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This new paper on chemical risk from anaesthetic agents in operating theatres is the natural progression of that published in this journal in supplement 1-2013, as it constitutes a development and complement of the previous work and an applicative confirmation from the highest organ of administrative justice, the Consiglio di Stato, regarding, in particular, the obligation of adopting the technically most advanced "measures" to eliminate or, at least, minimise risk in the use of new generation and the most commonly-used anaesthetic agents (sevoflurane and desflurane). Therefore, in this paper, the authors commence by referring to the starting point, consisting in the conclusions of the previous study, which highlighted the extraordinary convergence of technical and scientific, legislative and case law data on the same result, constituted by the possibility, and consequent obligation, of implementing, also in operating theatres, the greatest technologically possible safety, starting with the choice of the most suitable equipment, methods and quality systems for avoiding the diffusion, dispersion and /or leakage of volatile hazardous agents that may contribute - together with those chemical reactions that are foreseeable and avoidable, given the characteristics of the materials, substances and relative "packaging" - to workplace pollution, which can, in any case, reach levels that are hazardous due to the concentration of anaesthetic gases. Subsequently, once the "scientific" fruit of the previous contributions has been discussed, the authors evaluate the impact of the result already achieved in practice with concrete cases and the judgement expressed with a series of judgements issued in rapid succession by the Consiglio di Stato, showing the application, not merely of the legislative "data" but also of the references and citations that these "data" contain regarding the "knowledge acquired regarding the relationship with technical progress". Lastly, the Authors provide, as a further, definitive conclusion, the singular unit of the guidelines provided by case law, the result of a univocal and continuous multitude of judgements issued at the highest degree of administrative justice, albeit for very diverse situations and circumstances, which provide, therefore, a direction and an operative guide for which they are called on to adopt roles and responsibilities for the choices of "products", "systems" and "methods" destined to affect - for the use of anaesthetic agents - the health and safety of healthcare staff and of patients themselves.

Unlabelled: «Muskuloskeletal pain and perceived stress in civil servants»., Background: Musculoskeletal pain is the most important symptom reported in many occupations causing disability and long-term sick absence. Epidemiological research has linked this symptom to physical activities in the workplace but also to psychosocial factors, than can increase pain perception., Objectives: To evaluate pain perception, psychosocial factors and stress in 413 workers in hospitals compared to 294 white collar workers at University of Trieste., Methods: The study population included workers who underwent periodical health surveillance from 20th of January, 2011 to 20th of June 2012. Psychosocial factors were evaluated using the Siegrist Effort Reward Imbalance Questionnaire, and depression and anxiety by means of the Goldberg General Health Questionnaire (GHQ). Pain perception in different body sites was reported on a visual numeric scale 0-10. The relation between pain perception in different body sites, individual characteristics, work tasks and psychosocial/psychological factors was assessed by means of multivariable logistic regression analysis., Results: The study population was characterized by low Effort and good Reward. In the multivariate linear regression pain perception was significantly related to age, to female sex in neck (OR=1.63; CI95% 1.13-2.34) and shoulder (OR=2.18; CI95% 1.49-3.2) pain and to Effort in all sites while occupational exposure as health care workers was significantly associated to higher pain in upper limbs (OR=1.76; CI95% 1.11-2.8) and low back (OR=1.73; CI95% 1.21-2.49)., Conclusions: Our study demonstrated that psychosocial factors can have an important role in pain perception in all body sites suggesting the need to consider these factors together with physical exposures in workplaces.

The present molecular epidemiology study was carried out to evaluate the genotoxic effects of occupational exposure to antineoplastic drugs (ANP). The study was conducted in 52 hospital workers involved in the preparation, handling or administration of ANP in a hospital in Perugia (central Italy) and in 52 non-exposed control subjects matched for age, gender and smoking habits to the exposed subjects. Both comet assay and the micronucleus test were used to evaluate genome damage in peripheral blood lymphocytes in study subjects. The extent of primary DNA damage, as evaluated by the comet assay, was significantly increased in exposed personnel with respect to matched controls. On the other hand, no significant differences in micronuclei frequency was observed between the two groups. Multivariate linear regression analysis showed an association between years of occupational exposure over 10 years and higher extent of primary DNA damage in the exposed group. The results of this study confirm that handling ANP without appropriate precautions carries a genotoxic risk for exposed healthcare workers. These results address the need for regular biological effect monitoring of staff occupationally-exposed to ANP.

The present study analyses how continuity of care is perceived by health professionals and GRACER (Gravi Cerebrolesioni Acquisite Emilia Romagna) patients' caregivers, in order to investigate where the gap between expectations and reality is more heavily felt and which dimension of the continuity of care is the most important both for health professionals and GRACER patients' caregivers. The study has been developed following the Gap Analysis theoretical model. A questionnaire, based on ServQual model, was used to collect data about the three dimensions of the construct of continuity of care related to information, management and relation, declined along the lines of expectations and perception of reality. The questionnaire was administered to health professionals and caregivers of GRACER patients (12-36 months after the event) inside 4 healthcare institutes in Emilia Romagna. The PAI (Piano Assistenziale Individuale) approach was the methodology applied in these 4 sites. To both groups the relational continuity was the most important dimension, followed at a long distance by the informational and the management ones. It has also been noted that to professionals reality is always worse than expectations, with the exception of only two items in the dimension of management continuity. To caregivers reality is worse than expectations in some items in the dimensions of information and management The study has shown that the relational dimension of continuity of care should be more investigated, as confirmed by literature. More research is needed about the professionals' dissatisfaction generated by the negative balance between expectations and perception of reality.

Many health professionals show their concerns about the "professional misconduct"committed by their colleagues. Such concerns are sometimes referred to colleagues or superiors, but they are rarely communicated directly to the persons concerned. Starting from these assumptions we wanted to investigate whether in the setting of italian intensive care unit, you have the same perception. A phenomenological study was performed, aiming at collecting the experiences of health care professionals about the professional mistake question. As a means of detection we used a semi-structured, audio-recorded and transcribed in full interview. The analysis was done using the Giorgi method. Six units of meaning have been identified, expression of the most important and recurring experiences. They are: the climate / alliance and sense of belonging, the meaning of mistake: tolerable and not tolerable, the incident, the emotions / feelings; the mistakes / reasons; communication. The research highlights that the "culture of silence" is not widespread so when a mistake occurs the professional is usually faced by a colleague However, there are two exceptions:when the mistake is not serious, or when the professional to be faced is higher in the hierarchy. Those who committed a mistake, usually don't admit it because they don't want to damage their "image" or because they are afraid of the consequences.

Introduction: In Italy, the effectiveness of public health services must be assessed trhoug the assessment of efficency of employees., Objective: To acquire from this activity useful information to assess and promote the well being at work., Methods: During the assessment activities, a questionnaire was administered to assess the efficency of the management in manage perceived critical organizational aspects., Results: The 44-58% consider not sufficient the management efficency in manage perceived critical organizational aspects, exspecially for quality of services, communication, vocational training and risks for worker's health and safety., Conclusions: The study provide useful suggestions to better assess and manage the risk of work-related stress and exploit the key consultant role of occupational physician in the organizational context.

Environmental and biological monitoring performed in health care settings during a 14-year period allowed numerous data to be obtained by using the HPLC coupled with tandem mass spectrometry (HPLC-MS/MS). Data was stored in a specific data-base for the assessment of risk exposure to antineoplastic agents (CA). The strategy of analysis was based on the simultaneous determination of different active substances with a lower limit of quantification (LOQ) optimized in the range of sub-units of microg/L. In the present study, the MRM-ESI-MS/MS profiles of seven antineoplastic agents in both environmental and biological matrices are reported. These methods validated according to FDA guidelines allowed our lab to define a profile of antineoplastic agents that was representative of the four IARC classes, such as cyclophosphamide (group 1), cisplatin and doxorubicin (group 2A), daunorubicin (group 2B), 5-fluorouracil, ifosfamide (group 3), taxol, and gemcitabine (group 4). Moreover, contamination levels on a number of work surfaces and trends over a 14-year period are presented. The evaluation of occupational exposure to CA has been based on ALARA principle for most of the past decades but this principle is nowadays overwhelmed by the fast development of technology. The assessment of a possible in-take of CA in hospital personnel, when the sources of environmental contamination are identified, has become possible by the defining of a limit of exposure close to the limit of detection of the analytical method.

The study analyzes the prevalence of thyroid disease in 1960 healthcare workers, classified as occupationally exposed to ionizing radiation, who have worked at the University Hospital of Pisa. They underwent a medical surveillance protocol from January 2005 until Mars 2012 at the Operative Unit of Occupational Medicine. A positive history of thyroid disease was found in 221 persons, but only 110 (the 5.61% of the population) developed the disease during or after the occupational exposure. Benign thyroid diseases, found in 93 workers, were in order of frequency: Hashimoto's thyroiditis, nodular disease, Basedow's disease, multinodular goiter, subacute thyroiditis and hypothyroidism. Malignant thyroid diseases were found in 17 workers (the 0.87% of the total population), 15 workers suffered from the papillary histotype and 2 from the medullary histotype.

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.

In this study exposure to anesthetic gases in health care workers of a hospital of Milan was investigated. The evaluation focused on the period 2007-2010 and was performed by environmental monitoring (20 operating rooms and 54 samples) and biological monitoring (180 workers and 242 urine samples). Mean airborne exposure was 3:15 and 0.34 ppm for nitrogen protoxide (N2O) and sevorane; in end-of-exposure urine samples the concentration of N2O and hexafluoroisopropanol, metabolite of sevorane, were 4.85 mg/L and 0.21 mg/L, with 80 and 21% of values below the quantification limit. Sevorane monitoring exceeded or equaled the environmental limit value of 0.5 ppm and the biological exposure index in 17 and 11% of measures. There were no observed exceedances of the limit for N2O. The anesthetist and scrub nurse were tasks with greater exposure. There was a significant correlation between airborne halogenated gases and urinary hexafluoroisopropanol. The results of this study indicates that further efforts are needed to improve the hygienic conditions in the investigated hospital.

In the health sector, the theme of work-related stress is a major issue, representing a significant risk factor on health-care providers which can also affect the quality of health services provided. It is therefore important to adopt a multidimensional evaluation system of work-related stress in order to integrate the results of the analysis of objective and subjective stress indicators. The adoption of a multidimensional validated tool as the one proposed by Inail, allows an integrated analysis of sentinel indicators, objective factors of context and content jointly to direct analysis of the subjective perception of workers through the analysis of the Management Standards developed by Health and Safety Executive. The comparison between three Healthcare Districts, three Mental Health Centers and Administrative Offices of an Healthcare Organization (652 workers involved) revealed the most critical areas which need urgent improvement intervention.

Shift and night work are necessary in hospital work organization. They may have adverse effects on workers' health, due to disruption of biological rhythms, mainly as concerns sleep, digestive, fertility, psychoneurotic, metabolic, and cardiovascular disorders, besides being a probable (according to IARC) risk factor for cancer (breast in particular). Hence, the primary intervention deals with a proper organization of shift schedules according to ergonomic criteria, able to avoid or limit the circadian disruption and related consequences as much as possible. In addition, useful countermeasures should be adopted, dealing with reduction of night work, increase of rest pauses and rest days, improved social services, and temporary transfer to day work, as well as a careful medical surveillance, aimed at detecting early signs of intolerance and at counseling for improving self-care strategies for a better coping.

The performed study assesses the exposure to biological liquids among health operators of Hospitals belonging to the ASL Salerno/1 in the period 2006/2008. In the following case all work injuries announced in the mentioned period were considered. Overall, 633 injuries have been analysed. Of these, 323 had significant biological risk. Collected data highlighted that professional categories mostly affected are hospital nurses and doctors, and that most injuries happened during injecting therapy and also that the most frequent injury has been caused by the noodle injection.

Musculoskeletal disorders (MSDs) are common among hospital workers. This cross-sectional study on 1744 hospital workers showed strong interaction between temperature complaints (OR 2.73), other environmental complaints (OR 3.12) and upper limbs disorders. A significant interaction between temperature and strain for upper limbs disorders (F = 9.52, p = 0.023) was also found. Environmental and psychosocial factors can interact increasing significantly the risk of MSDs.

Some studies reported high levels of severe burnout syndrome in emergency workers. We compared different categories of health care workers (129 of Medicine Department e 47 of Laboratory analysis Department) and emergency workers (42 of 118 and 37 of Emergency Department) Subjects were administered the Organizational Checkup System (OCS) to evaluate subjects' risk of burnout and their perception of their own work role and of their organizational environment The operators of 118 showed a condition of wellbeing and a less tendency to burnout. This Finding was accompanied to a better perception of their own work role and of their organizational environment.

An analysis of occupational radiation exposure from 1988-2008 of 43 medical, 41 nurses and 4 nuclear medicine technicians of interventional cardiology, nuclear medicine, radiology-neuroradiology, urology and orthopedics has been performed. The mean annual effective dose to the whole body of all monitored workers are decreasing; one vascular surgeon, has exceeded 20 mSv/year. The doses received by physicians in the hands were up in radiology, urology and cardiology. Currently, interventional cardiology-hemodynamic is the most department-average exposure. Nurses are overall less exposed, the great exposure is in nuclear medicine, where the technicians are included.

This survey was aimed at showing the relationship between some working organizational indicators--work-related stress "sentinel events" such as sick leaves and work accident--and some sociodemographic (gender, age) and organizational (homogeneous tasks, departmental areas) parameters. In the decade 2001-2010 a progressive decrease of the absenteeism and work accident rates was evidenced. The absenteeism rate was inversely related to job-qualification and it was higher among female workers. The highest requests of medical visits by auxiliary personnel showed a lower adaptation to job content, looked upon as low-rewarding in this homogeneous task.

Shift and night work are one of the most important risk factors for health and well-being of hospital workers, in relation to interference at biological (perturbation of the sleep/wake cycle and circadian rhythms), occupational (impaired performance, errors, accidents), health (digestive, neuropsychological, cardiovascular disorders and, probably, cancer) and social (work/family conflicts) level. Such negative effects show a high interindividual variability due to several interacting factors, dealing with individual (age, gender, personality, life styles), living (marital status, children, social activities, commuting), and working (physical and mental workload, human relations, motivation, work hours and schedules) conditions. This report deals with a short review of some recent surveys carried out in Italian hospital shift workers, concerning main discomforts and troubles, psycho-physical conditions, work ability, work satisfaction, work/family conflict, and organization of shift schedules according to ergonomic criteria.

Aim: The aim of the study is to explore the nature and causes of aggressions and to identify possible solutions to support HCWs., Method: An open and closed questions questionnaire was distributed to the 5337 HCWs (nurses, doctors, nurses aids, technicians) of a large Italian hospital., Results: Only 467 useful questionnaires were returned (8.6%); 37.2% of respondents experienced one or more aggressions, mostly verbal (59.2%) and physical and verbal (16.7%). Nurses and doctors were more exposed to aggressions and the main aggressors were patients and their relatives. Younger people are at higher risk. Half of the victims report consequences on private and working life., Conclusions: As recommended by the Health Ministry, preventive measures should be adopted and the HCWs' ability to deal with conflicts should be reinforced.

Healthcare-associated infections are a critical challenge for the public health sector. Most are acquired through contact, predominantly with the hands of health care personnel. Hand hygiene, therefore, is the single most effective measure for preventing and controlling infectious diseases. Recently, cases of acute hepatitis C occurred in patients who had undergone contrast-enhanced computed tomography. This was probably related to inadequate handling by health care staff. Rigorous compliance with standard precautions is therefore compulsory even in radiology, a setting traditionally considered at low risk for the transmission of pathogens. Adherence to standard precautions is still poor and the persistence of inappropriate practices responsible for preventable incidents is very common in radiology, often owing to underestimation of risk. Radiology units must promote compliance with correct hand hygiene through appropriate education programmes and provision of adequate areas and hand hygiene products. The evidence base to support the use of alcohol-based hand rub is demonstrating that these formulations are effective in improving hand hygiene compliance and preventing infections.

Background: Hospital work consists of the care and assistance of patients, who therefore constitute another group of individuals besides the workers, which is a completely different situation compared to other workplaces in manufacturing industries., Objectives: Health professionals must know how to use the right devices to protect both the patients and themselves. In the case of protection of the hands, health professionals must also know when to use gloves as "individual protection gloves" and when to use gloves as "medical devices", and comply with both Italian and European Community regulations., Methods and Results: The Hospital of Vimercate (Milan) has drawn up technicalprocedures regarding the various types of gloves used in hospitals, which provide health care workers with accurate information on regulations and protocols, prevention guidelines, safety management recommendations, purchasing specifications, quality controls, correct uses of gloves and devices.

Background: There are few studies in the Italian literature on musculoskeletal disorders (MSD) among health care workers (HCW) keeping and holding awkward postures during their job., Objectives: The aims of this study were to determine the prevalence of low-back, neck and upper limb complaints and the association between risk factors and MSD in HCW working in 15 wards of the Hospital of Cuneo., Methods: A questionnaire was submitted to 113 HCW. Information about demographic and occupational factors, and MSD characteristics were collected to be statistically elaborated., Results: The prevalence of complaints regarding at least one of the 3 body regions was 71% in the whole sample (80 subjects). Low back, neck and upper limb were interested, respectively, in 58.4%, 50.4% and 25.7% of the cases. Logistic regression showed a significant association of MSD with score > 7 on the Borg scale (OR = 9.70; CI: 2.01-46.9; p < 0.01), positive musculoskeletal clinical history (OR = 3.67; CI: 1.24-10.88; p < 0.05), and visual defects (OR = 2.88; CI: 1.07-7.81; p < 0.05). Based on the answers from the questionnaire, the onset of MSD was attributed in 41 cases to organizational problems, and in 14 cases to the ergonomic characteristics of the job., Conclusions: The index of prevalence of MSD associated to work-related awkward postures (71%) is very high, greater than that observed among HCW exposed to manual lifting of weights (21%) in the hospital. Thereafter, assessment of exposure and containment of such occupational risk must be considered useful.

Among the many workplaces where there is a chemical risk, hospitals are surely one of the most complex when it comes to risk assessment. Numerous highly toxic substances are routinely used; clinical decisions often mean health workers come into contact with latest-generation drugs whose secondary effects are not yet fully known; they may have to execute procedures using different chemicals at the same time, as often happens in therapy or surgery. We studied two provincial hospitals in order to make a preliminary risk assessment, using an algorithm model. The chemical risk in the environments analyzed was mainly moderate, though some specific settings call for closer attention. Certain at-risk conditions can be solved by simple procedural changes, but others need to be tackled with a view to residual risk management. Some critical points came to light, linked to the algorithm employed, which need further examination to fit the model better to this particular context.

Within a stepwise approach to remove natural rubber latex products from the hospital of Cuneo, latex gloves for examination were completely replaced by nitrile powder free gloves. About a month after their introduction in the whole facility, 31 health care workers (HCW) presented with symptoms of dermatitis characterized by erythema, itching, dryness and chapping on the dorsum of the hands. The symptoms typically appeared 1-3 days after the first nitrile gloves employment, 1-3 hours after they were put on. On the basis of both a detailed clinical examination and specific laboratory tests a diagnosis of irritant contact dermatitis was confirmed in all symptomatic HCW. Samples of nitrile gloves were submitted for analysis by a university toxicological laboratory. Evident traces of a powder containing calcium carbonate were found inside of the gloves. Therefore the declaration of the firm that the product was absolutely powder free must be considered wrong. We suppose that frequent and prolonged contacts between the alcaline pH of the powder found in the gloves and the acid pH of the skin of the hands - together with other individual and environmental factors - could have determined the onset of the symptoms in the HCW. In spite of this adverse reaction, a significant reduction (-68%) of the incidence of latex sensitization and latex-related symptoms was observed in 2006 compared to 2005. We conclude that the complete removal of latex gloves from the workplace is a favourable preventive measure and that switching to nitrile powder free devices is a safe and cost-effective alternative to the latex gloves. However, it is always advisable to demand to the producer a formal declaration of compliance to the security standards of the medical devices.

A descriptive exploratory survey was used to investigate the occurrence of physical workplace violence among health care workers as well as the complaints and responses to such violence. The questionnaire was used for collecting data from a sample of 355 workers. Results showed that 25.6% of hospital workers reported physical aggression at any time of the working life, 8.5% in the last year. Injured workers showed significantly higher environmental complaint score than other workers. The results of the study indicated the importance of adopting hospital policies for dealing with incidents of violence.

In this contribution, a revision of ionizing radiations exposed workers' dosimetric data in four hospital structures is showed, and, consequently, recommended optimization measures are identified.

Objectives: To summarize the evidence on the Tuberculin Skin Test (TST) survey among healthcare workers (HCWs) in hospital, in the last decade., Methods: A systematic search was conducted in PubMed and in the Proceedings of the congresses of the Italian Society of Occupational Health and Industrial Hygiene (SIMLII); researches conducted in areas with medium-high incidence of Tuberculosis were excluded., Findings: 25 publications were identified. The compliance of HCWs to TST surveys ranged from 80 to 100%, the incidence of TST-conversion from 0.07 to 3.7% and the prevalence of positive TST from 5,7 to 57%. TST-conversion and positive TST were significantly associated to BCG vaccination and foreign-born. Most studies found an association between TST-conversion and occupational exposure in certain location (emergency facilities, internal medicine, infectious diseases, intensive care units, pathology, microbiology) and occupational categories (nurses, laboratory technicians). In some studies, period of hospital employment do not increased TST conversion rate., Discussion: Positive TST and TST conversion rate seem to be associated with occupational exposure to Mycobacterium Tuberculosis in hospital, considering non-occupational factors. Evidence from literature seemed to support the use of TST in the tuberculosis screening programme of HCWs in hospital.

Latex allergy may be manifested in a variety of clinical disturbances such as contact urticaria, angioedema, rhinoconjunctivitis, asthma, and anaphylactic reactions. The aim of this follow-up study was to determine whether a change in glove use from powdered to powder-free latex gloves at previously surveyed hospital workers reduced the work-related symptoms. 53 hospital workers with work-related symptoms where followed up 4,6 years after first investigation. On re-examination, 54.7% use both powdered and powder-free gloves, 37.7% used only latex free gloves and 7.6% stopped the glove use. At follow-up, in 68% of subjects there was the remission or the improvement of work-related symptoms. The improvement of symptoms was greater in workers using powder-free gloves than in others (p < 0.005). In conclusion our study shows that preventive measures, such as the use a powder-free latex gloves, are sufficient to induce a reduction of work-related symptoms.

Using the Hospital computerized database, individual variables including referral source, gender; age, life style, work sector, clinical and work history, final clinical diagnosis and work-relatedness evaluation were retrieved and analysed. The results of this survey showed a significant increase of number of cases, especially from 1999 to 2006. Shoulder disorders showed a significant increase in the latest years of the observation period, while the other upper limb districts remained constant. The work sectors mostly affected were textile, construction, metalmechanical and food industry. The findings of this study indicates an increasing demand for clinical assessment of work-related musculoskeletal disorders of the upper limb. Therefore, it is important that a standardized diagnostic procedure is applied together with an accurate evaluation of biomechanical overload.

Health care workers are exposed to a wide range of musculo-skeletal hazards: manual loading (nurses, ancillary personnel, blue-collars), body posture (technicians, physicians, nurses, blue-collars), repetitive motions (clerks, blue-collars, technicians). An integrated management approach to tackle musculoskeletal disorders (MSDs) was proposed in three health care organizations. An action programme, including participatory modification of tasks and jobs, and early identification and treatment of MSDs cases has been implemented, following a proper assessment of the hazards and risks. Participatory ergonomics programs proved to be effective in reducing absence rate and prevalence of workers with reduced work capacity, and in increasing workers' job satisfaction.

This study is a retrospective inquiry, based on the data of University Hospital "L. Sacco" in the period of five years 2002-2006. They were analyzed the relevant data to beyond 350 events cause of working inability.

In 2006 an extensive survey took place in all hospitals of Lombardia, to assess, through inspections, the safety conditions and the efficiency of the organisations invested to assure that. During these inspections were evaluated 6 safety sections and hospital organization and efficiency, by means of a questionnaire. The aim was to assess the internal consistency of questionnaire sections, the presence of differences of such scores among public, private non-profit and profit hospitals and the correlations among safety scores and among these latter and efficiency indexes. Significant differences for size factors and efficiency indexes have been pointed out among different types of hospitals. Instead, safety scores showed good internal consistency and have been resulted statistically significant correlated in most cases. For all types of hospital have been observed high values for safety scores, with exception of occupational health service, better organized in public hospitals, and of safety conditions of worker from external agencies, which have been displayed low. This last consideration stick out the need to pay more attention to safety conditions of these workers.

This study describe accidents occurred in the period between 1999 and 2006 in the Hospital of Cremona, in which about 2400 subjects operate. The analysis of Accident Register showed a reduction of about 30% of the total number of accidents during the examined period and a non homogeneous distribution of the various types of accidents. The most frequent accidents were prick (25.8%), trauma (22.9%) and "in itinere" accidents (7.8%). One type of accident has been little considered up to now: the aggressions. Professional nurses were the most frequently involved and the most affected units were those that belong to the Internal Medicine Department. "In itinere" accidents had the longest average prognosis (11.6 days). The repetition of accidents occurred to the same operator hasn't been analysed before now: a professional nurse had nine accidents (of various type) in the seven years considered. Probably the reduction of accident must be attributed to the effectiveness of the prevention activities undertaken during the reviewed period. Biological accidents, for which it was possible to implement prevention programs, have been markedly reduced; it was not the same for "In Itinere" accidents, that depend significantly on external factors that are not easily dismissed.

Background: Due to the resurgence of tuberculosis (Tb), health care workers (HCW) are considered at increased risk for Latent Tuberculosis Infection (LTI). According to the national guidelines health care facilities are required both to perform tuberculin skin tests (TsT) on all employees with potential occupational exposure to Tb and to analyze the results obtained. However, only a limited number of studies can be found in the literature reporting data of Tb prevalence in Italian hospitals., Objectives: The aim of this study was to determine the prevalence of and the relative risks for positive TsT among employees of the Hospital of Cuneo., Methods: After informed consent, a questionnaire and a TsT according to the Mantoux technique were administered to the 2368 employees of the hospital exposed to occupational risk for Tb. The variables considered for the univariate and multivariate analysis included several anthropometric, occupational and clinical factors, Results: 274 of the 2210 employees who completed the screening programme had positive TsT (12.4%). Only one subject had been treated for active Tb. Factors significantly associated with a positive TsT were duration of employment (odds ratio [OR]:4.90, CI: 2.25-10.66, for length of employment 10-17 years; and OR: 8.77, CI: 3.53-21.81, for length >17 years; p < 0.001); working in a Tb high-risk occupational setting (OR 4.26, CI: 1.90-9.57for level of "limited" risk and OR: 5.68, CI: 2.47-13.07 for level of "medium" risk; p < 0.001); belonging to nurse or assistant nurse job categories (OR: 2.80, CI: 1.09-7.19; p < 0.05); history of active or latent Tb infection (OR: 11.54, CI: 5.54-24.06; p < 0.001); birth in a foreign country (OR: 4.40, CI: 1.30-14.85; p = 0.01); and BCG immunization (OR: 2.51, CI: 1.68-3.75; p < 0.001). Seventeen subjects had a positive reaction after a two-step test (0.8%). Boosting occurred among elderly employees (mean age: 48, 3 +/- 8.0 yrs), with long duration of employment (22, 2 +/- 10.5 yrs), vaccinated with BCG (17/17)., Conclusions: Our data suggest that a baseline survey based on TsT is useful to assess the prevalence of and risk factors for TLI in a health care setting. The high rate of participation in the survey (93.3%) was probably due to the training and awareness efforts aimed specifically at exposed HCW.

Purpose: The aim of our study was to assess the smoking habits in health care workers., Materials and Methods: In concomitance with a medical examination for Health Care Surveillance requested by the Italian Laws (D. Lgs. 626/94), our operative units interviewed 2,000 persons (47.9% males, 52.1% females, mean age = 45 yrs (SD+/-9.41 yrs) working in two General Hospitals of Eastern Sicily., Results: The prevalence of smokers was found to be higher in men (34.5%) than in women (33.6%), in Health Care Operators (36.4%) and professional nurses (36.2%) than in medical doctors (27.7%), in night-time workers (34,5%) then in day-time-workers (28,7%). The compliance with smoking restriction was found to be poor; in fact, 60% out of smokers declared to smoke during the working hours., Conclusions: This investigation has revealed the significant prevalence of tobacco smoking among the health care workers in general. We think that the inclusion of an anonymous questionnaire on smoking habits within the Services of Sanitary Surveillance may help in the national campaign against cigarette smoking.

Background: Over the last years several mathematical methods have been proposed by The Italian Society for Occupational Health and Industrial Hygiene (SIMLII) with the aim of assessing exposure to occupational risks. The current way of assessing biological risk is based on the widely used but poorly accurate formula R = P x D. Use of more complex methods of assessment of exposure involves many problems due to: complexity and poor standardisation of micro-organisms concentration, ubiquitary diffusion of biological agents in the working environment, lack of dose-response curves, uncertainty about the existence of an effective infection threshold for many micro-organisms, etc., Objectives: In order to assess occupational exposure to biological risk in health care settings an index method was developed according to the Guidelines for health surveillance of health care workers drawn up by SIMLII., Methods: A check-list containing the features of the two main modes of transmission of infectious diseases (blood-borne and air-borne) was applied to the wards of Cuneo Hospital. The selected variables were combined, according to the different transmission modalities, into two mathematical models producing, for each of them, a numeric value of the degree of the risk., Results and Conclusions: The cut-off values chosen to separate both the final degrees of exposure by blood-borne (mild, medium and high) or by air-borne transmission (very low, very limited, limited, medium) were statistically different (P < 0.001). The most important determinants of the differences found in the comparison between different exposure levels were: frequency of work manoeuvres at high risk of exposure and/or frequency of performance, building deficiencies, extent of application of the work and behaviour procedures, degree of training, number of occupational injuries, the occupation of physician, and, for the nursing category, duty in a medical ward. This index method seems to assure better results, both in terms of efficacy and appropriateness, compared to the methods previously used to assess biological exposure. The results justify the need for further investigation.

Objective: To estimate the occupational exposure of hospital personnel handling antineoplastics drugs using a highly sensitive and specific analitycal method in biological and environmental samples., Design: To develop analitycal methods for the biological and environmental monitoring of more than one substance., Setting: Five departments of the Policlinico Sant'Orsola-Malpighi (Bologna, Italy) involved in the preparation and administration of antineoplastic drugs., Participants: 50 nurses handling antineoplastics drugs., Main Outcome Measures: Evaluation of the occupational exposure of hospital personnel handling and administering anticancer drug cocktails., Results: 19 of 50 subjects were positive to biological monitoring. Three were positive for MTX only, 11 for CP only and 5 subjects were positive for both. Urinary MTX levels ranged from 0.3 to 2.0 ppb, CP ranged fom 0.06 to 10.0 ppb. Wipe tests showed a higher contamination on the hoods working tray (where drugs are prepared), suggesting that the organization layout can affect the surface contamination level. Samples from each department resulted positive for at least one of three drugs., Conclusions: The analytical methods developed allow sensitive and specific determination of indicators of internal and external dose. Biological monitoring is of primary importance for assessing the real espoxure of hospital personnel during the preparation and administration of the drugs. Environmental monitoring stresses the importance to observe the Guidelines for standard operating procedures and the importance of protective disposables to reduce exposure and the associated health risk.

This study evaluated the prevalence and determinants of low back pain (LBP) in Terni hospital workers. Each ward sister completed a questionnaire about potential determinants of LBP associated with physical loads. Moreover, a trained ward sister administered a questionnaire about the characteristics of low back pain to 512 subjects. In the previous year the prevalence of LBP was 58.8%. It was more common in subjects under 45 years of age. >3 LBP episodes annually were more frequent in operating rooms and medical wards. LBP lasted >1 week in 29% of females and in 23% of males. LBP caused change of duties or time off work in 11% of females and in 8% of males.

The Work Ability Index was used as a complementary tool for the periodical health surveillance of health care workers in order to evaluate their functional working capacity and to plan more appropriate preventive and compensatory measures. 867 health care workers of both sexes (337 men, 530 women), aged between 23 to 65 years and with a work experience from 0.5 to 48 years were examined. They were physicians, registered and assistant nurses, biologists, technicians and clerks, working in hospital departments, ambulatory health care services, laboratories and offices. WAI proved to be "excellent" in 27.0%, "good" in 49.7%, "moderate" in 20.1% and "poor" in 3.2%. Women showed significantly lower mean WAI than men in all age groups, particularly among registered and assistant nurses. Women shift workers showed a more pronounced decrease of WAI over the years as compared to their colleagues day workers by increasing the number of illnesses suffered, WAI similarly decreased in all age groups, but less among physicians and clerks.

Introduction and Objectives: Even if work musculo-skeletal disorders represent a serious and commonly observed health problem among health care workers, few data are available about physical therapists. This study aims to compare the musculoskeletal disorders prevalence over two different health care populations and, Materials and Methods: Two populations have been studied: (i) 100 nurses working in the teaching hospital Azienda Policlinico di Modena and (ii) 100 physical therapists working in different hospitals in Modena and Reggio Emilia. The ergonomic risk assessment has been made according to the Ergo Web questionnaire. A self-reported questionnaire [partly built according to Outil de Repérage et d'Evaluation des Gestes (OREGE) method] has been used to collect data about physiological factors, musculo-skeletal symptoms of the upper limb and spine, stress indexes and psychosocial indexes., Results: The two populations are comparable as far as the data of physiological and working anamnesis. The physical therapists have an higher prevalence of neck pain (p<0.01), whereas the nurses have an higher prevalence of low back pain (p<0.01). Furthermore, the physical therapists have an higher index of pain (involving prevalence, number of occurrences and intensity of the disorder) of right upper limb too. The nurses have higher working strain (p=0.00), attention need at work (p=0.00), poor autonomy (p<0.01) indexes than physical therapists. The indexes' analysis shows that musculo-skeletal disorders are associated to stress and psychosocial factors in both populations.

The Authors describe the personal and environmental preventive measures suggested to protect health workers from the risks due to a potential exposure to SARS agents. The Authors stress the need that workers are allowed to wear individual protective disposable complying with technical regulations in order to be assured the best protection.

To study professional exposure to biological materials an investigation was carried out in the Hospital-University Complex of Sassari during the period January 1st 1995-December 31 2000. 1003 occupational accidents were notified (incidence rate=6%). Infirmaries were the most at risk category (45%) and about the half part of the accidents occurred in surgical area (44.7%). The most frequent accident was needle puncture (53%); exposure involved principally the hands (76.3%). The basal serology of injured personnel showed low positivity for any HBV markers (72.7%), HCV (0.4%) and no positivity for HIV; while high levels were found among source patients. From the comparison between serological data (injured vs source), when ascertainable, emerged a biological hazard of 7.7% for HBV, 30.2% for HCV and 3.2% for HIV; however no seroconversions were observed at follow up. The study also pointed out the need of improve prevention programmes.

Since headache is one of the most frequent complaints in clinical practice, its burden in terms of the both social cost and individual sufference is considerable. Headache is a frequent cause of absence from work and decreased productivity; it is therefore clear that investigating its possible relationship with working conditions represents a topic of increasing interest for the scientific community. This study was aimed at identifying specific occupational factors able to modify the prevalence of headache in a population of hospital workers undergoing periodic examinations. It was indeed suspected that the hospital environment could be per se a predisposing factor for headache onset, due to the considerable impact of stress on such working environment. The results obtained suggest that specific occupational conditions such as shift work and P.C. use may play an important role in headache development even in the presence of a wide number of professional risk factors.

Purpose: To assess the prevalence of hepatitis C virus (HCV) in the population exposed to biological risk of two hospitals in southern Italy., Patients and Methods: All health care workers of two main hospitals of Sicily, potentially exposed to biological risk underwent health surveillance. Health care personnel were arranged into seven occupational group, and five age bands (< 30, 31-40 years, 25-30 years, 41-50, 51-60 years, > 60 years). We estimated the prevalence of hepatitis C infection in 1800 healthcare workers by means of nucleic acid amplification and genotype by means of sequencing, the workers were also tested for liver function., Results: The overall prevalence of anti-HCV was 2.1%, corresponding to 39 persons. The prevalence in health workers was higher in nurses than in surgeon, group perceived to be at greatest risk of occupational exposure, and higher in elderly workers (> 45 years) than in younger ones., Conclusion: Prevalence of anti-HCV in our study was higher than in blood donors, and lower than in general population in southern of Italy. The 45% of HCV infected healthcare workers were unaware of their condition and their potential to infect patients. Testing for HCV infection should be routinely performed for health care workers to detect the infection, which frequently results in a chronic asymptomatic carrier state for many years before the development of symptomatic liver disease, and perform precocious therapy with interferon.

Background: To evaluate the air pollution in operating theatres of a Sicily Hospital produced by 2% alkaline solutions of glutaraldehyde, which is used to disinfect flexible endoscopy units, filling tanks and cleaning surfaces. Personnel reported subjective symptoms as: headache, dizziness, anxiety, drowsiness on the job, loss of attention, irritation of the skin and respiratory tract., Methods: Environmental valuation of glutaraldehyde was made by infrared photoacustic spectroscopy., Results: The final results is not very comforting infact we found value of glutaraldehyde which exceeded the upper limit value (0.05 ppm) due to behavioral rules, to not well ventilated workplaces and to not automated washing units.

An assessment of the electromagnetic fields emitted from short and ultrashort wave diathermy sources and from magneto therapy operating at a frequency of 50 Hz was made to evaluate the occupational exposure to the operators. Operators were exposed to electromagnetic fields which rarely exceed the recommended limits of International Commission on Non-Ionizing Radiation Protection (ICNIRP) and American Conference of Governmental Industrial Hygienists (ACGIH). Only a measurement of electromagnetic fields near short wave diathermy equipment operating at a frequency of 27.12 MHz exposed operators to levels above those recommended by ICNIRP at a distance of 1 metre. Magnetic fields of magneto therapy exceeded residential exposition of 1 microtesla, at a distance of 4 metres.