Studio di incidenza sugli infortuni biologici nei medici in formazione specialistica dell’Azienda Ospedaliero Universitaria di Ferrara e stato immunitario nei confronti delle principali infezioni prevenibili [Incidence of biological accidents at work and immune status for vaccine-preventable diseases among resident physicians in specialist training at Ferrara University Hospital]

The hospital as a work environment is particularly characterized by various risks for healthcare workers (HCWs). The main risk is represented by biological accidents, associated with the parenteral transmission of pathogens. Biological injuries can occur during the care service and the manipulation of biological fluids. Hepatitis B (and hepatitis D), hepatitis C and HIV are the most common infections transmitted by biological injuries. Physicians should acquire awareness of the risks associated with their professional activity during their training as medical residents (MRs). Some infectious diseases are preventable by vaccination and the "National Immunization Plan 2017-2019" (PNPV) recommends HCWs vaccination against hepatitis B, influenza, measles -mumps -rubella, chicken pox, and pertussis. Besides, not only HCWs' vaccination can prevent the disease in healthcare professionals, but it also may reduce the transmission to patients. Therefore, active immunization of HCWs by recommended vaccinations plays an important role to prevent disease cases, complications and death in patients. An increased awareness of risk behaviors is the first important point to address in order to reduce biological accidents and infectious diseases transmission, so as to reduce their frequency. Besides, HCWs' vaccination is useful to reinforce protection and to prevent the transmission of some infectious diseases in case of exposure. The aim of this five-year incidence study is to investigate the MRs' biological accidents characteristics and to analyze the MRs' immune status at the University of Ferrara in the period 2011-2015. Data on MRs' biological accidents and immune status at Azienda Ospedaliero-Universitaria of Ferrara in 2011-2015 were analyzed by Microsoft Excel 2007 Software. In this study, the percentage of MRs' biological injuries compared to the total number of MRs showed an annual variability, with a peak in 2011 (11.9%). During the analyzed period, there were 190 biological injuries among the MRs: 81% were percutaneous injuries and blood was the biological fluid involved in 86.3% of cases. The most frequent lesion was puncture (62.6%), occurred in 41.1% of cases by suture needles; 46.3% of accidents occurred in the operating block. These data can be explained by the more invasive and at risk activities carried out in these Operative Units. The high injuries percentage in MRs may be related to less work experience and inadequate training or informations about personal protective equipment use. Among MRs, 93.7%, 93.3% and 96.6% were immune to measles, chicken pox and hepatitis B, respectively; only in the case of rubella, 11.9% of MRs was not immune. This research showed, accordingly to published data, high adhesion to hepatitis B vaccination. However, the healthcare workers' vaccine coverage is still sub-optimal; active immunization by recommended vaccines should be implemented for both parenteral and airborne diseases. As a matter of fact, the recent measles outbreak has involved healthcare workers (4689 cases of measles, 305 in HCWs). Finally, the General Directorates of Health-care settings should improve healthcare personnel adhesion to vaccinations, such as influenza, by promotion activities in the workplace. A proposal in order to achieve coverage objectives could be making vaccinations mandatory, as well as already implemented in other countries.

Gli infortuni da rischio biologico (IRB) costituiscono un pericolo professionale per il personale sanitario. Le patologie più frequentemente implicate sono quelle a trasmissione parenterale come l'epatite B (e l'epatite D), l'epatite C e l'HIV. Una misura efficace per la prevenzione delle malattie trasmissibili è la vaccinazione degli operatori sanitari (OS). Lo scopo dello studio è indagare le caratteristiche degli IRB e analizzare lo stato immunitario dei medici in formazione specialistica (MFS) dell'Università degli Studi di Ferrara nel periodo 2011-2015. Sono stati analizzati i dati relativi agli IRB e allo stato immunitario nei MFS in servizio presso l'Azienda Ospedaliero-Universitaria di Ferrara nel periodo 2011-2015. L'elaborazione è stata effettuata attraverso il Software Microsoft Excel 2007. Nel periodo considerato si sono verificati 190 IRB tra i MFS, di cui l'81% è avvenuto per via percutanea e il materiale biologico coinvolto è stato il sangue nell'86,3% dei casi. La lesione più frequente è stata la puntura (62,6%), provocata nel 41,1% dei casi da ago da sutura; il 46,3% degli incidenti si è verificato nel blocco operatorio. Riguardo allo stato immunitario dei MFS, il 93,7% era immune per il morbillo, il 93,3% per la varicella, l'85,4% per la rosolia e il 96,6% per epatite B. L'elevata percentuale di infortuni nei MFS può essere correlata alla minore esperienza lavorativa e alla non adeguata formazione/informazione. Il PNPV 2017-2019 raccomanda per gli OS le vaccinazioni anti-epatite B, anti-morbillo-parotite-rosolia, anti-influenzale, anti-varicella, anti-pertosse e l'offerta attiva potrebbe migliorare le coperture vaccinali tuttora sub-ottimali.