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Introduction: Needlesticks and cuts are the most common occupational injuries in healthcare workers (HCWs). Directive 2010/32/EU defines principles and preventive interventions., Objectives: To assess, in hospitals participating in the Italian Study on Occupational Risk of HIV (SIROH) project, which are very active in prevention, the degree of application of the measures provided for by the Directive, prior to its incorporation into Italian law., Methods: An open questionnaire covering the 9 focal points of the Directive, as a guide for a presentation at the SIROH meeting in 2013., Results: Of 100 SIROH hospitals, 97% and 96% respectively provide specific information and education initiatives (54% and 73% of which expressly for new employees). All centres reinforce the ban on recapping, and 30 monitor its application by inspecting sharps containers; all hospitals place containers on mobile trolleys and 78 provide operating procedures for their replacement; all introduced at least one needlestick-prevention device (NPD; 4 on average, range 1-11), most frequently intravenous catheters (91%) and winged needles (87%), but 39% only in selected units; 14 centres implemented initiatives to eliminate unnecessary needles. Regarding hepatitis B, all centres screen and vaccinate HCWs but only 78% monitor their response: 89% of HCWs were immunized. Post-exposure management protocols, although based on the same rationale, differ significantly causing considerable differences in  costs., Conclusions: Most of the preventive interventions covered by the Directive were implemented in SIROH hospitals. It is necessary to invest in NPD availability and dissemination, elimination of unnecessary needles, and streamline post-exposure protocols. The situation in the remaining Italian facilities should be investigated.

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.

Healthcare workers (HCW) are exposed to many different pathogens, and cases of occupational infection have been reported involving the vast majority of known and emerging agents. The risk is present during all the phases of patient care and manipulation of biologic materials, and the implementation of Standard Precautions--and biosafety level 2 measures in the laboratory--and Transmission-Based Precautions in all health settings represents the necessary preventive intervention required by law. Percutaneous exposures represent an extremely frequent event in healthcare facilities; among the many pathogens acquired through this type of exposure, those of highest concern due to the frequency of exposure are HIV, HBV and HCV. Over the last 10 years, though the risk of exposure is still not negligible, occupational infection with HBV has become a rare event; conversely, the incidence of acute C hepatitis became significantly higher among HCW (1,6 per 100.000 inhabitants) with respect to the general population (0,6), with a seroconversion rate following an occupational exposure between 0,5% and 1,8%; finally, reports of occupational HIV infection have decreased, probably also as a secondary beneficial effect of antiretroviral treatment in patients and post-exposure prophylaxis in HCW. The Studio Italiano Rischio Occupazionale da HIV (SIROH) documented from 1986 to 2009 one occupational HBV case, 6 HIV cases (the last one in 2007) and 32 HCV cases. In Europe, the Directive 2010/32/EU approved on May 10 2010 requires Member State to implement within three years a global strategy to prevent occupational exposures in the healthcare setting, particularly with respect to needlestick and sharp injuries, including the adoption, based on risk assessment, of devices incorporating safety features. In Italy the introduction of these devices, according to data collected by the SIROH, showed the possibility to decrease percutaneous exposures by 75%, an effect sustained over time if supported by information, education and training.

Background: Several studies have investigated both the frequency and modality of occurrence of occupational exposure of health-care workers to blood-borne pathogens. At the moment no complete epidemiological data are available covering the hospitals of an entire Region., Objectives and Methods: To describe the characteristics of mucocutaneous and percutaneous exposure to body fluids of the healthcare workers in 47 out of the 56 public hospitals (90% of a total 15,000 beds, 28,000 health-care workers full time equivalent) in Piedmont, Northern Italy (4.5 million inhabitants) over a three-year period (1999-2002), using SIROH (Studio Italiano Rischio Occupazionale da HIV) model to collect the data., Results and Conclusions: 5174 percutaneous injuries (12.7/100 beds) and 1724 mucocutaneous exposure (4.1/100 beds) were recorded. Surveillance data were similar to those collected in other multi-hospital studies. The variability of rates between hospitals was high, most likely due to the amount of underreporting. The categories most at risk of percutaneous and mucocutaneous exposure were, respectively, surgeons (9.3/100 surgeons) and midwives (2.9/100 midwives). Needles (syringe, winged steel, suture) were the medical devices most frequently involved in percutaneous injuries, 60% of which occurred after the use of such devices. Eighty-three per cent of healthcare workers had been HBV-vaccinated versus only 45% of cleaning staff. After percutaneous injuries with exposure to an HIV positive source only 40% of those exposed received post-exposure prophylaxis; in the case of mucocutaneous exposure the rate was 11%. We recorded 2 seroconversions following occupational exposure to an HCV positive source (risk of seroconversion: 0,2%). In order to implement preventive programmes the use of safety devices, an increase in the number of HBV-vaccinated contract workers, the use of chemoprophylaxis for HIV exposure, and the use of protective equipment are deemed necessary.

The average risk of HIV infection after percutaneous exposure to HIV-infected blood is 0.3%. Higher risk factors of HIV transmission to health care worker after percutaneous exposure are deep injury, visible blood on device, procedure involving needle in artery or vein and terminal: Illness in source patient or high viremia. It has been shown that post-exposure use of zidovudine diminishes risk of transmission. In Italy 5 occupational HIV infections in health care workers have been documented. Although prevention of exposure to blood is the best method to avoid occupational risk of HIV infection, nevertheless an adequate management of blood-borne exposure is essential for achieving a safer health care workplace. In this paper we reviewed the modality and the frequency of blood-borne exposures in Italian health care setting, focusing on in obstetric and gynaecology. Finally, Italian recommendation for the management of blood-born exposure, including post-exposure chemoprophylaxis are discussed.

Drugs need to be evaluated both in terms of efficacy, safety and regarding the patient's perception of his own health status. For these reasons, sensible, reliable and patient-oriented instruments are needed, besides the methodologies for evaluation of drug efficacy and safety. Such instruments substantially evaluate Health related Quality of Life (HrQoL). Concerning gastric acid hypersecretion few papers are available, based on HrQoL questionnaires, both general and specific. A research project led us to develop through patients and physicians involvement, a specific instrument to evaluate HrQoL as to the various aspects of the peptic disease. The project started in 1993 through a series of 4 focus groups with gastroenterologists and patients, followed by the preparation of a questionnaire named QPD48. Such instrument was psychometrically validated through a study named Herqules 1, involving 176 gastroenterologists and 1774 patients. The psychometric analysis on QPD48 led to the re-issue of a questionnaire named QPD32 with Chronbach's alfa equal to 0.91, based on 3 factor-referenced subscales evaluating pain, induced anxiety, constrained daily living and awareness of symptoms and agents. Concerning the concurrent validity a one-way analysis of variance showed highly significant differences associated with attack frequency with substantial effect sizes ranging from 0.46 to 1.27 of a standard deviation in the full scale. QPD 32 is patent protected and will be used in clinical trials.

Forty adult patients with UTI complicated by local and/or general diseases have been treated, 20 with Cefotetan and 20 with Ceftriaxone. Both treatments showed good clinical and bacteriological efficacy, with no statistically significant differences between the results. Cefotetan and Ceftriaxone were both well tolerated, without any local or systemic side effects.