1%, R 47-96.8%, Me 71.4-97.8%, Mu 52.5-87.6%) were detected. In a subgroup, a relevant number of non immune HCW was also found among women infertile age and areas at higher risk. Statistically significant differences were detected only for selected variables and viruses. DISCUSSION AND CONCLUSIONS: Data of multicenter study confirm literature evidences and allow to define good medical practices for manage and minimize the risk of nosocomial transmission of V, R, Me and Mu. Recommendation are issued about serologic screening on HCW exposed to all 4 viruses thorough the modern analytical techniques, in order to assess risk on individual a group basis and to select priorities for intervention. Vaccination should be prescribed for those HCW non immune, selecting areas and HCW according to priorities.

[Focus on coverage and promotion of anti influenza vaccine in health workers: results and perspectives of a multicenter working group]. / Focus so copertura e promozione della vaccinazione antinfluenzale nei lavoratori della sanità: risultati e prospettive di un gruppo di lavoro multicentrico.

INTRODUCTION: The influenza illness is a concern for health care workers (HCW) due to the potential nosocomial transmission and sickness absenteeism. Immunization and Isolation Precautions might be effective preventive measures. AIMS: To formulate recommendations on vaccination in healthcare settings. METHODS: A multidisciplinary working group, led by occupational physicians (OP), examined the information on seasonal influenza immunisation campaign in 9 Italian hospitals in the period 2005-2009 and reviewed scientific evidence. RESULTS: Many health organizations recommend vaccination of HCW. The literature shows that seasonal influenza vaccination of healthy adult have a modest effect in reducing work day lost; there is no evidence that it affects transmission or it prevents the disease in elderly residents. These observations might be conditioned by methodological limitations. Further studies are required to avoid the risk of bias and in pediatric settings. The rate of flu vaccination among HCW is widely variable and it depends on individual risk perception and information about efficacy and side effects. In the considered hospitals, in the five-years period the vaccination rate ranged between 0 and 29%: the median value was 16-17% in 2005, 2008 and 2009 (only against H1N1 influence), 11% and 13% in 2007 and 2006 respectively. OP participation in the vaccination campaign seems to increase the immunization rate. DISCUSSION: Seasonal influenza immunization of HCW might be effective. We recommend to formalize written procedures in health care settings, to perform data computing and to periodically revise immunization activities and promotion and scientific literature, with the aim to appropriately address resources.

[Vaccination and immunization in healthcare workers, towards specific infections: measles, varicella, rubella and mumps. The experience in a hospital in Lombardy]. / Vaccinazioni e immunizzazione nel personale sanitario verso infezioni specifiche: morbillo, varicella, rosolia e parotite. L'esperienza di una Azienda Ospedaliera Lombarda.

Lombardy Region, with the Deliberation NoVIII (22-12-2005), about vaccinations in childrens and adults, suggest to offer to the healthcare workers (HCW) of 'Infectious diseases' and of 'Obstetrics and 'Pediatrics' Department, the vaccines for varicella and measles, mumps and rubella (MMR). We performed in 120 HCW of our hospital the dosage of antibodies versus these infectious diseases, in order to protect both workers and critical patients. The study results show that more than 80% of the HCW was immune to all the four infectious diseases. The percentage of immunisation to measles, varicella and rubella exceeded the 90%, while 87.5% of HCW was immune to mumps. We are going to offer the vaccine to the operators that are not immune, but we are also thinking about offer it to the HCW working with critical patient.

[Job fitness management regarding university school of nursings students: our experience over three years (2005-2007)]. / Giudizio di idoneità al tirocinio pratico per studenti del corso di laurea in infermieristica: casistica triennale (2005-2007) dell'Azienda Ospedaliera Ospedali Riuniti di Bergamo.

Based on definition of worker according to D.Lgs.626/94, art.2, c.1 also the University Students before to start their pratical training in Hospital must be submitted to sanitary surveillance by Occupational Health Physician. Aim of this paper is to report about the Job Fitness Management regarding no. 231 University School of Nursing's Students that in some cases has involved the formulation of limitations and/or prescription.

Contact urticaria from latex in healthcare workers.

BACKGROUND: Latex allergy is an important medical problem for an increasing number of patients. It has been documented as causing immediate hypersensitivity reactions ranging from mild urticaria to life-threatening anaphylaxis after cutaneous, mucosal or visceral exposure. Recent studies in northern Europe and the USA suggest that between 2.8 and 16.9% of healthcare workers are affected by latex hypersensitivity type I reactions. OBJECTIVES: To test the prevalence of contact urticaria from latex gloves in a group of healthcare workers, to examine the factors associated with latex allergy and to evaluate some diagnostic methods used in latex allergy. METHODS: A total of 929 employees of the surgical units who used latex gloves on a regular basis, at least once a day, were invited to participate in this study including administration of a questionnaire, a prick test with a commercial extract of latex, a prick test with latex glove eluate, a use test, RAST and an immunoblotting system; moreover, a prick test with a group of common inhalant allergens and a prick-by-prick test with fresh fruit (banana, kiwi, avocado, chestnut) were employed. RESULTS: Of the 929 staff sent questionnaires, 313 (33.5%) replied; of those who responded, 118 gave a history of hand problems such as itch, erythema, wheals when wearing gloves, dryness and irritation most marked on the backs of the hands. Among these 118 workers, 16 refused skin testing and examination of blood, so 102 subjects were studied for latex allergy; 21/118 (17.8%) healthcare workers were found to be latex allergic. Eighty-one staff members gave a history of hand problems worsened by wearing gloves but were not latex allergic on testing. Those healthcare workers who completed the questionnaire and answered negatively (195/313) were not tested for latex allergy. Prick tests with the commercial solution were positive in 11 of the 21 subjects studied; prick tests with the eluate of glove, RAST and the use test were positive in all workers; 10 of the 21 sera showed positive immunoblot results. Atopy and a preexisting irritant contact eczema of the hands were present in a high percentage of the workers. CONCLUSION: In this study of healthcare personnel, we found that allergic contact urticaria from latex was present in 21 workers of the 313 (6.7%) who responded to the questionnaire and of the 102 (20.5%) who were tested for latex allergy. Atopy and irritant contact eczema of the hands were frequent in these subjects. Skin prick testing with latex glove eluate and the use test seem to be more sensitive than in vitro testing, particularly immunoblotting, and are biologically more relevant; skin testing with glove eluate must be preferred to testing with a commercial extract.

[Repetitive movement of the upper limbs: results of exposure evaluation and clinical investigation in wood sanding in Bergamo]. / Movimenti ripetitivi degli arti superiori: risultati della valutazione dell'esposizione e dell'indagine clinica nella carteggiatura del legno nel bergamasco.

The authors report their findings regarding a risk assessment study and clinical tests carried out among a group of 121 workers whose job was to sandpaper and buff timber products. The results of the risk assessment indicate that the job in question is at significant risk for the development of WMSDs in relation to the principal risk factors (repetitiveness, force, posture, short recovery periods). The clinical tests, undertaken by medical staff, complied with the anamnestic models proposed by EPM. The results showed that 21 workers were above the anamnestic threshold, and were thus referred for specialist examinations. As a result of the latter, the relevant diagnoses were made. A positive correlation was reported between the occupational exposure level and the clinical abnormalities detected.