The European practice database (EPD): results of the study in thte North-East of Italy.

The survey, realized in 2002-03 in the North-East of Italy, describes renal care in dialysis services. A questionnaire, structured at European level, was sent to all dialysis centres by mail. The questionnaire was returned from 21 centres (61.8%) and related satellite units. Results show nonhomogeneity in renal care. Some important results were: low use of peritoneal dialysis (18%), compared to the rest of Europe, elevated presence of older people on haemodialysis, reduced percentage of patients on transplantation waiting list, diffused use of isolation for HCV positive patients, high use of AV fistulae (84%), low employment of renal technicians, absence of renal dieticians and social workers and nurses performing prevalently direct care. Data can be used for different goals: benchmarking activities, selection of deeper research topics and development of more oriented continuous education activities.

Basic tools to integration in management and continuous quality improvement: protocols and procedures.

In order to support interested colleagues with the concepts of Continuous Quality Improvement (CQI) and Clinical Standards for Nephrology Practice, a package of education support has been set up. We enhance the use of procedures, protocols, working plans, guidelines and nursing care plans as instruments of organisational integration. For the nursing care of renal patients in HD and PD we believe that all the procedures and protocols (P&P) above could have an important impact in the renal nursing practice. We propose that group members run a programme which is presented and implemented as a modular package including, theoretical knowledge, setting up working groups involved in literature revision, evaluation of defined P&P after a period of implementation, final implementation & periodic evaluation.

Results of a national epidemiological investigation on HCV infection among dialysis patients. (Survey by the Italian Branch of EDTNA/ERCA).

The Italian Branch of EDTNA-ERCA organised a retrospective epidemiological investigation on the spread of HCV infection in dialysis. A questionnaire was sent to 830 Italian dialysis centres to collect information about prevalence and incidence of HCV infection among patients and staff, anti-HCV testing, presumed sources of infection, sanitation procedures and dialysis strategies adopted to prevent or reduce the transmission of HCV infection. Twenty-seven percent of the dialysis centres responded to the questionnaire. The answers confirmed the decline in HCV prevalence and incidence. At variance with official health organisation recommendations, isolation of anti-HCV-positive patients is still used in many centres (25%) despite the fact that it is not advisable in view of the high cost and uncertain benefit. Dedicated machines for anti-HCV-positive patients should be adopted, at least in units with a high prevalence of these cases.

Results of a national epidemiological investigation of HCV infection in dialysis patients.

The Italian Branch of EDTNA/ERCA organised a national, epidemiological, retrospective study to collect data and implement preventative measures for the spread of HCV infection in dialysis units. A questionnaire was sent to staff in 830 dialysis centres to collect information relating to 1996. Data are presented on incidence/prevalence of HCV infection, antibodies, viraemia and mortality, and comparison of the management of HCV between centres. At variance with the recommendations of the Official Health Organisations, dedicated machines and separate rooms are used in many centres and this paper concludes with recommendations for units, in particular those units with a low prevalence of anti HCV positive patients.

[The organization of the nursing service in dialysis centers in Italy. A national study promoted by the EDTNA-ERCA--Italian branch. European Dialysis Transplant Nurses Association-European Renal Care Association]. / L'organizzazione del servizio infermieristico nei centri dialisi in Italia. Indagine nazionale promossa dall'EDTNA-ERCA--Filiale Italiana.

A 45 multiple choice questions questionnaire was mailed to the nursing personnel of the 687 public and private Italian dialysis units, in 1991. The survey was promoted by the Italian branch of the EDTNA-ERCA (European Dialysis Transplant Nurses Association). The questions related to the following areas: structure of the service, organization of the activities, dialysis methods; number of nurses, communication systems, basic and continuing education and main problems encountered by nursing personnel in some areas. 185 questionnaires were returned (21.2%). The situation is highly dishomogeneous. The working team is formed by physicians and nurses only or may include dietitians, social workers, technicians etc. In 102 centres 55% of the respondents, nurses perform non nursing activities (from the incanulation of the arterovenous fistula to activities related to the maintenance of dialysis apparatus). Problems most frequently encountered include conflicts with the patients on criteria and conditions in handling dialysis procedures and lack of collaboration with physicians.