Colonization by Legionella spp. of water networks in residential buildings of the Province of Pisa, Italy

Despite the increase of community acquired cases of legionellosis in Italy over the last years, the Italian guidelines do not give indications for prevention and control of Legionella in the hot water networks (or centralized conditioning systems) of residential buildings. We performed a survey on eight medium sized apartment buildings in the Pisa district to assess the prevalence of Legionella spp. in the water network and the respondance to drinking water requisites at the point of use, according to the Italian norms

Epidemiologia molecolare dei ceppi di Legionella pneumophila sierogruppo 1 isolati dal sistema idrico dell'Azienda Ospedaliero-Universitaria Pisana

La variabilità genetica di ceppi di Legionella pneumophila sierogruppo 1 è stata studiata applicando due metodiche di tipizzazione molecolare: la pulsed-field gel electrophoresis (PFGE) e la sequence-based typing (SBT) di sei loci flaA, pilE, asd, mip, mompS and proA. I ceppi sono stati isolati nel corso di quattro anni di monitoraggio della rete idrica dell’AOUP, effettuato prima e dopo l’installazione di generatori di biossido di cloro, per la clorazione in continuo dell’acqua potabile. 61 ceppi di L. pneumophila sg 1 (41,5% dei campioni positivi) sono stati selezionati seguendo un criterio spaziale e temporale al fine di valutare l’evoluzione della colonizzazione del sistema idrico. L’analisi della sequenza del gene mip ha consentito di attribuire tutti i 61 stipiti alla specie Legionella pneumophila ceppo Wadsworth. Entrambe le metodiche utilizzate hanno rilevato la presenza e la persistenza nel sistema idrico ospedaliero di tre cloni caratterizzati da differenti profili allelici e patterns elettroforetici. Il clone 1 e il 2 sono risultati predominanti e variamente distribuiti nei vari padiglioni, durante i quattro anni di monitoraggio, mentre il clone 3 è stato isolato solo a distanza di tre anni dall’installazione dei generatori di biossido di cloro

Three scenarios of clinical claim reimbursment for nosocomial infection: the good, the bad, and the ugly

Summary We studied the extent to which hospitals can expect to receive reimbursement for costs relating to nosocomial infections (NI) under the diagnosis-related groups (DRG) system of clinical claims and calculated the loss of reimbursement due to missed or incorrect registration of infective complications on hospital discharge records (HDR). We calculated clinical claim reimbursement in three scenarios: the good, in which all NI are recorded on HDR; the bad, in which a proportion of NI recorded on HDR observed at the 41 participating hospitals; the ugly, in which none of the NI are recorded on HDR.We analysed in which patients the recording of infective complications changed the DRG clinical claim and the economic consequences on reimbursements. Compared with the ugly scenario, the bad scenario, which is closest to what actually occurs, with only 55.9% of NI (180/322) properly recorded, produced an increased DRG clinical claim in 30 cases, of on average e403 for every NI. Compared with the ugly scenario, the good scenario, produced an increased DRG clinical claim in 45 cases with an average reimbursement of e618. The difference between the bad and the good scenarios shows an average loss of e215 for every case. Our calculated good scenario could cover only 3.8% of direct costs per case attributable to NI. Real, tangible benefits in health, both social and economic, will only accrue from the monitoring and control of NI in hospitals