[Health criteria and scope of workers' periodic health check-ups for selected types of work and exposure factors - Nofer Institute of Occupational Medicine guidelines]. / Kryteria zdrowotne i zakres badan profilaktycznych dla wybranych rodzajów prac i czynników narazenia ­ wytyczne Instytutu Medycyny Pracy w Lodzi.

Workers' medical prophylactic examinations referred to in the Labor Code are one of the tasks of the occupational medicine services. They are regulated by law which has been in force for more than 20 years in unchanged form. During this period, new harmful, burdensome or dangerous to health factors appeared in the workplaces, for which no preventive health check-up standard was defined. In the meantime, the health criteria for drivers and persons applying for driving licenses have also been significantly liberalized. The above changes, the authors' own experience, comments and problems reported by physicians who provide workers' prophylactic health care and employers as well as analysis of literature related to workers' health care in other countries have created the need to harmonize and update guidelines on health requirements for selected types of work. In addition the scope and frequency of prophylactic examinations for exposures, which are not included in applicable legal acts, has been developed. Med Pr. 2019;70(1):125-37.

[Chronic kidney disease - The relevant information for an occupational physician]. / Przewlekla choroba nerek ­ istotne informacje dla lekarza medycyny pracy.

For a number of years chronic kidney disease (CKD) has been listed in the group of lifestyle diseases, such as obesity, diabetes, cardiovascular disease and hypertension. It is estimated that in Poland more than 4 million people may suffer from various stages of CKD. Chronic kidney disease may also be a consequence of all the other civilization diseases. At the same time it is worth noting that nephrological problems are increasingly being taken into account in modern medical certification. The aim of this work is, among other things, to improve safe access to the labor for patients with kidney diseases. In the legislation existing in our country since 2014 it is stated that chronic renal failure is a potential health contraindication to driving. Also in the annex to the Regulation of the Minister of Health dated 9 December 2015 on health conditions required for seafarers to work on a seagoing ship, it is said that ICD-10 codes (International Classification of Diseases) corresponding to acute and chronic renal failure (N17-N19) should be taken into account when qualifying employees to work at sea. Med Pr 2018;69(1):67-75.

[Challenges to occupational medicine in view of the problem of work-related diseases and the aging of workforce. Directions for further development and intentional changes in preventive care of employees in Poland]. / Wyzwania medycyny pracy wobec problemu chorób zwiazanych z praca oraz starzenia sie populacji osób pracujacych. Dalszy kierunek rozwoju i celowe zmiany w opiece profilaktycznej nad pracujacymi w Polsce.

The system of occupational health care in Poland, based on occupational medicine service, takes care of almost 12.5 million employees subjected to over 4.5 million obligatory periodic medical check ups. This form of providing prophylactic care comes down to examinations dictated by legal regulations, whose scope is not oriented towards a comprehensive workers' health assessment, but to the examination of the systems and organs critical to work-related dangers. Simultaneously, epidemiological data indicate a large number of chronic diseases, which may influence the professional activity, like hypertension or diabetes and a high percentage of patients not aware of their illness. Since patients participating in obligatory examinations usually feel healthy and do not use health care services on a daily basis, an occupational medicine physician has a unique opportunity to detect health disorders at an early stage, which can prevent the development of health complications affecting the condition of the patient, limiting their professional activity, but also causing additional costs of the health care system. The authors have proven the need to involve occupational medicine services in the prevention of chronic diseases and the need to introduce additional sources of financing for procedures enabling early detection of diseases the patient may not be aware of or control of the effectiveness of already diagnosed illnesses. They addressed the need to change the current legal form of establishing and announcing the range of examinations and directives for certifying the lack or presence of health contraindications to work to the specified and updated standards prepared by scientific research institutes and occupational medicine societies. Med Pr 2016;67(5):691-700.

[New occupational diseases legislation rules - functioning evaluation]. / Ocena funkcjonowania nowych regulacji prawnych dotyczacych chorób zawodowych.

BACKGROUND: On 3 July 2009, new law pertaining to occupational diseases (ODs) became effective in Poland. The article presents opinions of the representatives of the 1st degree ODs certification entities and sanitary inspectorates on the changes in OD) law and the problems that may cause difficulties and/or certification errors. MATERIAL AND METHODS: A questionnaire study was performed covering representatives of 20 voivodeship occupational medicine centers and 40 national district sanitary inspectorates. We received 57 completed questionnaires which were analyzed. RESULTS: Positive opinions were expressed on changes in procedures on reporting suspected occupational diseases (50%), keeping time limits for diagnosing ODs (89.2%), and changes pertaining to entities responsible for certifying infectious ODs (92.9%). A large group of respondents (66.7%) was in favor of conducting jointly an occupational exposure risk analysis by occupational medicine physicians and occupational health and safety practitioners and/or sanitary inspectors. One-third of the respondents declared that changes in the list of ODs had no influence on the certification procedure. CONCLUSIONS: New law has improved the existing procedure of ODs certification. There is a need to elaborate detailed diagnostic guidelines on and criteria for ODs identification and recognition. A panel of experts should be established by the Ministry of Health to track the latest advancements in medicine and to update the list of OD)s. Conducting jointly an occupational exposure risk analysis by occupational medicine physicians and occupational health and safety practitioners and/or sanitary inspectors should become a standard.

[Good practice in occupational health services: recommendations for prophylactic examinations and medical certifications in persons with diabetes mellitus]. / Dobre praktyki w opiece profilaktycznej nad pracujacymi-zalecenia do badan profilaktycznych oraz postepowania orzeczniczego u osób z cukrzyca.

The prevalence of diabetes and a significant proportion of unawareness of its risk among the patients indicate the need to include into general prophylactic examinations the standards of medical certification, which would prevent discrimination and ensure public safety. In certifying medical predispositions to work in a person with diabetes mellitus the key issue is to distinguish 2 categories of medical requirements: the higher - related to qualifying workers for jobs demanding psychophysical abilities, which affect the safety of the workers and their environment and the lower - related to qualifying workers for jobs characterized by harmful factors and nuisances, which might have a negative effect on the course of diabetes. The very fact of having diabetes cannot be the reason for the patient being disqualified and the decision on certifying the capacity to perform a particular job should always be based on an individual health assessment of the patient, taking into account the risk of hypoglycemia, metabolic control, the progression and dynamics of chronic complications, as well as the level of health awareness in patients. The objective assessment of the health status of the patient with diabetes involves the judgment of an attending physician, additionally supported by the consultation of a diabetes specialist to ensure that the patient is able to perform properly the job, requiring psychomotor abilities.

Attitudes regarding vaccination on the example of COVID-19 prevention.

BACKGROUND: COVID-19 vaccines for public use were approved at the turn of 2020 and 2021. The level of vaccination coverage against COVID-19 in Poland is one of the lowest in Europe. Despite scientific studies there are people who are afraid of vaccinations and spread false information about them. Vaccinations against COVID-19 allowed to learn about the attitudes of people who decided to be vaccinated, which can be used to improve the effectiveness of the infectious diseases prevention in the work and public environment. The aim of the study was to analyze the main reasons determining a decision to get vaccinated against COVID-19. MATERIAL AND METHODS: The study was carried on among all the people who decided to be vaccinated against COVID-19 in Nofer Institute of Occupational Medicine in Lódz. All vaccinated people completed an anonymous survey containing questions related to the most important factors, which encouraged them to undergo this vaccination. RESULTS: The study involved 945 people vaccinated against COVID-19. Statistical significance was revealed between 3 different reasons (one's own health, stress-free work, safe travelling and easier access to entertainment) for getting vaccinated and age, gender and a form of employment. The authors also found statistical significance of the correlation between the age, gender, education and form of employment of the respondents and the reason for choosing the specific vaccine product. CONCLUSIONS: Despite evidence presented by scientists about the effectiveness and safety of vaccinations, many people refused and still refuse to receive the vaccine. In order to increase the readiness of the population for vaccinations against COVID-19 and subsequent ones, if there is a need to limit new epidemics, the following should be done: introduce activities to raise health awareness, intensify strategies and campaigns aimed at increasing public trust in available vaccines against COVID-19, devolop individualized messages that contribute to vaccine hesitancy. Med Pr Work Health Saf. 2024;75(2):123-131.

Work safety among Polish health care workers in respect of exposure to bloodborne pathogens.

OBJECTIVES: Viral hepatitis is the second most often identified infectious illness acquired at work and it is mostly registered among health care personnel. This group of workers is at greater risk of exposure to blood and bloodborne pathogens, including hepatitis B and C viruses. The aims of this study were to evaluate the efficacy of methods promoting work safety in healthcare settings, to assess the frequency of exposures in the last 12 months prior to the study and to determine a rate of reporting them to appropriate authorities. METHODS: A total of 1138 Polish healthcare workers were interviewed during the study period (between 2009 and 2010). RESULTS: Sustaining accidental occupational percutaneous exposure during last 12 months was declared by 242 workers (21% of the whole group). Only in 146 cases these incidents were reported to authorities. Exposure incidents were associated with self-perception of high risk of exposure (OR = 3.69, p = 0.0027), employment in out-patient (vs. hospital-based) healthcare setting (OR = 1.71, p = 0.0089), conviction that the level of information about bloodborne infections conveyed at work was insufficient, lack of both exposure reporting system and knowledge about the ways of reporting. CONCLUSIONS: Despite the different established proposals of the post-exposure procedures, it turns out that particularly in small, not providing 24 hours service healthcare settings these procedures are not known or are not respected. More attention should be given to education, especially in regard to the risk of infection, advantages of post-exposure prophylaxis and reporting exposure incidents.

COVID-19 caused by the SARS-CoV-2 as an occupational disease in Poland.

BACKGROUND: The unexpected outbreak of the COVID-19 pandemic has led huge impact on health and safety of employees. Although now the epidemiological situation has improved, but it remains a challenge, especially in light of the emergence of new threats. The aim of the work is to present an epidemiological analysis of data on COVID-19 as an occupational disease in Poland. MATERIAL AND METHODS: The analysis covered all cases of occupational diseases sent by state sanitary inspectors to the Central Register of Occupational Diseases. The years 2020-2022 and such available data as: age, gender, activities and territorial differentiation were analyzed. The data were presented as absolute numbers and incidence rates per 100 000 employed persons and for healthcare workers also per 100 000 persons authorized to practice. RESULTS: In the period 2020-2022 in Poland 7030 diseases recognized as occupational diseases were recorded, of which almost half were infectious diseases (47%). Among infectious diseases, dominated COVID-19 in number of 2059 cases. In this period 98.6% of all cases of COVID-19 were concentrated in the health care and social activities. According to workplaces, most diseases were caused by working in hospitals - 1825 cases (88.6% of all COVID-19 cases in the healthcare workers). Most cases concerned nurses - 1355 cases (65,8%) and doctors - 212 cases (10,3%). The incidence of COVID-19 in the group of physicians per 10 000 persons entitled to practice ranged from 2.6 in 2020 to 68.3 in 2022, while among nurses and midwives the rates were 7.9 and 194.9, respectively. CONCLUSIONS: The COVID-19 pandemic changed the picture of occupational diseases in Poland. Therefore, it is very important to understand the key contributions of people working in environments where workers are at increased risk of contracting COVID-19 due to the nature of their work, and to promote the recognition of COVID-19 as an occupational disease. Med Pr Work Health Saf. 2023;74(6):479-86.

Recognition COVID-19 as an occupational disease in Poland - definition, criteria and recommendation.

A major challenge over the pandemic period was to establish the criteria for recognizing COVID-19 as an occupational disease. The European Center for Disease Prevention and Control has attempted to estimate the incidence of COVID-19 in individual occupational groups and economy sectors in the European Union and the United Kingdom, and to identify possible factors increasing the transmission of the virus at workplaces. Legal regulations of various countries in the world allow COVID-19 to be recognized as an accident at work and/or an occupational disease. In Poland, an occupational disease is defined as a disease caused by harmful factors occurring in the work environment or connected with performing a given job, included in the official list of occupational diseases. When assessing occupational exposure in the healthcare sector, it should be considered that healthcare workers include all persons in contact with patients or their biological material, as well as employees who are not medical professionals but who share a common space with patients due to the nature of their work. The latter group includes administrative and technical employees, control and rescue service workers, people supporting medical staff, and employees of nursing homes. In the case of non-medical occupations, the decision to recognize COVID-19 as an occupational disease should be made on an individual basis, after confirming a significant risk of contracting a SARS-CoV-2 virus infection at the workplace and in the absence of evidence of a non-occupational source of infection. An assessment of occupational exposure should always include evaluating the possibility of SARS-CoV-2 transmission. Med Pr Work Health Saf. 2023;74(5):435-42.

[Evaluation of vibration exposure long-term effects in people with diagnosed vibration syndrome]. / Ocena odleglych skutków zdrowotnych narazenia na wibracje miejscowa u osób z rozpoznanym zespolem wibracyjnym.

BACKGROUND: Long-term exposure to hand-transmitted vibration can increase the occurrence of symptoms and signs of vascular neurological and musculoskeletal disorders of the upper extremities. The most common is the angioneurotic type of the vibration syndrome. Very little is known about possibility of withdrawal of symptoms after exposure cessation. OBJECTIVES: The aim of the study was to evaluate the long-term effects of vibration exposure in people with diagnosed vibration syndrome. The particular aim of the study was to gain the information on possible withdrawal of symptoms in the peripheral vascular and nervous system after exposure cessation. MATERIALS AND METHODS: The medical documentation of patients with vibration syndrome symptoms, examined in the years 1999-2004 in the Outpatient Clinic of the Nofer Institute of Occupational Medicine and in three Voivodeship Centers of Occupational Medicine has been analyzed. RESULTS: A group of 45 people who had been suffering from diagnosed angioneurotic vibration syndrome for at least 5 years was chosen. The mean age of the examined group at the time of occupational disease certification was 48.2 and the mean period of exposure to hand-transmitted vibration was nearly 20 years. The major group comprised persons with vibration syndrome diagnosed at an 'early symptoms' stage, an advanced stage of the disease was described in only 5 cases. From the time of occupational disease certification only 7 persons have been performing any job, and more than a half of the group has been granted disability pension. CONCLUSIONS: The results of the study show a bad prognosis of angioneurotic vibration syndrome despite cessation of the exposure to vibration. The total withdrawal of symptoms is possible only in people with vibration syndrome diagnosed at an 'early symptoms' stage, at young age and after short period of exposure.

[Prophylactic care of workers with disabilities--the problem of contemporary occupational health service?]. / Opieka profilaktyczna nad pracownikiem niepelnosprawnym--problem wspólczesnej medycyny pracy?

According to the 2002 data there are in Poland 14.3% of people with disabilities. On the other hand, an employment level of people with disabilities in Poland is one of the lowest in Europe with its percentage rate of 13% in the year 2004. Therefore, the improvement in certification system and its efficacy is needed. Occupational health service (OHS) plays an important role in the process of occupational elicitation of this group of people. Barriers at the level of OHS mainly result from the lack of guidelines in this field, so now it is essential to implement those that have been proposed. The improvement in occupational medicine physicians training is also essential. Difficulties in certification of ability to work is also the result of unavailable data on patient's health. Psychiatric problems, epilepsy and diabetes cause the major problems in the certification of capacity to work.

[Prophylactic care of apprentices occupationally exposed to allergens]. / Badania profilaktyczne uczniów narazonych na czynniki alergizujace drogi oddechowe.

An increase in the frequency of allergic diseases, including bronchial asthma, in the children population has been observed over several last decades. This trend is reflected in the increasing number of young workers who suffer from allergy and asthma. The problem determines a new challenge to physicians responsible for medical prophylactic care of this group of patients. Active occupational counseling should be performed especially by general practitioners and occupational medicine specialists in in cooperation with allergologists. Apprenticeship is a period of increased risk of work-related respiratory allergic diseases, particularly in the case of occupational exposure to high molecular weight agents. An adequate prophylactic care of apprentices exposed to aeroallergens at workplace may help to reduce work-related allergic health problems, mainly by supporting adolescents in choosing their jobs.

[Coexistence of two occupational infectious diseases in one patient--borreliosis and tick-borne encephalitis--a case report]. / Borelioza i kleszczowe zapalenie mózgu jako wspólistniejace choroby zawodowe--opis przypadku klinicznego.

Recently, infectious diseases have been found to be the most frequent among occupational diseases. Borreliosis, the most common among them, as well as tick-borne encephalitis is transmitted by ticks. Recognition of occupational etiology of such diseases is possible only when the relationship between the infection, occupational exposure and performed work is proved. A case report of a forest worker with borreliosis coexisting with tick-borne encephalitis is presented. Despite nonconcurrent recognition of both diseases it was highly possible that contagion took place at the same time or at a very short time interval. Despite high prevalence of tick-borne diseases, occupational etiology of these two infectious diseases in one patient is very rarely recognized.

[Identification of the most common problems and mistakes in the medical certification of inability to work for disability pension provision based on the expertise carried out by the Out-Patient Clinic of Occupational Diseases, Nofer Institute of Occupational Medicine, Lódz, 2005-2007]. / Identyfikacja najczesciej wystepujacych problemów w orzekaniu o niezdolnosci do pracy dla celów rentowych na podstawie dzialalnosci ekspertyzowej Przychodni Chorób Zawodowych w latach 2005-2007.

BACKGROUND: The definition of "inability to work" and principles of medical certification of disabilities, determining the entitlement to an ill-health pension provision are regulated by law. However, the term ,,"inability to work" is not precisely defined and the standards of its assessment are not accurately formulated. This refers not only to the term "loosing ability to work to considerable degree", but also to the criteria of occupational qualifications. OBJECTIVES: The aim of this study was to identify the most common problems and mistakes in the medical certification that entitles to disability pension provision. MATERIALS AND METHODS: The study, based on medical consultations provided for the president of the Social Insurance Company (ZUS) in the years 2005-2007, was carried out in the Out-Patient Clinic of Occupational Diseases, Nofer Institute of Occupational Medicine, Lódz. In total, 293 medical cases were analyzed, of which 61 concerned consequences of occupational diseases, 44--accidents at work and 188--idiopathic diseases. RESULTS: Men formed the majorityof the study group (66%) and the mean age of the examined individuals was 49. The predominant causes of medical certification of patient's inability to work, both in men and female, were musculoskeletal disorders, cardio-vascular diseases, diabetes and mental health problems. Significant discrepancies in the medical statements on inability to work were observed between ZUS and the Nofer Institute of Occupational Medicine. They concerned the evaluation of people's inability to work in general, as well as the degree (partial or complete) of lost capability for work. A consensus of medical statements was found in 153 cases, and differences in other 140 (47.8%) cases. Most differences were found in the evaluation of inability to work caused by consequences of occupational diseases. CONCLUSIONS: Lack of certification guidelines, excessive preference of medical criteria used for defining body fitness disturbances and insufficient consideration of occupational and economic aspects of certified inability to work in terms of assuming work in future) are the main reasons for difficulties in inability to work certification. The scheme of certification procedure was also suggested.

[The management of obstructive sleep apnea syndrome in drivers - recommendations of the Polish Society Of Occupational Medicine, The Polish Respiratory Society, The Nofer Institute of Occupational Medicine in Lodz and The Polish Sleep Research Society]. / Postepowanie lekarskie w obturacyjnym bezdechu sennym u osób kierujacych pojazdami − zalecenia Polskiego Towarzystwa Medycyny Pracy, Polskiego Towarzystwa Chorób Pluc, Instytutu Medycyny Pracy w Lodzi i Polskiego Towarzystwa Badan nad Snem.

The findings of numerous studies and analyzes conducted in many countries have proven that obstructive sleep apnea (OSA) negatively affects the psychophysical abilities drivers. Therefore, in Commission Directive 2014/85/EU of July, 1 2014, OSA was recognized as one of the most important risk factors for car accidents. The implementation of said Directive by Member States is to contribute to reducing the risk of such accidents. The implementation of the Directive in Poland has resulted in enacting the Ordinance of the Minister of Health of December 23, 2015 amending the ordinance on medical examinations of applicants for a driving license and drivers. Although Annex 2 to that regulation sets out the detailed conditions for a medical examination for OSA, it does not regulate or clarify the issue of tools and methods for suspecting OSA in a moderate or hard form. Therefore, it was necessary to develop standards of management for doctors authorized to perform medical examinations of drivers and applicants for a driving license in the case of suspected OSA. The paper presents an algorithm of proceedings that streamlines the case-law process in the above-mentioned cases, which was developed by the Polish Society of Occupational Medicine in cooperation with the Polish Respiratory Society, the Nofer Institute of Occupational Medicine in Lódz and the Polish Sleep Research Society. Med Pr. 2020;71(2):233-43.

[Preventive care of workers at risk of blood-born infections in view of binding regulations]. / Opieka profilaktyczna nad pracownikami zagrozonymi zakazeniem krwiopochodnym w swietle obowiazujacych przepisów prawnych.

The principles of performing prophylactic medical examinations of workers are regulated by the Labor Code and relevant executive regulations. There are also other regulations that concern particular groups of workers--like health care workers. The range and frequency of medical examinations are determined by the doctor who performs the examination on the basis of "Guidelines on prophylactic medical examinations of workers". Before determining the range of medical tests, the risk of occupational exposure to biological hazards in some of health care workers must be taken into account. This article presents legal regulations that determine the standards of prophylactic medical examinations of workers who are at risk of contracting pathogens such as HBV, HCV and HIV.

[Guidelines on prophylactic medical examinations of drivers]. / Wskazówki do przeprowadzania badan profilaktycznych kierowców.

The performance of workers' prophylactic medical examinations is regulated by the Labor Code and relevant executive regulations. There are also other regulations that concern particular groups of workers, e.g., drivers. The range and frequency of medical examinations are determined by the physician responsible for their performance on the basis of the "Guidelines on prophylactic medical examinations of workers" The Guidelines do not focus on particular jobs, but on occupational exposure to physical, chemical, biological, and psychosocial hazards. Driving is a kind of job that requires total psychomotor efficiency. This article presents standards of prophylactic medical examinations of drivers who are engaged in the commercial "road transport", i.e., drivers who do not come under the provisions of the "Road Transportation Act", as well as of other persons who use their driving rights for occupational purposes.

Night shift work and modifiable lifestyle factors.

OBJECTIVES: Night shift work has been linked to some chronic diseases. Modification of lifestyle by night work may partially contribute to the development of these diseases, nevertheless, so far epidemiological evidence is limited. The aim of the study was to explore association between night shift work and lifestyle factors using data from a cross-sectional study among blue-collar workers employed in industrial plants in Lódz, Poland. MATERIAL AND METHODS: The anonymous questionnaire was self-administered among 605 employees (236 women and 369 men, aged 35 or more) - 434 individuals currently working night shifts. Distribution of the selected lifestyle related factors such as smoking, alcohol drinking, physical activity, body mass index (BMI), number of main meals and the hour of the last meal was compared between current, former, and never night shift workers. Adjusted ORs or predicted means were calculated, as a measure of the associations between night shift work and lifestyle factors, with age, marital status and education included in the models as covariates. RESULTS: Recreational inactivity (defined here as less than one hour per week of recreational physical activity) was associated with current night shift work when compared to never night shift workers (OR = 2.43, 95% CI: 1.13-5.22) among men. Alcohol abstinence and later time of the last meal was associated with night shift work among women. Statistically significant positive relationship between night shift work duration and BMI was observed among men (p = 0.029). CONCLUSIONS: This study confirms previous studies reporting lower exercising among night shift workers and tendency to increase body weight. This finding provides important public health implication for the prevention of chronic diseases among night shift workers. Initiatives promoting physical activity addressed in particular to the night shift workers are recommended.

Hepatitis B and C infection: is it a problem in Polish healthcare workers?

OBJECTIVES: Hepatitis B (HBV) and C viruses (HCV) are among the most frequent blood borne pathogens. According to WHO, 5% of healthcare workers (in central Europe), are exposed to at least one sharps injury contaminated with HBV per year, 1,7% - contaminated with HCV. AIMS: The aims of the study were to determine prevalence of HCV and HBV infections, vaccination efficacy against hepatitis B and usefulness of alanine aminotransferase (ALT) testing in prophylactic examinations in healthcare workers (HCWs). MATERIAL AND METHODS: In a group of 520 healthcare workers, a survey, laboratory and serologic tests such as ALT, HBsAg, anti-HBs, anti-HBcT and anti-HCV were carried out. RESULTS: The study revealed a low rate of workers with presence of HBsAg and anti-HCV (1,2% and 0,8% respectively). Anti-HBcT was found in 99 subjects (19%) without a significant association with experiencing an occupational percutaneous injury. Being vaccinated against HBV was declared by 90% of the subjects. There was no relationship between ALT level rise and positive HBsAg, anti-HCV and anti-HBcT tests. CONCLUSION: A seroprevalence of HBV and HCV markers in HCWs found in the study is low and similar to the one found in general population. Current or past hepatitis B infections were independent of needle stick injuries. Vaccination against HBV coverage, although found to be high, should improve to 100%. Occupational prophylactic medical examinations found performing ALT test (obligatory in Poland for HCWs) not helpful. It seems that determination of anti-HBcT and anti-HCV status would be essential in pre-employment medical examinations.