Catheter associated urinary tract infection (CA-UTI) incidence in an Internal Medicine Ward of a Northern Italian Hospital.

Catheter-associated urinary tract infections (CA-UTI) are estimated to be the most frequent nosocomial infections (40%). A catheter is introduced to 10-25% of inpatients, and is often left on site for a long period of time. We carried out a prospective study on inpatients of our Internal Medicine ward to assess the incidence of CA-UTI under the implementation of corrective action. All inpatients who underwent introduction of a urinary catheter upon or after admission to our ward were included in the study. Patients with bacteriuria or positive urine culture before catheterization, others with less than 24 hours catheterism, or bearing a catheter on admission were all excluded from the study. CA-UTI diagnosis was assessed on the basis of CDC 2009 guidelines. The investigation was held between June 2010 and March 2013 in five steps or phases. In the first phase open circuit drainage catheterism was used, in the second phase close circuit drainage catheterism was introduced, while in the third phase disposable lubrification was added to closed circuit drainage catheterism. In the next step (phase 4) we introduced number of days of catheterism control and nurse training; in the last phase (5) emptying urine collection bags on a container was added. In phase 1 we estimated six UTIs out of 18 patients (incidence 33%), in phase 2 we had four infections out of 10 patients (40%). Given the results, we had to reflect on the quality of the procedures of catheter positioning and management . Where feasible, we improved technical practices and during follow-up there was evidence of CA-UTI in 10 patients over 25 (phase 3, 40%), and eight infections over 25 (phase 4, 32%). Once all these steps had been implemented, in phase 5 we determined a sharp reduction in CA-UTI (2 patients over 27, or 7.5%, p=0.025). This improvement was particularly evident in the rate of infection per days of catheter, which was reduced from 43.4/1000 to 13.6/1000. Although the statistical power of the present study has its limitations, we attained a significant reduction in catheter-associated UTIs through the implementation of close circuit catheterism and improvements in care practices.

The epidemiological pattern of chronic liver diseases in a community undergoing voluntary screening for hepatitis B and C.

BACKGROUND: Vallecamonica-Sebino is a community in Northern Italy (99,776 inhabitants) with one of the highest mortality rates for primary liver cancer and cirrhosis in Italy, and voluntary screening for HCV and HBV is widespread. The aim of this study was to estimate the prevalence of chronic liver diseases and their aetiology in the area. METHODS: We used the following sources of data, linked at an individual level: (1) hospital discharge data; (2) local Viral Hepatitis Services; (3) tests for anti-HCV antibodies and HBsAg from local laboratories; (4) Local Health Authority registry of chronic liver disease patients; (5) drug prescriptions for HBV and HCV treatment; (6) archives of Alcohol Units. RESULTS: 3.5% of the residents had chronic liver disease, mainly chronic hepatitis (61.6%), followed by cirrhosis (14.0%) and alcoholic liver disease (11.2%). HCV was the main cause of chronic liver disease in females (46.3%) and males (29.8%), followed by alcohol abuse in males (22.9%) and HBV (10.9% males and 9.2% females). Prevalence of anti-HCV positivity was 3.2%, and increased with age to 8.8% in subjects aged 65 years and over. CONCLUSION: This study shows that an epidemiologic pattern of the prevalence of chronic liver diseases and their aetiology can be obtained using routinely collected data.

High prevalence of Parkinsonian disorders associated to manganese exposure in the vicinities of ferroalloy industries.

OBJECTIVE: To assess the prevalence of Parkinsonian disturbances in relationship to environmental exposure to manganese due to ferroalloy industries in the province of Brescia, Northern Italy. METHODS: Manganese concentrations were measured in settled dust collected in each of the 206 municipalities. Parkinsonian patients were identified using two sources: (1) clinical registers from local hospitals, specialized neurologists, and exemption from prescription payment; (2) L-Dopa prescriptions. Standardized prevalence rates and raw and full Bayesian-smoothed standardized morbidity ratios (SMRs) were calculated for the entire province and for each municipality. RESULTS: Manganese concentrations in settled dust were significantly higher in the surroundings and downwind from the industrial plants. A total number of 2,677 Parkinsonian cases were identified among 903,997 residents (crude prevalence, 296/100,000; 95% CI: 284.80-307.20; standardized prevalence, 407/100,000; 95% CI: 393.87-420.12). Significantly higher SMRs (Kruskal-Wallis chi(2) 1 df = 17.55, P < 0.001) were observed in 37 municipalities in the vicinities of ferromanganese plants (324 cases among 77,708 residents; standardized prevalence 492/100,000; 95% CI: 442.80-541.20), compared to the other 169 municipalities of the province (2,353 cases among 826,289 residents, standardized prevalence 321/100,000; 95% CI 308.80-333.20). Row and Bayesian SMRs were associated with the concentrations of manganese in settled dust. CONCLUSION: Study results suggest that environmental exposure to manganese is associated with an increased prevalence of Parkinsonian disturbances. Since the highest prevalence rates were observed in a closed community of the pre-Alps where the industries are located, further research should address a possible interactive role of genetic factors.