Post-exposure rate of tuberculosis infection among health care workers measured with tuberculin skin test conversion after unprotected exposure to patients with pulmonary tuberculosis: 6-year experience in an Italian teaching hospital.

BACKGROUND: This study assesses the risk of LTBI at our Hospital among HCWs who have been exposed to TB patients with a delayed diagnosis and respiratory protection measures were not implemented. METHODS: All HCWs exposed to a patient with cultural confirmed pulmonary TB and respiratory protection measures were not implemented were included. Data on TST results performed in the past (defined as T0) were recorded. TST was performed twice: first, immediately after exposure to an index patient (T1) and three months later (T2). The period of time between T0 and T1 was used to calculate he annual rate of tuberculosis infection (ARTI), while le period of time between T1 and T2 was used to calculate the post exposure annual rate of tuberculosis infection (PEARTI). RESULTS: Fourteen index patients were admitted; sputum smear was positive in 7 (58.3%), 4 (28.6%) were non-Italian born patients. 388 HCWs were exposed to index patients, a median of 27 (12-39) HCW per each index patient. One hundred eighty (46.4%) HCWs received BCG in the past. One hundred twenty two HCWs (31%) were TST positive at a previous routine screening and not evaluated in this subset. Among the remaining 255 HCWs with negative TST test in the past, TST at T1 was positive in 11 (4.3%). ARTI was 1.6 (95% CI 0.9-2.9) per 100 PY. TST at T2 was positive in 9 (3.7%) HCWs, that were TST negative at T1. PEARTI was 26 (95% CI 13.6-50) per 100 PY. At univariate analysis, older age was associated with post exposure latent tuberculosis infection (HR 1.12; 95% CI 1.03-1.22, p=0.01). CONCLUSIONS: PEARTI was considerably higher among HCWs exposed to index patients than ARTI. These data underscore the overwhelming importance of performing a rapid diagnosis, as well as implementing adequate respiratory protection measures when TB is suspected.

[Tuberculosis risk assessment in Italian healthcare centres]. / La valutazione del rischio tubercolosi nelle strutture sanitarie.

BACKGROUND: Tuberculosis transmission is a significant hazard in healthcare settings. METHODS: Risk factors suggested by CDC guidelines in 1994, which were adopted by the Italian Ministry of Health, were assessed in 29 centres via questionnaires in 2005. RESULTS: Few centers were equipped with negative pressure, respiratory isolation rooms. Half of the centres had high or ongoing risk. CONCLUSIONS: The hazard is underestimated mostly because of a high number of initially undiagnosed TB patients.

[Accidents with risk of blood-borne infections in obstetricians: analysis of a hospital case records]. / Infortuni a rischio di malattie a trasmissione ematica nel personale ostetrico: analisi di una casistica ospedaliera.

BACKGROUND: Health care workers (HCW) are at high risk of accidental contact with biological fluids. In spite of extensive recom mendations concerning HCW accidents continue to be frequent and seem to be related to specific factors. OBJECTIVES: To evaluate the factors influencing risk of blood-borne infections in a particular category of HCW--obstetricians, and obtain information useful for prevention guidelines. METHODS: Data were obtained from the exposure registers of nursing and of the Emergency Ward staff where HCWfirst report after accidental contact with biological fluids. RESULTS: Accidents with risk of blood-borne diseases were more frequent in obstetricians with lower job seniority. They usually occurred between 8 a.m. and 4p. m., in the patient's room. The hands and face (particularly the eyes) were the body parts more often involved In almost half of the accidents, the worker was not wearing any personal protective device. Although some contacts were with infected blood, no seroconversion occurred. CONCLUSIONS: Obstetricians are at high risk of contact with biologicalfluids. Prevention requires a global strategy including the availability of protective and safety devices, as well as worker education, especially concerning the use of such devices, the application of the universal rules of prevention and the improvement of risk awareness. An adequate post-exposure management of accidents in also required