Biomedical subjects

V Puro

Publications and source records attributed to V Puro.

80 records · Page 5Linked to original sources

PubMedDate not supplied

Short-term adverse effects from and discontinuation of antiretroviral post-exposure prophylaxis.

OBJECTIVE: To evaluate short-term toxicity from and discontinuation of antiretroviral combination prophylaxis in HIV-exposed individuals in Italy. DESIGN: Longitudinal, open study conducted by prospective collection of data in the National Registry of PEP. SETTING: All the Italian centres dedicated to HIV related care and licensed by the Ministry of Health to dispense antiretroviral drugs. STUDY POPULATION: Health care workers and other persons consenting to be treated with post exposure prophylaxis (PEP) after exposures to HIV. RESULTS: Until October, 2000, 207 individuals receiving two nucleoside reverse transcriptase inhibitors (NRTIs), and 354 receiving two NRTIs plus a protease inhibitor (PI) were enrolled. More individuals experienced side-effects in the 3-drug group (53% and 62%, respectively; OR 0.68, (95% CI 0.48-0.98), p < 0.03). However, the proportion of individuals discontinuing prophylaxis because of side-effects did not differ significantly between the 2 groups (21% and 25% respectively; OR 0.82 (95% CI 0.53-1.26); p=0.4). The 43 individuals in the 2 NRTI group discontinued PEP after a mean of 10.4 days of treatment (median 8, range 1-27), similarly to the 88 discontinuations observed in the 3-drug group (mean duration 10.5 days, median 7.5, range 1-26). Type and incidence of specific adverse effects were similar to those reported in the literature. CONCLUSION: Our study indicates that the difference in the proportion of individuals developing side effects and discontinuing PEP is not significant. The rate of discontinuation because of protease inhibitor side-effects does not justify per se the initial use of a less potent PEP regimen. We suggest initiating PEP with a three-drug regimen and discontinuing the protease inhibitor in the case of adverse effects.

Anti-HIV Agents↗

PubMedDate not supplied

Risks faced by laboratory workers in the AIDS era.

Laboratory workers are at occupational risk of exposure to microrganisms that cause a wide variety of diseases, from inapparent to life-threatening ones. Principal routes of transmission include percutaneous and permucosal inoculation (comprising clinical inapparent cutaneous or mucosal exposure to blood or blood products), inhalation, and ingestion. The appearance of the Acquired Immunodeficiency Syndrome (AIDS) epidemic and the first reports of occupational Human Immunodeficiency Virus (HIV) infections in health care workers resulted in high anxiety among laboratory workers. Indeed, 21% of worldwide documented cases of occupational HIV infection occurred among laboratory workers. Research laboratories pose the highest risk of infection. Safe methods for managing infectious agents ("containment") in the laboratory setting include laboratory practice and technique, safety equipment, and facility design. Infection control in the laboratory setting should take into account adherence to guidelines (biosafety levels), education and training, and the development of safety products designed to reduce the risk of exposure.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

The model of response to viral haemorrhagic fevers of the National Institute for Infectious Diseases "Lazzaro Spallanzani".

Viral haemorrhagic fevers (VHF) are severe and life-threatening diseases caused by a range of viruses. However, only four agents of VHF are known to be readily capable of person-to-person spread: Lassa virus, Crimean/Congo haemorrhagic fever virus, Ebola and Marburg viruses. Diseases caused by these viruses are endemic only in few areas in the world, most notably Africa and some rural parts of the Middle East and Eastern Europe. Nonetheless, the increasing volume of international travel presents a greater likelihood for the importation of these infections or of suspected cases in non endemic countries. Four conditions can lead to the importation and to the subsequent recognition of VHF within Europe: 1) patients arriving as a result of a planned medical evacuation; 2) persons who became sick on route to their destination; 3) persons discovered ill when entering a country, for example during routine clinical examination at the airport; 4) persons becoming sick after their arrival. Public health implications and the risk of secondary spread of pathogens in the above reported circumstances are very different. Similarly, preparedness and response should vary. This paper summarizes the present knowledge on the four VHF capable of person-to-person spread, describes the high isolation area constructed at the Italian National Institute for Infectious Diseases Lazzaro Spallanzani in Rome to respond to the occurrence of VHF. A brief overview of procedures and equipment adopted is provided.

Disease Outbreaks↗

PubMedDate not supplied

[HIV, HBV, or HCV transmission from infected health care workers to patients].

BACKGROUND: The report of transmission of viruses, such as human immunodeficiency virus (HIV), hepatitis B virus (HBV) and hepatitis C virus (HCV), from health care workers (HCWs) to patient has alarmed public opinion with potential repercussions on health organisation. OBJECTIVES: To review available information on cases of transmission of HIV, HBV and HCV from HCW to patient reported worldwide. METHODS: A literature review was conducted with a Medline search of English language full papers, using the following key terms: HIV, HBV, HCV; healthcare workers, occupational and hospital transmission, outbreak, look back investigation. The Medline search was supplemented by a manual search using reference lists of published studies and proceedings of meetings, including some personal communications already reported in a previous review. RESULTS: Since 1972, 50 outbreaks have been reported in which 48 HBV infected HCWs (39 surgeons) transmitted the infection to approximately 500 persons. To date, 3 cases of transmission of HIV and 8 confirmed cases of transmission of HCV (to a total of 18 patients) from infected healthcare workers to patients have been reported. The factors influencing the transmissibility of infection include: type of procedures performed, surgical techniques used, compliance with infection control precautions, the clinical status and viral burden of the infected HCW and susceptibility of the patient to infection. The risk of transmission of HIV, HBV and HCV from HCWs to patients is associated primarily with certain types of surgical specialties (obstetrics and gynaecology, orthopaedics, cardiothoracic surgery) and surgical procedures that can expose the patient to the blood of the HCW: exposure-prone procedures. Since the early 90's industrialized countries have issued recommendations for preventing transmission of blood-borne pathogens to patients during "exposure prone" invasive procedures. With regard to HBV there is common consent to restricting or excluding HCWs tested HbeAg positive or HBV DNA-positive from performing exposure-prone procedures, while there are still some discrepancies in the different countries for dealing with HCV-infected personnel and in some cases also for those with HIV infection. CONCLUSIONS: Efforts to prevent surgeon-to-patient transmission of blood-borne infections should focus not only on ascertaining the infection status of the HCW but principally on eliminating the cause of blood-borne exposures, for example by the use of blunt suture needles, improved instruments, reinforced gloves, changes in surgical technique and the use of less invasive alternative procedures. These measures should be implemented in order to minimize the risk of blood exposure and consequently of virus transmission both to and from HCW to patients.

HIV Infections↗

PubMedDate not supplied

[Identification and control of workers that pose a risk to others in the health field].

BACKGROUND: Working in health care increases the probability that an impaired worker be hazardous for third persons. METHODS: A literature review concerning identification, intervention, and treatment of hazardous health care workers is here reported. RESULTS: Published reports of health care worker-to-patient transmission of bloodborne infections, and papers concerning the so-called "impaired physician", have been reviewed. DISCUSSION: According to European directives on workers' health and safety, the occupational health physician charged of medical surveillance of hospital workers is often mandated to manage impaired professionals. CONCLUSIONS: Strategies for early identification, treatment and rehabilitation of impaired physicians are reviewed and suggestions for preventive action are given.

Health Personnel↗

PubMedDate not supplied

[Critical aspects of the management of "hazardous" health care workers. Consensus document].

BACKGROUND: A worker is considered to be hazardous to others when, in the course of performing a specific work task, his/her health problems (e.g., substance dependence, emotional disorders, physical disability, transmissible diseases) pose a risk for other workers' or the public's health and safety, or begins to interfere with ability to function in profession life. The presence of certain illnesses or the fact that a health care worker is impaired because of them do not necessarily imply that he, or she, is hazardous for others. Working in health care increases the probability that an impaired worker being hazardous for others. Management of hazardous workers requires new techniques and procedures, and specific policies. OBJECTIVE AND METHODS: An interdisciplinary group of experts from medical, bioethical, legal and administrative disciplines, together with trade union and employers' representatives, is currently attempting to define a way to put prevention measures into practice in accordance with state laws and individual rights. RESULTS: A consensus document is presented, covering critical aspects such as: social responsibility of the employer, risk management, informed consent, non compliance, confidentiality, responsibility of workers, disclosure of risk to patients, non-discrimination, counselling and recovery of impaired workers, effectiveness of international guidelines. CONCLUSIONS: Occupational health professionals are obliged to adhere to ethical principles in the management of "hazardous" workers; the assessment of ethical costs and benefits for the stakeholders is the basis for appropriate decisions.

Confidentiality↗

PubMedDate not supplied

Device-specific risk of needlestick injury in Italian health care workers.

OBJECTIVES: To identify the types of medical devices causing needlestick injuries among Italian health care workers, to document the device-specific injury rates and time trends for different hollow-bore needles, and to compare injury rates from these devices with those reported in the United States. DESIGN: Longitudinal survey. SETTINGS: Twelve Italian acute care public hospitals. METHODS: Data were obtained from a multihospital surveillance database on the number of total injuries reported in each device category. Hospitals provided the corresponding number of devices used annually for each needle type. MAIN OUTCOME MEASURE: Number of needlestick injuries by type of hollow-bore needle per 100,000 devices used per year. RESULTS: A total of 2524 injuries from hollow-bore needles were reported. Disposable syringes/hypodermic needles accounted for 59.3% of injuries, followed by winged steel needles (33.1%), intravenous catheter stylets (5.4%), and vacuum-tube phlebotomy needles (2.2%). Intravenous catheter stylets had the highest needlestick injury rate (15.7/100,000 devices used), and disposable syringes had the lowest needlestick injury rate (3.8/100,000). In contrast to the other devices, the injury rate from winged steel needles increased from 6.2 per 100,000 in 1990 to 13.9 per 100,000 in 1992. CONCLUSIONS: The device-specific needlestick injury rates in Italy are similar to those reported in the United States, suggesting similar exposure experience in two countries. However, in contrast to the United States, needleless intravenous access is standard practice in Italy and thus eliminates one potential risk to Italian health workers. Implementation of safer equipment, such as shielded or retracting needles, and continuing training programs are needed to further reduce the hazards that health care workers face.

Accidents, Occupational↗

PubMedDate not supplied

Issues on antiretroviral post exposure combination prophylaxis.

Early antiretroviral chemoprophylaxis after HIV exposure can reduce the risk of transmission according to in vitro studies, animal experiments, and the results of a case control study on occupationally exposed health care workers. Additional consistent evidence comes from trials on treatment of acute infection and on prevention of vertical transmission. Combination post exposure prophylaxis (PEP) with available antiretroviral agents is recommended because of higher antiretroviral activity, and to overcome the increasing problem of resistant HIV strains. Recommendations include the addition of a second reverse transcriptase inhibitor antiretroviral agent to zidovudine for the majority of exposures and the addition of a protease inhibitor for, at least, highest risk exposures. Starting PEP as soon as possible is strongly recommended, within 1-4 hours from the exposure; the recommended duration is four-weeks. Contraindications are those specified in the package insert for each product. PEP guidelines refer to exposures occurring in health care settings. PEP can be considered in the case of rape or sexual exposure that occur in isolation in individuals committed to safe practices, as in the case of breakage of condoms in a discordant couple, or who intend to stop risk practices, as an intravenous drug user who comply to maintenance or detoxification program. PEP is not recommended in the case of injury with abandoned needles. Being the ideal PEP regimen not fully defined, there is the need to collect further information through the institution of National and International Combined PEP Registries. Because of its complexity PEP management needs high professional skills and service organisation. Moreover, the suggested guidelines can not be considered definite and post exposure policies and PEP protocols that reflect best updated practice should be ensured.

Animals↗