Violence against healthcare workers during the phases of the COVID-19 Pandemic: a descriptive observational study from 2018 to 2023 in the metropolitan city of Genoa (North-Western Italy)

Background: Violence against healthcare workers is an escalating public health concern, affecting the quality of care, and causing significant psychological and physical effects on healthcare professionals. This study analysed the trend in aggressions in healthcare settings in the pre-pandemic, pandemic, and post-pandemic periods.

Methods: An observational descriptive study was conducted to analyse reports of violence against healthcare workers from January 2018 to June 2023 at a Local Health Authority "ASL3" in the Liguria region of Italy. The study considered variables such as the severity of aggression, professional category involved, and location of incident. Episodes of violence were classified according to severity by means of a colour-coded system. We used multinomial logistic regression to examine any associations between the pandemic phase and the various factors, while controlling for relevant variables.

Results: The number of reported aggressions rose from 48 in 2018 to 90 in 2022, with a partial count of 35 in the first half of 2023. The pandemic phase saw a rise in incidents classified as Green codes, which accounted for 58.3%, and a significant involvement of District Services. The post-pandemic phase showed a reversion to pre-pandemic levels but with an increase in Yellow codes (5.6%). Nurses were the most frequent victims, with figures ranging from 50.8% to 95.6% over the years. The Emergency Department and Psychiatric Services emerged as the most critical settings of aggressions, with incidents recorded in these areas constituting over half of the total number. However, an increase in violence was also recorded in district healthcare settings during the post-pandemic phase.

Conclusions: There is an urgent need for comprehensive strategies for the prevention of violence in healthcare settings. The increasing trend in violence, especially during the pandemic, necessitates integrated approaches that encompass training, psychological support, security policies, and a strong organizational culture to promote safety and respect. Protecting healthcare workers is crucial to their wellbeing and the quality of healthcare delivery.