Accident Insurance Institutions Research Articles

Structured image diagnosis of vertebral body degeneration and intervertebral disc damage - Binary image criteria and comparison for systematic image analysis for occupational diseases 2108 and 2110.

Job-related limitations of earning capacity are eligible for recognition under social legislation and may be subject to compensation (see Part 1). For the recognition of an occupational disease (BK), diagnostic imaging is required as part of the legal determination procedure for occupational diseases 2108/2110 ("occupational disc disease"). The focus is on image criteria on X-ray images and MRI examinations. In a consensus paper under the guidance of the German Social Accident Insurance Institutions from 2005, the characteristic patterns are defined and explained extensively and summarized in typical occupation-related constellations. This article presents representative image examples as a reference system for expert reporting as far as the typical patterns from the consensus paper are concerned. In Part 2, comparison images with the typical findings of the vertebral bodies and intervertebral discs according to occupational diseases are systematically presented, explained, and offered as a reference system for expert assessment. The image criteria can be used as "evidence by eye" (Heuck) in the recognition procedure. · Occupational diseases are defined by the legislator in the "List of Occupational Diseases".. · For occupational intervertebral disc diseases (OD nos. 2108/2110), constellations of findings are defined.. · Within the scope of diagnostic imaging, a large number of image criteria are used.. · Part 1 explains the basics and the legal background.. · Part 2 provides the image criteria on the basis of "comparison images" as a reference catalog.. · Braunschweig R, Kildal D, Meyer-Clement M et al. Structured image diagnosis of vertebral body degeneration and intervertebral disc damage - Binary image criteria and comparison for systematic image analysis for occupational diseases 2108 and 2110. Fortschr Röntgenstr 2024; DOI: 10.1055/a-2224-9100.

Quality of patch testing patient's own material in patients with suspected occupational skin diseases throughout Germany: Interim results of the German Social Accident Insurance (DGUV) research project FB 317b.

Due to limited availability of commercial test preparations, patch testing patient's own material (POM) is of great importance to diagnose occupational allergic contact dermatitis. To assess the quality of performance and documentation of patch testing with POM in patients with suspected occupational skin diseases (OSD) in Germany. Retrospective-prospective analysis of protocols of patch tests with POM was conducted between 2013 and 2021 in patients with suspected OSD and submitted to statutory accident insurance institutions. Assessments were done by predefined criteria. Three thousand and four patch tests with POM from 460 patients were included. A full description of the POM was provided in 73.3% of all tests. The test concentration, test vehicle and pH value were documented in 74.3%, 70.5% and 42.2% of tests, for which the respective parameters were considered relevant. One hundred and sixty-one positive reactions to POM were documented. In 72%, sufficient patch testing with commercial test substances was conducted to investigate the positive reaction. In 30.4%, consecutive patch testing of all ingredients of the POM was done. The results not only show considerable shortcomings mainly in documentation but also to some extent performance of patch tests with POM in patients with suspected OSD in Germany.

The German experience with asbestos-related diseases: a failure of compensation due to the manipulation of science

The world pandemic of asbestos-related diseases results from inadequate prevention and late bans on asbestos use. For years in Germany there has been an annual average of about ten thousand new claims. Many countries deny compensation due to unsound diagnostic applications that have entered into the literature and are used to deny compensation. One such well-established incorrect scientific strategy is the use of quantifying asbestos bodies or fibers in lung tissue and setting restrictive thresholds on the findings in tissues of workers who had been exposed primarily to chrysotile which shows low bio-persistence, movement to the pleura, and rarely forms asbestos bodies. The so called one thousand asbestos body hypothesis for the diagnosis of asbestosis, originating from the German Mesothelioma Register run by the employers’ statutory accident insurance institutions, has been applied in Germany and similarly in several other western countries. As opposed to the well-substantiated hit and run phenomena that has been predominantly applied to chrysotile asbestos, low asbestos body or fiber counts in tissue had been systematically misinterpreted. This, combined with restrictive histopathology definitions, have been used for the manipulation not only of diagnostic criteria but also of science and has had an effect on laws governing compensation. The counting of asbestos bodies or fibers in human lungs should under no circumstances invalidate a qualified occupational history of exposure as the hallmark requisite tool for assessing asbestos exposure and acceptance of asbestos-related diseases in compensation schemes. An outcome suggested by this paper is the need to broaden the WHO beneficial initiative to eliminate ARD worldwide by establishment of an international board of independent scientists on remedial action that would recommend standards for acknowledgement and compensation. Such a board should be supported by national legal branches recognizing possible regional differences and initiating compliance with the recommendations.

Psychische Belastungen und berufliche Mobilitätsunfälle

Mental stress and occupational mobility accidents – What can organisations and employees do about the number one cause of death in the workplace? Mobility accidents are the most frequent cause of death in the work context. With regard to participation in road traffic, numerous risk factors in terms of technology and environment, organisation, the person and the situation are known to be psychological strains which exercise an influence on the probability of accidents. Nevertheless, traffic participation as part of the occupational activity is little considered in risk assessments and the issue of road safety plays almost no role in the organisational context. After a classification of the relevance, therefore, this overview presents a framework model for the systematic observation of hazards and the resulting mental stress in the context of occupational mobility. This is followed by an overview of the most relevant empirically proven risk factors in the context of traffic participation. Finally, a free and proven instrument of the accident insurance institutions and the German Road Safety Council for hazard assessment and the risk evaluation of organisational mobility (GUROM) is presented, as well as other measures for organisations that have been empirically proven to be successful. It is very much hoped that many readers and managerial staff in companies will be inspired and take the opportunity to do something about the number one killer in the working world. Keywords: mental stress – occupational mobility – road safety – risk assessment – GUROM

COVID-19 as an insurance case of the statutory accident insurance: occupational disease or occupational accident : Relevant knowledge for the (general and abdominal) surgeon

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic resulted in many infections with the virus and sickness due to coronavirus disease 2019 (COVID-19). Therefore, there was adramatic increase in the number of reported and recognized occupational diseases (Berufskrankheit, BK) and occupational accidents (Arbeitsunfall, AU) at the German Social Accident Insurance Institutions (BG) and accident insurance funds (Unfallkassen).The publication aims to show the differences between BK and AU and to review the current data on occupational diseases. It deals with the definitions of BK and AU, the differences in the conditions for recognition as BK or AU. Furthermore, the claims for benefits are presented. Finally, statistical key figures of the BK according to No.3101 and the AU are presented.Results (key points)-According to §7 SGBVII, AU and BK are insured events of the statutory accident insurance.-In surgery, like specifically in the rest of the healthcare system, the relevance of the SARS-CoV‑2 infection with post-COVID in personnel for occupational medical prevention and as acase to be recognized by the statutory accident insurance (BK or AU) becomes clear.-Relevant for the recognition are the duration and the intensity of the contact (local proximity) and the SARS-CoV‑2 occupational health and safety rule of 20 August 2020 essentially recognizes acontact duration of at least 15 min at aspatial distance of less than 1.5-2 m (further aspects: more intensive shorter contacts, number of verifiably infected persons in the closer activity environment or the usual personal contacts, spatial situation, work route, special constellations).-No case numbers can be elicited for the detailed presentation of the surgery setting.-There are still immense problems and challenges in the assessment of COVID-19 consequences or post-COVID as occupational disease, as numerous uncertainty factors, such as insufficiently secured knowledge about the further long-term course over the years or the widely varied symptom spectrum complicates the medical assessment of the consequences of this disease.Conclusion: the SARS-CoV‑2 pandemic is aspecial challenge for surgery with intensive patient contact and for the entire healthcare system. This caused long-lasting changes and the adequate health care as well as insurance law processing of the (case-specific) consequences might still require considerable efforts and resources.

Patient education in work-related hand eczema : Importance and challenges in health care practice

Patient education can help patients with work-related hand eczema to cope with their skin disease in an informed and responsible manner and to improve their personal skin protection behavior in everyday working and private life. Skin protection education in centers specialized in occupational dermatology is apivotal component of outpatient and inpatient individual prevention programs for individuals with work-related skin diseases provided by the statutory accident insurance institutions in Germany. Patient education should be patient-oriented and promote learning, e.g., through interactive, activating discussions and design, references to everyday life, and methodically and didactically well-prepared media and materials in clear, understandable language. Challenges may arise in educational practice, e.g., due to subjective illness perceptions, participants with alack of motivation, language barriers, functional illiteracy, or heterogeneous patient groups. In this article, different challenges are presented and educational and health psychological perspectives are discussed to meet these challenges in order to provide an optimal, patient-oriented individual prevention measure.

Trend Analysis by Risk Observation: How the German Statutory Accident Insurance Prepares for the Future in Occupational Safety and Health

BackgroundThe risk observatory (RO) of the German Social Accident Insurance (DGUV) provides strategic support to the German Social Accident Insurance Institutions (GSAII) in proactive prevention. It does so by identifying future challenges and opportunities for occupational safety and health (OSH) resulting from new trends and developments that affect employees as well as children in elementary education, pupils, and students. MethodsThe core of the RO is an online survey that relies on a pool of new trends and developments identified via internet and literature research. 865 prevention experts of the GSAII and the DGUV participated in the survey. They rated trends and developments regarding their sector-specific risks and opportunities for OSH in the 5 years to come. ResultsSector-specific and over-all results show that besides well-known OSH risks such as musculoskeletal stress and noise, developments relevant for OSH come to the fore that do not have their origin in work itself, but are strongly influenced by political, social, economic, environmental, or technical developments that accident insurance can only peripherally influence. Shortage of skilled staff was identified as a threat to OSH in almost all sectors. ConclusionsPrevention must find ways to address repercussions of such OSH risks. Cooperation and political awareness are therefore gaining in importance. Also, implementing a prevention culture in society and strengthening individuals’ health and safety literacy, e.g., by target-group-specific communication and sensitization, as well as early safety and health education, help to counteract those OSH risks.

When must the suspicion of an occupational disease or urological sequelae of an occupational accident be reported? : Legal background, medical obligations and course of the procedure

Physicians are obliged to report the suspected presence of an occupational disease to the German Social Accident Insurance Institutions or to the state authority responsible for occupational health and safety. In the field of urology, tumors of the urinary tract are the most common, followed by the less common renal cell cancer and mesothelioma of the tunica vaginalis testis; however, for such asuspicion to arise at all, sufficient knowledge of urological occupational diseases must be present and the occupational or work history over the entire training and working life since the beginning of employment must be collected. In daily life the notification often fails at this point. In addition to the legal foundation and the principal course of the procedure, this article explains how arelevant comprehensive medical history by means of questionnaires can contribute to the fact that neither too many or all tumor diseases are unreflectedly reported, nor that occupational diseases are overlooked due to the lack of a medical history or detailed knowledge (or fear of this). Urological sequelae of accidents are often not adequately appreciated in the primary process or may take along time to develop. In this case reporting the aggravation of the consequences of the accident is essential.

Development of an app-based maintenance programme to promote skin protection behaviour for patients with work-related skin diseases

Objectives: Digital interventions are increasingly used to support behaviour change. In the prevention of chronic work-related skin diseases, the sustainable implementation of appropriate skin protection behaviour following tertiary individual prevention is important. However, there exists no intervention to support the maintenance of these behaviour changes until now. We report the systematic development of a technology-based maintenance programme to support patients to sustainably implement skin protection behaviour and to overcome barriers. Design: Complex intervention development based on a five-step multi-methods process. Setting: Tertiary individual prevention of work-related skin disease in Germany. Methods: Intervention development comprised the following steps: literature review, qualitative focus groups with stakeholders, quantitative assessment of the patients’ needs, development of a programme theory, and intervention development and concept validation. Results: We developed a concept for a complex intervention based on results from the literature review, with seven reviews meeting the criteria; qualitative focus groups involving three dermatologists, five health educators, two psychologists and three employees of an accident insurance institution; and a quantitative needs assessment with 72 patients. Key requirements were derived from this process: for example, the need to develop an app to self-monitor skin protection behaviour and skin condition and to inform the individual about ways of dealing with barriers encountered during the uptake and maintenance of skin protection behaviour. In addition, patients will participate in an individual goal-setting exercise to identify individual behavioural goals. Conclusion: A technology-based approach to the prevention of work-related skin diseases was developed. During the process of development, the perspectives of relevant stakeholders and the target group were considered in a participatory way.

Das beruflich bedingte Harnblasenkarzinom – Die BK 1301-Matrix als Algorithmus und Entscheidungshilfe für eine Zusammenhangsbegutachtung

Work-related bladder cancer – The BK 1301 matrix as an algorithm and decision aid in the context of an assessment of an occupational disease The risk of developing bladder cancer can be influenced by various occupational and non-occupational risk factors. These need to be evaluated in the context of an assessment of an occupational disease according to no. 1301 (BK 1301: Mucosal changes, cancer and other neoplasms of the urinary tract (hereinafter referred to as “bladder cancer”) caused by aromatic amines) of the Annex to the Ordinance on Occupational Diseases. The BK 1301 matrix presented here for the assessment of the causal relationship in urinary bladder cancers after proven and relevant occupational exposure to carcinogenic aromatic amines was derived as a convention by a working group, based on the results of a workshop with more than 230 participants. It can be applied even in the absence of an individual cumulative exposure dose. The decision matrix is intended to support experts experienced in occupational medicine in the field of BK 1301 in the assessment procedure. It also provides an overview of relevant aspects of work-related bladder cancer for the purposes of accident insurance institutions and courts. The BK 1301 matrix includes occupational indicators such as exposure duration, exposure frequency and exposure intensity, as well as the age of onset, the latency period and competing non-occupational risk factors such as smoking behaviour. Based on the BK 1301 matrix, the relevant arguments favouring or refuting a causal occupational relationship in the individual case can be evaluated in detail by the occupational physician, resulting in a recommendation for or against recognition of the bladder cancer as an occupational disease. This notwithstanding, the decision as to whether an occupational disease is indeed present is ultimately an administrative act of the responsible accident insurance institution, which may be subject to review by the social courts. Keywords: expert opinion – occupational disease 1301 – bladder cancer – aromatic amines – matrix – convention

COVID-19 als Berufskrankheit und Arbeitsunfall – Analyse der gemeldeten und anerkannten Fälle der Deutschen Gesetzlichen Unfallversicherung

COVID-19 as an occupational disease and work-related accident – Analysis of reported and recognised cases handled by German Social Accident Insurance (DGUV) Objectives: This article analyses the number of cases of occupational disease (OD) and work-related accidents in connection with COVID-19 reported to all accident insurance funds (UVT) in Germany and duly recognised as claims. Methods: The analysis covers data from a special survey of the German Social Accident Insurance (DGUV), the umbrella association of the accident insurance institutions for the industrial and public sectors (the BGs and the public-sector accident insurers respectively), and routine data from the social accident insurance provider for the health and welfare sector (BGW). In the case of the BGW data, we present the COVID-19 cases per 1,000 full-time equivalents (FTE) separated by sector. Results: Since the beginning of the pandemic, the UVT have registered 202,945 cases related to COVID-19 and recognised 121,027 of these as insurance claims. Most reports related to an OD (83.3 %). The most affected UVT is the BGW, with 59.7 % of all reported cases. On average, 24.05 OD per 1,000 FTE were reported to the BGW. Clinics and nursing homes had the highest rates (53.9 and 46.7 OD per 1,000 FTE). Nursing and kindergarten jobs, typically held by women, accounted for 77 % of reports to the BGW. Nurses accounted for 71.2 % of insured persons treated in hospital and 44.8 % of deaths. Conclusion: The number of reported cases of COVID-19 recognised as insurance claims is high. The UVT are affected to varying degrees. The BGW is the most affected. The infection risk for nurses, a predominantly female job, is particularly high. Provision and compensation for insured persons will continue to be a major challenge over the next few years due to the potential long-term adverse effects of COVID-19. Keywords: COVID-19 – health protection – occupational disease – work-related accident

Sleep duration and sleep difficulties as predictors of occupational injuries: a cohort study

Study objectivesTo examine the association between sleep duration and sleep difficulties with different types and causes of workplace and commuting injuries.MethodsThe data were derived from the Finnish Public Sector study...

Studie zur Umsetzung und Akzeptanz des SARSCoV- 2-Arbeitsschutzstandards und der SARS-CoV-2- Arbeitsschutzregel für einen erfolgreichen Infektionsschutz im Unternehmen

Study of the implementation and acceptance of the SARS-CoV-2 occupational safety and health standard and the SARS-CoV-2 occupational safety and health rules for successful infection control in companies Objectives: This study is intended to provide insights into the real-life implementation of SARS-CoV-2-related occupational safety and health (OSH) measures in German companies. It should also help to identify possible perspectives for further measures to improve the approach of the German accident insurance institutions in comparable situations and to reduce the burden on employees. Methods: Between December 2020 and May 2021, we conducted an online survey on the implementation of SARS-CoV-2 OSH measures. With the help of various German Social Accident Insurance Institutions, we recruited 344 OSH professionals and 92 other people with OSH responsibility from the public sector, industrial, financial, retail and local public transport sectors, and analysed their responses. Results: Most OSH professionals are familiar with SARS-CoV-2 OSH standards, SARS-CoV-2 OSH rules and sector-specific supplements. In only very rare exceptions (1 %) were the employees not informed of preventive and occupational safety measures that had been initiated. Sector-specific differences were particularly evident in contact reduction measures and the stockholding of protective equipment. The increase in mobile working and the greater use of digital communication media were cited as major longterm consequences of the pandemic on future work types. Conclusions: This study confirms that the importance of occupational and infection protection has increased in the SARS-CoV-2 pandemic. Many companies took infection control measures early in the pandemic. Keywords: coronavirus – COVID-19 – SARS-CoV-2 pandemic – preventive measures – occupational safety and health professionals

COVID-19 with respect to occupational healthcare and public health services

HintergrundMedizinisches Personal hat ein arbeitsbedingtes Risiko für eine Infektion mit dem „severe acute respiratory syndrome coronavirus 2“ (SARS-CoV‑2) und kann COVID‑19 auf Patienten übertragen. Bei der zugehörigen Berufskrankheit handelt es sich um die BK 3101.FragestellungHäufigkeit von Verdachtsmeldungen berufsbedingter SARS-CoV-2-Infektionen und anerkannter COVID-19-Berufskrankheiten, Meldepflichten nach Infektionsschutzgesetz (IfSG) und Anzeigepflichten des Arztes.Material und MethodenSelektive Literaturrecherche unter besonderer Berücksichtigung von Daten der Unfallversicherungsträger zu arbeitsbedingten SARS-CoV-2-Infektionen des medizinischen Personals.ErgebnisseDie SARS-CoV-2-Pandemie stellt sich auch als Herausforderung der Arbeitsmedizin und des Öffentlichen Gesundheitsdienstes (ÖGD) dar. In den letzten Monaten wurden bei den Unfallversicherungsträgern im Zusammenhang mit COVID-19 vermehrt Verdachtsfälle einer Berufskrankheit (BK 3101) sowie eine steigende Zahl von Arbeitsunfallmeldungen registriert. Der ÖGD bearbeitet die Meldungen gemäß dem IfSG und koordiniert die Kontaktpersonennachverfolgung.SchlussfolgerungenArbeitsbedingte SARS-CoV-2-Infektionen geben Anlass zur Sorge. Die Meldedaten der Unfallversicherungsträger belegen hohe Fallzahlen. Präventive Maßnahmen, z. B. das Tragen der persönlichen Schutzausrüstung (PSA) und COVID-19-Impfungen, reduzieren sowohl das Infektionsrisiko der Beschäftigten signifikant als auch das Risiko einer nosokomialen Übertragung auf die Patienten.

Dokumentierte Risiken beim Einsatz von Desinfektionsmitteln

Documented risks when using disinfectants Objectives: Description of the occurrence of diseases through the use of disinfectants based on the data of the occupational disease routine database (BK-DOK) of the German Social Accident Insurance Institution for the health and welfare services (BGW) for the period from 2010 to 2019. Methods: An evaluation was carried out of the available data from the BK-DOK of the BGW on various diseases caused by chemical substances (BK 13xx), obstructive respiratory diseases (BK 4301/02) and skin diseases (BK 5101), which are possibly related to disinfection activities. The data covers the period from 2010 to 2019. The analysis drew a distinction between the 15 sectors of the BGW, the type of decision and the triggers for an occupational disease. Only decided cases were considered. Results: In the 10-year period, 81,960 cases of the selected occupational diseases were decided. Of these decisions, 92.2 % concerned BK 5101, 6.6 % BK 4301/02 and 1.2 % BK 13xx. Disinfectants were not documented as job-related reasons for the development of systemic diseases and only marginally for obstructive respiratory diseases. Disinfectants and wet work were documented as decisive influencing factors on the development of skin diseases. Conclusions: Skin diseases in particular occurred when handling disinfectants. This is attributed, on the one hand, to influences from the disinfectants themselves and, on the other hand, to the wet work caused by them. This was not only a problem in the health care sectors but affected every sector of the BGW. Increased prevention work and diligent risk assessment for disinfection and wet work are decisive factors in the reduction of occupational disease cases. Keywords: documentation of occupational diseases – disinfectants – wet work – skin diseases

Teilnahmebereitschaft für Maßnahmen der Sekundärprävention. Einflussfaktoren am Beispiel des BGW-Rückenkollegs

Willingness to participate in prevention programmes. Key factors based on the example of the BGW back school Objectives: Employees in nursing professions run a high risk of back-related disorders. The German Social Accident Insurance Institution for the health and welfare services (Berufsgenossenschaft für Gesundheitsdienst und Wohlfahrtspflege – BGW) has developed a multi-stage programme of secondary individual prevention (SIP) with a back clinic, back school and refresher course in order to counteract the cause of occupational diseases of the lumbar spine. The aim of the study was to identify what factors influence the willingness to participate in these programmes. Methods: The study is based on data from 1011 participants who attended the back clinic at the Hamburg regional office of the BGW between 2012 and 2019. They were collected by means of a standardised questionnaire and an orthopaedic examination. The evaluation was based on a t-test for independent samples and the Levene test, which was used to verify the homogeneity of variance. Results: It was found that increasing age and a higher number of years in the job results in a significant increase of willingness to participate. At the same time, a higher level of BMI and the number of non-back disorders both have a significant inhibitory impact on participation. Conclusions: The use of preventive programmes will increase in terms of relevance. General state of health is a key factor in whether or not programmes are used by potential participants. Finally, the overall objective should be to develop solutions that encourage the willingness to participate even in the early stages of working life. Keywords: lumbar spine – prevention – back clinic – back school

Ärztliches Meldeverhalten von Berufskrankheiten in Österreich am Beispiel Mesotheliom

Reporting of occupational diseases by physicians in Austria based on the example of mesothelioma Background: Physicians and employers in Austria have a duty to report the well-founded suspicion of the existence of an occupational disease to the responsible accident insurance institution. In particular, an occupational disease report must be made as a matter of principle in the case of mesothelioma, which is highly likely to be caused by job-related exposure to asbestos. Methods: In the pilot study, the available data on mesothelioma cases from Statistics Austria (StatAT) were compared with the corresponding cases of the General Accident Insurance Institution (AUVA) that were recognised as an occupational disease during the period from 2004 to 2016. Results: The results show that during the period under observation only about 40% of the mesothelioma cases registered by StatAT were recognised by AUVA as an occupational disease. There are some significant differences in the recognition rate if the cases of disease are differentiated according to the individual federal states of Austria where the enterprises are located in which the mesothelioma cases have occurred. Conclusions: The reasons for the relatively low recognition rate of mesothelioma cases in Austria can be complex. It is most likely that the relatively low recognition rate is related to poor reporting practice on the part of physicians. In order to improve this situation, appropriate information campaigns should be carried out among physicians in Austria. Keywords: occupational disease – cancer – mesothelioma – occupational disease report

Medical expert opinion of occupational illness using the example of pneumological diseases

Orders for medical expertise reports of the accident insurance institutions and the social courts often have very difficult and complex issues and therefore require a high level of medical expertise as well as occupational health and accident insurance law knowledge. This applies in particular to the expert opinion as to whether a causal connection exists between occupational effects and the disease. Causality must be described on the basis of the current state of medical and scientific knowledge in such a way that it is comprehensible for an accident insurance institution or for a court. The insured person himself should also be able to comprehensively understand the content of the opinion and its consequences.

BK3101-infectious diseases

Health care workers (HCW) are at risk of occupational exposure to infectious diseases and can also transmit diseases to their patients. The related occupational disease (BK: "Berufskrankheit") is BK3101. Number of claims and confirmed claims of occupational infections, risk of infection depending on occupation and field of activity, kind of infectious diseases, limits and opportunities of prevention. Selective literature search, particularly on data of accident insurance institutions regarding occupational infections among HCW. In 2017, BK3101 was the fifth most common cause of confirmed occupational disease. The number of occupational infections in HCW has decreased over the last 22years in Germany. The decrease was primarily due to lower rates of blood-borne infections. Occupational infections continue to be arisk for HCW. Preventive measures reduce the risk of infection among HCW as well as the nosocomial transmission among patients.

A decision support system for prevention and costing of occupational injuries

Shrinking budgets and decreasing economic growth force accident insurance institutions to focus on cost reduction programmes as well as on prevention measures. For this reason, we developed sophisticated decision support systems (DSSs) from 2001 to 2012 during three projects for the main of the four largest Austrian accident insurance institutions (Allgemeine Unfallversicherungsanstalt, AUVA), to support their policy makers three-fold. First, we apply complex calculation schemes with an underlying population model to predict short-term and long-term occupational accident costs on an individual case basis for the AUVA using micro-simulation. Second, a further analysis of these costs allows AUVA policy makers to define risk groups which is essential to derive prevention programmes and their corresponding budgets (e.g., utilization of personal protective equipment, improvement of transportation safety, enhancement of safe driving). Third, we reveal possible improvements in collecting and structuring data for the AUVAs data warehouse for better forecasting of subsequent occupational accident costs and the underlying risk groups. Beyond the focus on AUVA interests, we integrated main cost components for companies where casualties are working (e.g., continued remuneration) and for the economy (loss in productivity for professional/non-professional work, sickness benefit). As a main result of our DSS for all three projects from 2001 to 2012, protection clothes or specific timing of working breaks decrease costly accidents. The results of the first two project periods (2001-2005) helped reduce risks of falling, while the third project (2011-2012) pointed out to focus on traffic injuries in the next years. In the future, AUVA should focus on prevention strategies in the following industries: preparatory site operations, building installation, and other finishing trades.