Fitness for work in health care workers: biological risk.

The aim of this contribution is to propose good medical practice in formulating and managing fitness for work (FFW) for health care workers exposed to biological agents. A literature review was conducted, together with a critical analysis of available scientific evidence and presentation of practical examples taken from the Italian multicentric study in which the authors have been participating since 2008. Within the health care sector and with special reference to biological risk, making and subsequently managing a FFW for a specific job is in fact a particularly arduous task for the occupational physician and for the entire hospital management system. The process that leads to issuing a FFW needs to follow the appropriate guidelines and good technical and scientific practice and also take into careful consideration current legislation (national, regional, etc); it is the result of a well grounded balance between professional ethics, rights and duties of the worker and patient, but also of the employer and of all those involved. All these aspects need to be adapted to the single work situations, applying the principle of precaution and careful flexibility in management, with accurate evaluation of each individual clinical case with its peculiarities and referral, where necessary, to expert opinion. It is also indispensable to have in place a clear and jointly agreed hospital management policy where co-responsibility is taken by each single actor, always with due respect for specific roles, so that the Occupational Physician and employers are not left to manage the issue alone.

[Management of biohazard in health care settings]. / Gestione del rischio biologico in ospedale.

The management of biohazard in health care settings entails multidisciplinarity, valuing the interactions among stakeholders (General Manager, Medical Director, health care workers, prevention and protection units, infection control panels, occupational physicians), with the aim of protecting health and safety of workers, third parties and the health care service. The management issue was tackled within SIMLII guidelines on biohazards, as well as by the SIMLII Section on Preventive Medicine for Health Care Workers, followed by editorial initiatives. This contribution focuses on afield example on the management of data stemming from accidents involving biohazards, highlighting the need of information technology enabling management of enormous amount of health data. This work underlines the primacy of individual risk assessment and management, while combining information on working techniques and procedures with modern health surveillance, on the basis of accredited literature and good medical, organizational and technical practices.

[Analysis of audiometric data as a contribution to the noise risk assessment]. / L'analisi dei dati oudiometrici come contributo alla valutazione del rischio rumore.

METHODS: We have matched the annual rate of change for average of at 3, 4 and 3-4 kHz between 2617 workers of 15 Italian thermoelectric power plants exposed to noise and 90 workers non-exposed (ANCOVA test controlling for relevant confounders: age and high frequency hearing threshold level). RESULTS: Overall, workers exposed to noise did not show a statistically significant hearing loss (F: 1.03 p = 0.30 for 4-6 kHz). Five subgroups in two power plants showed a significant hearing loss suggesting a specific re-evaluation of prevention strategies CONCLUSIONS: The statistical analysis of hearing loss progression in a population of workers exposed to noise can be an effective instrument of occupational risk assessment and monitoring of the effectiveness of prevention strategies.

[Consensus Document. Update on latex exposure and use of gloves in Italian health care settings]. / Documento di Consenso. Aggiornamenti in tema di esposizione a latice e impiego di guanti in ambito sanitario.

This consensus document was prepared by an Italian working group including occupational health professionals involved for many years in the management of glove- and latex-related problems in health care settings. The aim of this document was to address the most significant technical, epidemiological, clinical, environmental and prevention problems related to the use of gloves and latex. The group's recommendations are based on scientific evidence and practical experience but they cannot be considered as final. These topics need to be periodically revised. The following points should be taken into account: glove quality seems to have improved considerably but the information on glove features provided by the manufacturers is often still inaccurate or incomplete; the regulations in force provide that the manufacturers perform tests to supply evidence for the quality of the products but they do not indicate which analytical method should be used and they do not require that the results be reported in the technical data sheets. Thus the manufacturers have only to declare that their products are "in accordance with the rules"; therefore, purchasers should require the manufacturing companies to supply detailed information and verify their reliability. Moreover, the rules should be adapted to higher quality standards; occupational physicians must be involved for the correct choice and purchase of protective gloves; the use of gloves (in particular latex gloves) and latex devices in health care settings should be based on specific criteria: procedures must be available stating which kind of gloves are suitable for specific tasks. When exposure to latex cannot be avoided it is necessary to choose products that have good biocompatibility (e.g., powder free-gloves with low allergen content); once and for all latex powdered gloves should no longer be commercially available! labels for latex devices (including gloves) should report the extractable latex allergen content. Limit values for extractable latex allergens should be established; the use of synthetic rubber gloves should be encouraged since some materials (e.g., neoprene and nitrile rubber) appear to have physical properties and protective efficacy similar to latex, plus good biocompatibility; more studies should be promoted to verify the protective efficacy of new synthetic materials; health care workers should be informed about the advisability and usefulness of using materials other than latex; health care services should not cause additional risks but rather highlight the advantages for workers and patients if the use of latex gloves and devices is minimized.