Hepatitis C virus outbreak in a haemodialysis unit: learning from failures.

The investigation of an outbreak of hepatitis C virus in an Italian haemodialysis (HD) centre showed that three patients acquired infection with the same strain, affecting a chronically hepatitis C virus (HCV)-infected patient receiving HD in the same room and during the same shifts. Through our observational analysis many possible modes of transmission were identified, but none could be definitively identified as the route of HCV spread in this small cluster. This outbreak confirms that repeated opportunities for nosocomial HCV transmission may occur among HD patients due to several breaches in the standard precautions for bloodborne infections by healthcare staff.

[Employment of psychiatrically disabled people. The Lavoro LiberaMente project]. / L'inserimento lavorativo dei disabili psichici. Il progetto Lavoro LiberaMente.

BACKGROUND: The complexity of giving psychiatrically disabled persons access to work is well known. The percentage of persons thus defined who are on the provincial unemployment lists is constantly increasing. OBJECTIVES: The 'Lavoro Liberamente" ('I work freely') project is aimed not only at enabling a number of psychiatric patients to gain access to work but to do so by experimenting with a network methodology that includes the various agencies that can contribute to a successful outcome. METHOD: The project was developed in various stages--psychiatric services and company awareness campaigns and task-definition, candidate selection, skills assessment, and work placement--all aimed at finding and maintaining employment. RESULTS: After a thorough preparatory phase, 19 psychiatrically disabled persons were placed in 14 companies. When the apprenticeship was concluded, 13 of them were hired. CONCLUSIONS: Considering the short time-frame--about one year between candidates being selected and finally recruited--the ratio between the number of disabled people recruited and those placed was satisfactory. This result should be interpreted positively because, even taking into account some of the most sensitive issues that surfaced and were analysed, it shows that access of the psychiatrically disadvantaged to work is possible if all involved people work synergistically, each according to their responsibilities and knowledge, and on condition that a recognised management of each individual project exists. Within such a network synergism, it is even possible to identify some tasks that are the responsibility of the Occupational Health Physician, therefore further contributing to the overall success of placements.