Gerbaudo Laura, Violante B
Struttura Semplice Medico Competente, Azienda Sanitaria Ospedaliera S. Croce e Carle, Cuneo.
Med Lav. 2006 Jul-Aug;97(4):597-612.
Over the last years several mathematical methods have been proposed by The Italian Society for Occupational Health and Industrial Hygiene (SIMLII) with the aim of assessing exposure to occupational risks. The current way of assessing biological risk is based on the widely used but poorly accurate formula R = P x D. Use of more complex methods of assessment of exposure involves many problems due to: complexity and poor standardisation of micro-organisms concentration, ubiquitary diffusion of biological agents in the working environment, lack of dose-response curves, uncertainty about the existence of an effective infection threshold for many micro-organisms, etc.
In order to assess occupational exposure to biological risk in health care settings an index method was developed according to the Guidelines for health surveillance of health care workers drawn up by SIMLII.
A check-list containing the features of the two main modes of transmission of infectious diseases (blood-borne and air-borne) was applied to the wards of Cuneo Hospital. The selected variables were combined, according to the different transmission modalities, into two mathematical models producing, for each of them, a numeric value of the degree of the risk.
The cut-off values chosen to separate both the final degrees of exposure by blood-borne (mild, medium and high) or by air-borne transmission (very low, very limited, limited, medium) were statistically different (P < 0.001). The most important determinants of the differences found in the comparison between different exposure levels were: frequency of work manoeuvres at high risk of exposure and/or frequency of performance, building deficiencies, extent of application of the work and behaviour procedures, degree of training, number of occupational injuries, the occupation of physician, and, for the nursing category, duty in a medical ward. This index method seems to assure better results, both in terms of efficacy and appropriateness, compared to the methods previously used to assess biological exposure. The results justify the need for further investigation.
在过去几年里，意大利职业健康与工业卫生协会（SIMLII）提出了几种数学方法，旨在评估职业风险暴露情况。当前评估生物风险的方法基于广泛使用但准确性欠佳的公式R = P×D。由于以下原因，使用更复杂的暴露评估方法存在诸多问题：微生物浓度的复杂性和标准化程度低、生物制剂在工作环境中普遍扩散、缺乏剂量反应曲线、许多微生物有效感染阈值的存在存在不确定性等。
为了评估医疗环境中的职业生物风险暴露，根据SIMLII制定的医护人员健康监测指南，开发了一种指数方法。
一份包含传染病两种主要传播方式（血源传播和空气传播）特征的检查表应用于库内奥医院的病房。根据不同的传播方式，将选定的变量组合成两个数学模型，每个模型产生一个风险程度的数值。
为区分血源传播（轻度、中度和高度）或空气传播（极低、非常有限、有限、中度）的最终暴露程度而选择的临界值在统计学上存在差异（P < 0.001）。在不同暴露水平比较中发现差异的最重要决定因素是：高暴露风险工作操作的频率和/或执行频率、建筑缺陷、工作和行为程序的应用范围、培训程度、职业伤害数量、医生职业，以及对于护理类别，在医疗病房的值班情况。与先前用于评估生物暴露的方法相比，这种指数方法在有效性和适用性方面似乎都能保证更好的结果。结果证明有必要进行进一步调查。
