[Fitness for work and public health in hospital workers].

Transmission of infection to patients from health-care workers has recently become a topic in medical literature. The Centers for Disease Control (CDC) and the Society for Healthcare Epidemiology of America (SHEA) in the US, and the UK Health Departments in the UK issued guidelines for professionals performing invasive procedures who may be infected with human immunodeficiency virus (HIV) or hepatitis B virus. The Italian Istituto Superiore di Sanità (ISS) in 1999 held a Consensus Conference advocating routine mandatory testing of health-care workers and a general restriction on performing exposure-prone invasive procedures. Nevertheless, the ISS failed to identify the institution that should be responsible for these controls. Harmful behavior of health-care workers comprises not only the risk of the impact of blood-borne infections but also the impact of, for example, depression, substance missuse, side effects of medication, family problems, fatigue or lack of insight. Time and effort is required for drafting, revising and refining policy in this area. The complexity of the matter hampers the standardisation of guidelines internationally: American and British policies are hardly enforceable in the Italian context. The Italian Study Committee for the Hospital Management of Workers affected by illnesses hazardous for the public (GIS GILMaPP) here discusses the legal end ethical issues surrounding the risk of "provider-to patient" transmission of disease. The policy dilemma involving patients' rights and sick workers should be addressed on a case-by-case basis. Strenuous efforts should be made to respect ethical and legal issues, such as informed consent, confidentiality, and to avoid discrimination. There is an urgent need for the medical community to find a broad consensus that would be acceptable for both the healthcare worker and the patient.