Einleitung Durch die SARS-CoV-2-Pandemie hatten besonders Beschäftigte im Gesundheitsdienst ein erhöhtes Infektionsrisiko. COVID-19 kann auch nach einem asymptomatischen oder milden Verlauf zu längerfristigen Beschwerden oder starken gesundheitlichen Einschränkungen führen. Ziel der Studie ist die Erfassung von Erkrankungsverläufen und Langzeitfolgen von COVID-19.

Prevention of adverse skin reactions among nursing staff through the use of personal protective equipment during the COVID-19 pandemic Objectives: The aim of the study was to investigate the prevalence and influencing factors for adverse skin reactions (ASR) due to occupational PPE use among nursing staff in Germany during the COVID-19 pandemic. Methods: The study uses a mixed methods design. A focus group was created with experts from the field of healthcare, and an online survey was then carried out among nursing staff. Influencing factors were identified using multivariate logistic regression via odds ratios with 95 % confidence intervals. Results: A total of 2274 nursing staff took part in the survey, with 1967 included in the analysis. The prevalence of ASR was 61 %, with the great majority of subjects reporting having developed at least one adverse skin reaction on the face (94 %). Statistically significant predictors of the more frequent developing of new adverse skin reactions were the wearing of FFP masks for four or more hours, being female and younger, and a known contact allergies. A pre-existing skin disease had a protective effect. Conclusions: The prevalence of PPE-related ASR underlines the necessity for targeted preventive measures for nursing staff during pandemic situation. Keywords: healthcare worker – COVID-19 – personal protective equipment (PPE) – adverse skin reactions – pandemic

Der folgende Beitrag beschreibt eine Studie zur Häufigkeit von Hautirritationen durch das Verwenden von persönlicher Schutzausrüstung während der Covid-19-Pandemie in Deutschland. Wie belastet ist das Pflegepersonal? Welche Empfehlungen zur Prävention werden diskutiert?

Introduction: Health Workers (HW) have an increased risk for SARS-CoV-2 infection. With effective vaccines available since the end of 2020 and most HW in Germany vaccinated by now, this burden is mitigated but does still exist. In particular, high hygiene standards need to remain implemented to protect HW and patients. The increased use of hand washing, disinfections, and personal protective equipment (PPE) might increase the risk for skin diseases in HW. For this presentation, we analysed claims for occupational diseases (OD) concerning COVID-19 and skin diseases and we report results of a survey on skin irritation because of PPE during the pandemic in HW in Germany. Materials and Methods: The BGW is a compensation board for work related diseases in HW. Claims of ODs of the BGW concerning SARS-CoV-2 infections were analysed since the beginning of the pandemic in March 2020. An online survey concerning skins irritation was carried out with the support of a professional nursing association. The survey was completed by 1.500 nurses or 10 % of those invited. Results: About 80.000 COVID-19 cases are confirmed as OD. About 100 HW died because of COVID-19 and about 1.500 were hospitalized or need long-term rehabilitation. The number of ODs because of skin diseases did not increase during the pandemic. However, 280 claims because of skin irritations of the face or head were filled. Irritation of the skin because of wearing masks was reported by 60 % of the survey participants. Conclusions: The burden of COVID-19 in HW is high. Protection of HW is important but might cause skin irritation, which also need to be taken care of.

Health workers are at increased risk for SARS-CoV-2 infections. What follows the acute infection is rarely reported in the occupational context. This study examines the employees' consequences of COVID-19 infection, the risk factors and the impact on quality of life over time. In this baseline survey, respondents were asked about their COVID-19 infection in 2020 and their current health situation. Out of 2053 participants, almost 73% experienced persistent symptoms for more than three months, with fatigue/exhaustion, concentration/memory problems and shortness of breath being most frequently reported. Risk factors were older age, female gender, previous illness, many and severe symptoms during the acute infection, and outpatient medical care. An impaired health-related quality of life was found in participants suffering from persistent symptoms. Overall, a high need for rehabilitation to improve health and work ability is evident. Further follow-up surveys will observe the changes and the impact of vaccination on the consequences of COVID-19 among health workers.

Background Hepatitis C infections (HCV) are associated with an increase in morbidity and mortality. The aim of this study is to update the results of treatment with direct-acting antiviral agents (DAAs) using a larger population of healthcare personnel (HP) and a longer observation period. Methods Secondary data analysis of DAA treatment administered to HP (with confirmed occupational acquired HCV infection) between 1 January 2014 and 30 December 2018, is based on statutory accident insurance data from Germany. The end points of the study were results of a monitoring carried out 12 and 24 weeks after the end of treatment (sustained virological response, SVR), as well as side effects and the assessment of reduced work ability after treatment. Multivariate logistic regression models were constructed to investigate predictors of SVR. Results The study population (n = 305) mainly comprised HP with a genotype 1 infection. The average age was 63 (SD 10) and 77% were female. Two thirds of the HP suffered from fibrosis or cirrhosis, and had experience of treatment. Statistically, men were significantly more likely to suffer from cirrhosis than women (60% compared to 21%, p < 0.001). The end-of-treatment response (ETR) rate was 99% and the SVR12 and SVR24 rates were 98%. Liver cirrhosis proved to be a predictor of a statistically significant reduction in success rates. Conclusion DAA treatment leads to high SVR. Early HCV treatment is associated with higher SVR.

Zusammenfassung Hintergrund Für Beschäftigte in Küchenbetrieben liegen nur wenige Daten zum Arbeitsunfall- und Berufskrankheitengeschehen für Deutschland vor. Für eine differenzierte Analyse wurden Routinedaten der Berufsgenossenschaft für Gesundheitsdienst- und Wohlfahrtspflege (BGW) genutzt. Methoden Eingeschlossen wurden Versicherte, die als Küchenhilfe oder Koch tätig waren und für die ein Arbeitsunfall oder eine Verdachtsanzeige auf eine Berufskrankheit (BK) bei der BGW zwischen 2008 und 2017 gemeldet wurde. Die Ergebnisse wurden für die Berufsgruppen deskriptiv beschrieben und Gruppenunterschiede mittels Chi-Quadrat-Test überprüft. Ergebnisse Rund 70 % der Unfälle und BK-Anzeigen stammten von Küchenhilfen, 30 % von Köchen. Küchenhilfen verletzten sich häufiger bei Stolperunfällen und beim manuellen Transport von Gegenständen als Köche. Fast die Hälfte der Unfälle von Köchen wurde durch die Handhabung von Messern verursacht und knapp 17 % durch Verbrennungen. BK-Verdachtsanzeigen auf eine Hauterkrankung machten in beiden Gruppen jeweils über 80 % aus. Bandscheibenbedingte Erkrankungen der Lendenwirbelsäule hatten einen Anteil von 5 % und obstruktive Atemwegserkrankungen von 3 %. Der BK-Verdacht wurde in 78 % bestätigt, in den meisten Fällen handelte es sich um Hauterkrankungen, ausgelöst durch Feuchtarbeit, Desinfektions- oder Reinigungsmittel. Diskussion Schnittverletzungen und Stolperunfälle werden auch von anderen Autoren als Unfallschwerpunkte in Küchenbetrieben beschrieben. Das BK-Geschehen wurde überwiegend durch Hauterkrankungen bestimmt, das in diesem Ausmaß von anderen Autoren nicht berichtet wird. Berichtet werden vielmehr hohe Prävalenzen für muskuloskeletale Beschwerden im Bereich von Schulter und Hand, für die sich in den hier vorliegenden Daten keine Belege fanden.

Background Only few data are available on work-related accidents and occupational diseases for kitchen workers in Germany. Routine data based on claims data from the Occupational Accident Insurance for Healthcare and Welfare Services (BGW) were used for a differentiated analysis. Methods The analysis included BGW claims data between 2008 and 2017 for kitchen helpers and cooks with notification of a work-related accident or a suspected occupational disease. Descriptive statistics were used for occupational groups and group differences were evaluated using a chi(2)-test. Results Around 70% of the accidents and notifications of suspected occupational diseases were from kitchen helpers and 30% from cooks. Kitchen helpers were more often injured by stumbling accidents and in the manual transport of objects than cooks. Almost half the accidents suffered by cooks were associated with handling knives and almost 17% with burns. In both groups more than 80% of the suspected occupational diseases were skin diseases and 5% were diseases associated with lumbar disc problems caused by the lifting and carrying heavy loads. Just under 3% were obstructive airway diseases. The occupational disease was confirmed in 78% of cases, which were mostly skin diseases caused by working with fluids, disinfectants or cleaning agents. Discussion Incision wounds and stumbling accidents are also described by other authors as the most common accidents among kitchen workers. Most occupational diseases among kitchen workers in health services were skin diseases but similar prevalence rates have not been reported by other authors. In contrast, a high prevalence of musculoskeletal symptoms in the shoulders or hands have been reported for which no evidence was found in the present data.

Around 1% of the world’s population is infected with hepatitis C. The introduction of new direct-acting antiviral agents (DAAs) in 2014 has substantially improved hepatitis C treatment outcomes. Our objective was to evaluate the long-term cost effectiveness of DAAs in health care personnel (HP) with confirmed occupational diseases in Germany. A standardised database from a German statutory accident insurance was used to analyse the cost-effectiveness ratio for the DAA regimen in comparison with interferon-based triple therapies. Taking account of the clinical progression of the disease, a Markov model was applied to perform a base case analysis for a period of 20 years. The robustness of the results was determined using a univariate deterministic sensitivity analysis. The results show that treatment with DAAs is more expensive, but also more effective than triple therapies. The model also revealed that the loss of 3.23 life years can be averted per patient over the 20 years. Compared to triple therapies, DAA treatment leads to a higher sustained virologic response (SVR). Although this results in a decrease of costs in the long term, e.g., pension payments, DAA therapy will cause greater expense in the future due to the high costs of the drugs.

The aim of this study was to research the impact of inpatient rehabilitation on work ability and health-related quality of life factors for healthcare personnel (HP) with chronic hepatitis B and C virus (HBV and HCV) infection. A prospective evaluation study with three data collection times without an external control group was conducted. HP (n = 163) with an occupational acquired chronic hepatitis B/C infection who participated in an inpatient rehabilitation program were surveyed. Information was collected on work ability (WAI—Work Ability Index), quality of life (SF-36—Short Form-36 Health Survey), and anxiety and depression-related symptoms (HADS-D—Hospital Anxiety and Depression Scale). The majority of participants had HCV infection. Work ability was poor, improved significantly until the end of treatment, and remained at a moderate level six months later. The SF-36 showed no change in physical health over the study period, the results regarding mental health were in the average range with a significant improvement directly after intervention. The HADS-D results indicate noteworthy anxiety and depression symptoms during the study period. The inpatient rehabilitation program proved to be effective in the short term regarding mental health (SF-36) and WAI. To ensure long lasting positive results, services aimed at enhancing physical and mental health should be provided as early as possible and on a recurring basis.

Hepatitis C Virus (HCV) infections are blood-borne, generally chronic and are associated with increased morbidity and mortality. The aim of this study is to describe the results of therapies with direct-acting antiviral agents (DAAs) in healthcare personnel.

Introduction Healthcare personnel (HCP) have a risk of hepatitis C infection (HCI). Chronic HCI is associated with significant morbidity and mortality. The aim of this study is to describe the cost for occupationally-caused HCI based on data from an accident insurance carrier. Methods The secondary data analysis used the database of the German Institution for Statutory Accident Insurance and Prevention in the Health and Welfare Services. The analysis is based on a sample of HCP whose HCI were registered as occupational diseases (OD) between 1996 and 2013. Incurred cost was calculated for the period between 1 January 2000 and 31 December 2014. Result The number of registered ODs declined by 86% within the study period. A total of 1.121 ODs were registered. The majority was female, older than 40 years and medical nursing professionals. In the study period, the cost came to a total of € 87.9 million, of which 60% was attributable to pension payments (€ 51,570,830) and around 15% was attributable to medical treatment (€12,978,318). Expenses for drugs increased in 2012 (from around € 500,000–8 00 000 to € 1.7 million) and 2014 (to € 2.5 million). Pension payments came to € 1.6 million in 2000 and rose continuously to over € 4 million in 2014. Expenses for occupational rehabilitation accounted for less than 1%. Discussion For HCI as an OD, an increase in cost has been observed in recent years, while the number of registered cases has declined. This rise in cost is explained by the increase in pension payments and, since 2012, by a rise in the cost for drugs. In future the high cost of anti-viral therapies is potentially compensated by treatment benefits and savings for pension payments.

To estimate the prevalence of latent tuberculosis (TB) infection (LTBI) in Italian dental students exposed to the same occupational risks as dental health care personnel and to evaluate potential risk factors, a cross-sectional study was conducted on undergraduate and postgraduate students. After clinical evaluation, students were given a tuberculin skin test; in those found positive, an interferon-γ release assay (IGRA) was conducted. Of the 281 students enrolled, 10 were only TST positive; 8 were TST or/and IGRA positive. We found that participants testing positive at TST and/or IGRA, a group in which the risk of false LTBI positives is minimal, were older and had been studying longer. Although the prevalence of LTBI among dental students in our study was low, a risk of acquiring a work-related infection exists even in a country with a low incidence of TB. Thus, dental students should be screened to catch LTBI early on.

Hepatitis C infection is a global public health issue. Chronic hepatitis C infection is associated with significant morbidity and mortality. The aim of this study is to describe the costs for occupationally-cased hepatitis C infections based on data from an accident insurance carrier.

IntroductionThe aim of this review was to record systematically and assess the published literature relating to the occupational risk of influenza A (H1N1) infection among healthcare personnel during the 2009 pandemic.MethodsThe literature search was performed in June 2015. An update was carried out in May 2016. It was applied to the electronic databases EMBASE, MEDLINE, PsycINFO, PubMed, CINAHL and Google Scholar. The quality assessment was conducted with a tool using eight criteria. A meta-analysis was carried out to compute pooled effect estimates for influenza A (H1N1) infection.ResultsA total of 26 studies were included in the review, 15 studies met the criteria for the meta-analysis. After a sensitivity analysis the pooled analysis showed a significantly increased odds for influenza A (H1N1) infection for healthcare personnel compared to controls/comparisons (OR = 2.08, 95% CI = 1.73 to 2.51). The pooled prevalence rate for healthcare personnel alone was 6.3%.ConclusionsThis review corroborates the assumption that healthcare personnel were particularly at risk of influenza A (H1N1) infection during the 2009 pandemic. Healthcare facilities should intensify their focus on strategies to prevent infections among healthcare personnel, especially during the first period of pandemics.

The aim of this study was to estimate the prevalence of viral hepatitis C (HCV) infection among healthcare workers (HCWs) compared to the general population. A systematic search for the years 1989-2014 was conducted in the Medline, Embase and Cochrane databases. Studies on hepatitis C in HCWs were included if they incorporated either a control group or reference data for the general population. The study quality was classified as high, moderate or low. Pooled effect estimates were calculated to determine the odds of occupational infection. Heterogeneity between studies was analysed using the χ(2) test (p<0.10) and quantified using the I(2) test. 57 studies met our criteria for inclusion and 44 were included in the meta-analysis. Analysis of high and moderate quality studies showed a significantly increased OR for HCV infection in HCWs relative to control populations, with a value of 1.6 (95% CI 1.03 to 2.42). Stratification by study region gave an OR of 2.1 in low prevalence countries; while stratification by occupational groups gave an increased prevalence for medical (OR 2.2) and for laboratory staff (OR 2.2). The OR for professionals at high risk of blood contact was 2.7. The pooled analysis indicates that the prevalence of infection is significantly higher in HCWs than in the general population. The highest prevalence was observed among medical and laboratory staff. Prospective studies that focus on HCW-specific activity and personal risk factors for HCV infection are needed.

BACKGROUND:Occupational risks for carpal tunnel syndrome (CTS) have been examined in various occupations, and several systematic reviews (SRs) have been published on this topic. There has been no critical appraisal or synthesis of the evidence in the SRs. The aims of this study are (1) to synthesise the observational evidence and evaluate the methodological quality of SRs that assess the effect of biomechanical risk factors on the development of CTS in workers, (2) to provide an update of current primary research on this association, (3) to assess a potential dose-response relationship.METHODS:We searched MEDLINE, EMBASE, CINAHL, the Cochrane Library and the reference lists of articles. The first step covered SRs (1998-2014), and the second step covered current primary studies (2011-2014). The methodological quality of the SRs was evaluated by using the AMSTAR-R tool; primary studies were assessed using a list of 20 items. A qualitative approach was used for synthesising evidence. In addition, we undertook a meta-analysis of the primary studies to determine risk ratios in the dose-response relationship.RESULTS:We identified ten SRs that covered a total of 143 original studies. Seven primary studies met the criteria for inclusion, of which four provided longitudinal data. We found high quality of evidence for risk factors such as repetition, force and combined exposures. Moderate quality of evidence was observed for vibration, and low quality of evidence was found for wrist postures. An association between computer use and CTS could not be established. Recent primary studies supported the existence of a significant relationship between CTS and repetition, force and combined exposure. The meta-analysis of current research revealed a dose-response relationship between CTS and the American Conference of Governmental Industrial Hygienists' (ACGIH) threshold limit value (TLV) for hand-activity level (HAL). Those between the action limit and TLV and above TLV had RR of 1.5 (95% CI 1.02-2.31) and RR 2.0 (95% CI 1.46-2.82), respectively.CONCLUSIONS:Occupational biomechanical factors play a substantial role in the causation of CTS. Data from current primary studies on dose-response suggest that the risk of CTS increases with the ACGIH TLV levels.

BACKGROUND:The development of a vaccine against hepatitis B virus (HBV) has been a major achievement in terms of prevention of HBV infection. For the present study, we analysed the long-term immunogenicity and effectiveness of HBV vaccination among healthcare students with different working seniorities.METHODS:A cross-sectional study of undergraduate and postgraduate students attending the Medical School of the Second University of Naples was conducted between September 2012 and December 2014. HBV serum markers were determined and multivariate logistic regression analysis was used to identify factors associated with the level of long-term immunogenicity.RESULTS:Of the 2,932 subjects evaluated, only 33 (1.1 %) declared no history of vaccination. All vaccinated subjects were HBsAg/anti-HBc negative, 459 of which had an anti-HBs titre <10 IU/L. The latter were younger, more likely to be attending a healthcare profession school (i.e., dental hygienists, nursing, paediatric nursing, radiography and midwifery) than a medical school (at either undergraduate or postgraduate level) and more likely to have been vaccinated in infancy.CONCLUSION:The results of this study suggest that assessment of HBV serum markers in workers potentially exposed to hospital infections is useful to identify small numbers of unvaccinated subjects or vaccinated subjects with low antibody titre, all of whom should be referred to a booster series of vaccinations.

Background: Staff providing inpatient elderly and geriatric long-term care are exposed to a large number of factors that can lead to the development of burnout syndrome. Burnout is associated with an increased risk of absence from work, low work satisfaction, and an increased intention to leave. Due to the fact that the number of geriatric nursing staff is already insufficient, research on interventions aimed at reducing work-related stress in inpatient elderly care is needed.Objective: The aim of this systematic review was to identify and analyse burnout intervention studies among nursing staff in the inpatient elderly and geriatric long-term care sector.Methods: A systematic search of burnout intervention studies was conducted in the databases Embase, Medline and PsycNet published from 2000 to January 2012.Results: We identified 16 intervention studies. Interventions were grouped into work-directed (n = 2), person-directed (n = 9) and combined approaches (work- and person-directed, n = 5). Seven out of 16 studies observed a reduction in staff burnout. Among them are two studies with a work-directed, two with a person-directed and three with a combined approach. Person-directed interventions reduced burnout in the short term (up to 1 month), while work-directed interventions and those with a combined approach were able to reduce burnout over a longer term (from I month to more than I year). In addition to staff burnout, three studies observed positive effects relating to the client outcomes. Only three out of ten Randomised Control Trials (RCT) found that interventions had a positive effect on staff burnout.Conclusion: Work-directed and combined interventions are able to achieve beneficial longer-term effects on staff burnout. Person-directed interventions achieve short-term results in reducing staff burnout. However, the evidence is limited. (C) 2012 Elsevier Ltd. All rights reserved.