[Assessing the impact of bladder ultrasound on catheter-associated urinary tract infections and health-care costs: an observational pre-post study]

. Assessing the impact of bladder ultrasound on catheter-associated urinary tract infections and health-care costs: an observational pre-post study.

INTRODUCTION

The placement of a urinary catheter is a standard procedure, but it can cause discomfort, increase the risk of infections and costs. Pelvic ultrasound is a non-invasive assessment of the bladder and bladder catheter placement that can be performed by nurses.

AIM

To assess the appropriateness of urinary catheter placement using bladder ultrasound, to monitor urinary catheter-associated urinary tract infections and costs associated with catheter use.

METHODS

A single-centre pre-post observational study was conducted from September 2021 to August 2022 in patients aged >18 years requiring urinary monitoring; the first 6 months patients were assessed without the use of bladder ultrasound (control group), while the last 6 months with bladder ultrasound.

RESULTS

189 patients were included in the pre-ultrasound group and 175 patients in the post-ultrasound group; the demographic and clinical characteristics of the two groups were comparable. The rate of inappropriate catheterisation was 22.6% in the pre-group, whereas no inappropriate catheterisation was performed in the post-group. There was a 2.2% of absolute reduction in the rate of urinary tract infections (from 8.5% to 6.3%). Costs associated with the use of urinary catheters were reduced by 74.2% (from 173 to 44.8 euros).

CONCLUSIONS

Bladder ultrasound in clinical practice is feasible and reduced the inappropriate use of bladder catheters, reducing patient risks and healthcare costs.

Identification of relevant micropollutants in Austrian municipal wastewater and their behaviour during wastewater treatment

The European Union has defined environmental quality standards (EQSs) for surface waters for priority substances and several other pollutants. Furthermore national EQSs for several chemicals are valid in Austria. The study investigated the occurrence of these compounds in municipal wastewater treatment plant (WWTP) effluents. In a first screening of 15 WWTPs relevant substances were identified, which subsequently were monitored in 9 WWTPs over 1 year (every 2 months). Out of 77 substances or groups of substances (including more than 90 substances) 13 were identified as potentially relevant in respect to water pollution and subjected to the monitoring, whereas most other compounds were detected in concentrations far below the respective EQS for surface waters and therefore not further considered. The preselected 13 compounds for monitoring were cadmium (Cd), nickel (Ni), copper (Cu), selenium (Se), zinc (Zn), diuron, polybrominated diphenyl ethers (PBDEs), di(ethyl-hydroxyl)phthalate (DEHP), tributyltin compounds (TBT), nonylphenoles (NP), adsorbable organic halogens (AOX) and the complexing agents ethylenediaminetetraacetic acid (EDTA) as well as nitrilotriacetic acid (NTA). In the effluents of WWTPs the concentrations of the priority substances Cd, NP, TBT and diuron frequently exceeded the respective EQS, whereas the concentrations for DEHP and Ni were below the respective EQS. The effluent concentrations for AOX, EDTA, NTA, Cu, Se and Zn frequently are in the range or above the Austrian EQS for surface waters. Besides diuron and EDTA all compounds are removed at least partially during wastewater treatment and for most substances the removal via the excess sludge is the major removal pathway. For the 13 compounds which were monitored in WWTP effluents population equivalent specific discharges were calculated. Since for many compounds no or only few information is available, these population equivalent specific discharges can be used to assess emissions from municipal WWTPs to surface waters as well as to make a first assessment of the impact of a discharge on surface waters chemical status. Comparing discharges and river pollution on a load basis, the influence of diffuse sources becomes obvious and therefore should also be taken into consideration in river management.

Occurrence of polycyclic musks in wastewater and receiving water bodies and fate during wastewater treatment

The occurrence of cashmerane (DPMI), celestolide, phantolide, traesolide (ATII), galaxolide (HHCB) and tonalide (AHTN) in sewage and surface waters and their fate during wastewater treatment and anaerobic sludge digestion is investigated. AHTN and HHCB are the most important representatives and influent concentrations of 0.41-1.8 and 0.9-13 μgL(-1) are observed. DPMI is detected in influent and effluent samples but in notably lower concentrations than AHTN and HHCB. Major sources of polycyclic musks are households, whereas industrial emitters seem to be of minor importance. This conclusion is supported by the analysis of selected industrial wastewaters (metal, textile and paper industry). Specific emissions of 0.36 ± 0.19 and 1.6 ± 1.0 mg cap(-1)d(-1) for AHTN and HHCB are calculated. Overall removal efficiencies between approx 50% and more than 95% are observed during biological wastewater treatment and removal with the excess sludge is the major removal pathway. Log K(D) values of 3.73-4.3 for AHTN, 3.87-4.34 for HHCB and 2.42-3.22 for DPMI are observed in secondary sludge. During sludge digestion no or only slight removal occurred. Mean polycyclic musk concentrations in digested sludge amounted to 1.9 ± 0.9 (AHTN), 14.2 ± 5.8 (HHCB), 0.8 ± 0.4 (ATII) and 0.2 ± 0.09 (DPMI) mgkg(-1) dry matter. In the receiving water systems a comparable distribution as during wastewater treatment is observed. AHTN, HHCB and DPMI are detected in surface waters (ND (not detected) - <0.04, ND - 0.32 and ND - 0.02 μg L(-1)) as well as AHTN and HHCB in sediments (ND - 20, ND - 120 μg kg(-1)). For HHCB an apparent K(OC) value of 4.1-4.4 is calculated for sediments. Major source for polycyclic musks in surface waters are discharges from wastewater treatment plants. For HHCB and DPMI 100% of the load observed in the sampled surface waters derive from discharges of treated wastewater.

Occurrence of phthalates in surface runoff, untreated and treated wastewater and fate during wastewater treatment

Dimethyl phthalate, diethyl phthalate, dibuthyl phthalate, butylbenzyl phthalate, bis(2-ethylbenzyl) phthalate (DEHP) and dioctyl phthalate were analysed in raw and treated wastewater as well as in surface runoff samples from traffic roads. All six investigated phthalates have been detected in all raw sewage samples, in nearly all wastewater treatment plant (WWTP) effluent samples and in all road runoff samples, with DEHP being the most abundant compound. DEHP inflow concentrations ranged 3.4-34 microg L(-1) and effluent concentrations 0.083-6.6 microg L(-1). In two WWTPs the fate of the phthalates was assessed by performing mass balances. Overall removal efficiencies of approx 95% were calculated. Removal is attributed to biotransformation and adsorption and the relevance of the removal via adsorption to sludge increased with increasing molecular weight and increasing lipophilic character of the compound. Except DEHP phthalate concentrations were higher in treated effluent samples than in road runoff. The environmental quality standard (EQS) for DEHP in surface waters is exceeded only in a few effluent samples, whereas nearly all road runoff samples were higher than the EQS. An assessment based on pure concentrations is not feasible and a mass balance based approach is required. Nevertheless the observations highlight the relevance of stormwater emissions and direct emissions from separated sewer systems to surface waters in relation to emissions from WWTPs and the necessity to consider all potential influences in the assessment of the status of surface water bodies with reference to xenobiotics.

Perfluorinated alkylated substances in the aquatic environment: an Austrian case study

Perfluorinated alkylated substances (PFAS) are of global interest due to their occurrence and persistency in the environment. This study includes surface waters and sediments for the analysis of eleven PFAS. The PFAS studied can be grouped in perfluoroalkyl carboxylates (PFCAs), perfluoroalkyl sulfonates (PFS) and perfluoroalkyl sulfonamides (PFSA). The two most important compounds are perfluorooctanoate (PFOA) and perfluorooctane sulfonate (PFOS). These two substances showed the most significant values for surface water samples with maximum concentrations of 21 ng l(-1) for PFOA and 37 ng l(-1) for PFOS. Sediment samples from seven Austrian lakes and the river Danube were studied. Whereas PFSA and PFS were not detected in any sediment sample PFCAs were detected in most of the lake samples in concentrations up to 1.7 microg kg(-1) dry wt. PFOA, perfluorohexanoic acid (PFHxA) and perfluoroheptanoic acid (PFHpA) were detected in all Danube river sediment samples in concentrations varying from 0.1 up to 5.1 microg kg(-1) dry wt. For the various sampling points the proportional mass flows deriving from wastewater discharges were calculated. Whereas only up to 10% of the average flow is discharged wastewater up to more than 50% of the PFAS mass flows in the rivers can be attributed to wastewater discharges. Besides wastewater different other pathways as emissions from point sources, further degradation of precursor products, runoff from contaminated sites or surface runoff as well as dry and wet deposition have to be considered as relevant sources for PFAS contamination in surface waters.

Emissions of perfluorinated alkylated substances (PFAS) from point sources--identification of relevant branches

Effluents of wastewater treatment plants are relevant point sources for the emission of hazardous xenobiotic substances to the aquatic environment. One group of substances, which recently entered scientific and political discussions, is the group of the perfluorinated alkylated substances (PFAS). The most studied compounds from this group are perfluorooctanoic acid (PFOA) and perfluorooctane sulphonate (PFOS), which are the most important degradation products of PFAS. These two substances are known to be persistent, bioaccumulative and toxic (PBT). In the present study, eleven PFAS were investigated in effluents of municipal wastewater treatment plants (WWTP) and in industrial wastewaters. PFOS and PFOA proved to be the dominant compounds in all sampled wastewaters. Concentrations of up to 340 ng/L of PFOS and up to 220 ng/L of PFOA were observed. Besides these two compounds, perfluorohexanoic acid (PFHxA) was also present in nearly all effluents and maximum concentrations of up to 280 ng/L were measured. Only N-ethylperfluorooctane sulphonamide (N-EtPFOSA) and its degradation/metabolisation product perfluorooctane sulphonamide (PFOSA) were either detected below the limit of quantification or were not even detected at all. Beside the effluents of the municipal WWTPs, nine industrial wastewaters from six different industrial branches were also investigated. Significantly, the highest emissions or PFOS were observed from metal industry whereas paper industry showed the highest PFOA emission. Several PFAS, especially perfluorononanoic acid (PFNA), perfluorodecanoic acid (PFDA), perfluorododecanoic acid (PFDoA) and PFOS are predominantly emitted from industrial sources, with concentrations being a factor of 10 higher than those observed in the municipal WWTP effluents. Perfluorodecane sulphonate (PFDS), N-Et-PFOSA and PFOSA were not detected in any of the sampled industrial point sources.

Occurrence of selected surfactants in untreated and treated sewage

Several surfactants were monitored in treated and untreated sewage in nine municipal wastewater treatment plants (WWTPs) in western Austria. The nine sampled WWTPs cover a wide variety referring to size and applied treatment technology. The investigation focused on linear alkylbenzene sulphonate (LAS), quaternary ammonia compounds (QAC), nonylphenol (NP), octylphenol (OP), nonylphenolmono- (NP(1)EO) and -diethoxylates (NP(2)EO). Whereas LAS, NP, OP and NP(1,2)EO were analysed separately in the liquid phase and in the solid phase, the QACs were measured in the total sample. Total influent concentrations of LAS varied between 2.4 mg l(-1) up to 6.7 mg l(-1) whereas total effluent concentrations were in the lower microg l(-1) range (11-50 microg l(-1)). Whichever the type of treatment, a clear removal during treatment was observed. Solid liquid distribution coefficients K(d) were calculated for untreated sewage. The calculated K(d) values varied between 1300 and 3900 l kg(-1). OP was of minor importance with total influent concentrations below 1microg l(-1). NP and NP(1,2)EO were present in all analysed influents in concentrations between 1 and 35microg l(-1). Effluent concentrations were notably lower than the measured influent concentrations. K(d) values for NP varied between 500 and 6600 l kg(-1), for NP(1)EO between 800 and 2700 l kg(-1) and for NP(2)EO between 100 and 1800 l kg(-1). From the QACs several alkyl benzyl (BAC), dialkyl (DDAC) and trialkyl (ATAC) ammonium chlorides with varying alkyl chain lengths were analysed. Highest total concentrations in the influents to the WWTPs were observed for the BAC-C12 and the ATAC-C16 homologues. Effluent concentrations were notably lower compared to influent concentrations, indicating removal by adsorption and/or biodegradation. The influence of the removal by adsorption increased with increasing alkyl chain length.

Removal of selected pharmaceuticals, fragrances and endocrine disrupting compounds in a membrane bioreactor and conventional wastewater treatment plants

Eight pharmaceuticals, two polycyclic musk fragrances and nine endocrine disrupting chemicals were analysed in several waste water treatment plants (WWTPs). A membrane bioreactor in pilot scale was operated at different solid retention times (SRTs) and the results obtained are compared to conventional activated sludge plants (CASP) operated at different SRTs. The SRT is an important design parameter and its impact on achievable treatment efficiencies was evaluated. Different behaviours were observed for the different investigated compounds. Some compounds as the antiepileptic drug carbamazepine were not removed in any of the sampled treatment facilities and effluent concentrations in the range of influent concentrations were measured. Other compounds as bisphenol-A, the analgesic ibuprofen or the lipid regulator bezafibrate were nearly completely removed (removal rates >90%). The operation of WWTPs with SRTs suitable for nitrogen removal (SRT>10 days at 10 degrees C) also increases the removal potential regarding selected micropollutants. No differences in treatment efficiencies were detected between the two treatment techniques. As in conventional WWTP also the removal potential of MBRs depends on the SRT. Ultrafiltration membranes do not allow any additional detention of the investigated substances due to size exclusion. However, MBRs achieve a high SRT within a compact reactor. Nonylphenolpolyehtoxylates were removed in higher extend in very low-loaded conventional WWTPs, due to variations of redox conditions, necessary for the degradation of those compounds.

Quantification of sewer exfiltration using the anti-epileptic drug carbamazepine as marker species for wastewater

The anti-epileptic drug carbamazepine was used as marker species in wastewater to identify and quantify sewer exfiltration. In several studies carbamazepine turned out to be hardly removed in wastewater treatment and not or just slightly attenuated during bank infiltration. Concentrations in wastewater are generally 1000 times higher than the limit of quantification. In contrast to many other marker species a "young" drug as carbamazepine is discharged to the environment only by wastewater. The results from this study carried out in Linz, Austria indicate an average exfiltration rate, expressed as percentage of the dry weather flow that is lost on the city-wide scale, of 1%. This rate is lower than sewage losses reported in most other studies which attempted to quantify exfiltration on the basis of groundwater pollution. However, it was also possible to identify one area with significant higher sewage losses.

Monitoring of carbamazepine concentrations in wastewater and groundwater to quantify sewer leakage

Monitoring of carbamazepine concentrations in wastewater and groundwater enables us to identify and quantify sewer exfiltration. The antiepileptic drug carbamazepine is hardly removed in wastewater treatment plants and not or just slightly attenuated during bank infiltration and subsoil flow. Concentrations in wastewater are generally 1000 times higher than the limit of quantification. In contrast to . many other wastewater tracers carbamazepine is discharged to the environment only via domestic wastewater. The results from this study carried out in Linz, Austria indicate an average exfiltration rate of 1%, expressed as percentage of the dry weather flow that is lost to the groundwater on the city-wide scale. This rate is lower than sewage losses reported in most other studies which attempted to quantify exfiltration on the basis of groundwater pollution. However, it was also possible to identify one area with significantly higher sewage losses. This method seems to be very suitable for the verification of leakage models used to assess sewer exfiltration on a regional scale.

The solids retention time-a suitable design parameter to evaluate the capacity of wastewater treatment plants to remove micropollutants

Micropollutants as endocrine disrupting compounds (EDC) or pharmaceuticals are of increased interest in water pollution control. Wastewater treatment plant (WWTP) effluents are relevant point sources for residues of these compounds in the aquatic environment. The solids retention time (SRT) is one important parameter for the design of WWTPs, relating to growth rate of microorganisms and to effluent concentrations. If a specific substance is degraded in dependency on the SRT, a critical value for the sludge age can be determined. In WWTPs operating SRTs below this critical value, effluent concentrations in the range of influent concentrations or a distribution according to the adsorption equilibrium have to be expected, whereas in WWTPs operating at SRTs higher than the critical value degradation will occur. Critical SRTs were determined for different micropollutants, indicating that the design criteria based on the sludge age allows an estimation of emissions. Different treatment technologies as conventional activated sludge systems and a membrane bioreactor were considered and no significant differences in the treatment efficiency were detected when operated at comparable SRT. The results of the investigations lead to the conclusion that low effluent concentrations can be achieved in WWTPs operating SRTs higher than 10 days (referred to a temperature of 10 degrees C). This corresponds to the requirements for WWTPs situated in sensitive areas according to the urban wastewater directive of the European Community (91/271/EEC) in moderate climatic zones.

Carbamazepine as a possible anthropogenic marker in the aquatic environment: investigations on the behaviour of Carbamazepine in wastewater treatment and during groundwater infiltration

Sewage treatment plant (STP) effluents are significant sources of pharmaceutical residues in surface waters, where high concentrations of the antiepileptic drug Carbamazepine have been detected. The solids retention time (SRT) is the most important parameter for the design of STPs. It relates to the growth rate of microorganisms and to effluent concentrations. The influence of SRT on the removal of Carbamazepine was studied on lab-scale plants. The results from these tests were then validated on several full-scale plants. Due to the lack of suitable receiving waters and groundwater resources, one of these STPs has to infiltrate the treated wastewater into unsaturated soil. Here, groundwater samples at equal distances from the infiltration point were taken to estimate the behaviour of Carbamazepine during soil passage and within the groundwater. This antiepileptic drug seems to be very persistent in the environment, therefore qualifying as a suitable marker for anthropogenic influences in the aquatic environment.

Comparison of the behaviour of selected micropollutants in a membrane bioreactor and a conventional wastewater treatment plant

Micropollutants as pharmaceutical active compounds (PhACs), residuals of personal care products or endocrine disrupting chemicals are of increasing interest in water pollution control. In this context the removal efficiencies of sewage treatment plants (STPs) are of importance, as their effluents are important point sources for the release of those substances into the aquatic environment. Activated sludge based wastewater treatment is the worldwide prevalently used treatment technique. In conventional plants the separation of treated wastewater and sludge occurs via sedimentation. A new development is the application of membrane technology for this separation step. The studies focus on the influence of the solids retention time (SRT) on the removal efficiency, as the SRT is the most important parameter in the design of STPs. A conventional activated sludge plant (CASP) and a membrane bioreactor (MBR) were operated at different SRTs. The substances selected are the antiepileptic carbamazepine, the analgesics diclofenac and ibuprofen, the lipid regulator bezafibrate, the polycyclic musks tonalide and galaxolide and the contraceptive 17alpha-ethinylestradiole. No significant differences in the removal efficiency were detected. Due to the absence of suspended solids in the MBR effluent, substances with high adsorption potential could be retained to slightly higher amounts.

Relevance of the sludge retention time (SRT) as design criteria for wastewater treatment plants for the removal of endocrine disruptors and pharmaceuticals from wastewater

Wastewater treatment plants (WWTPs) represent a significant source for the input of micro pollutants as endocrine disruptors (EDs) or pharmaceutically active compounds (PhACs) into the aquatic environment. Treatment efficiency of WWTPs often is reported, taking into account only inflow and effluent concentrations without further specification of the WWTP investigated. In order to allow comparison and evaluation of the removal efficiency of different layouts and concepts in wastewater treatment, additional information like the sludge retention time (SRT) and sludge load (F/M ratio) are necessary. Presented results from different WWTPs show correlation of removal of EDs and PhACs to the SRT. Compared to WWTPs with high F/M ratio implementation of the nitrification process on WWTPs results in a significant increase of the removal efficiency for EDs and PhACs. This paper describes an approach to determine comparable removal rates for different activated sludge systems based on mass balance and SRT.

Investigation on the behaviour of selected pharmaceuticals in the groundwater after infiltration of treated wastewater

In a rural arid area without suitable receiving water the treated wastewater of a low loaded municipal wastewater treatment plant with full nutrient removal and additional post treatment steps is infiltrated into the unsaturated soil for groundwater recharge. Groundwater probes at increasing distances from the infiltration point have been sampled every two months over a period of 14 months. Beside conventional parameters (nutrients, carbon, and bacterial counts) samples were analysed for pharmaceutically active substances. Depending on and corresponding to their chemical structure and their fate during wastewater treatment, the selected substances showed different behaviour in the saturated zone of the groundwater. The antiepileptic Carbamazepine behaves very conservative and only is removed negligible even after long flow times within the subsurface zone. For other substances like the tranquilizer Diazepam or the analgesics Diclofenac a partial elimination during the different steps of wastewater treatment can be observed. Further degradation could be observed during the subsequent subsurface passage. In correlation with flow time additional removal of these substances from the aqueous phase can be observed. The musk substances Galaxolide and Tonalide were removed to some extend but not as good as the previous mentioned compounds.

Carbamazepine, diclofenac, ibuprofen and bezafibrate--investigations on the behaviour of selected pharmaceuticals during wastewater treatment

Numerous investigations in different European countries observed various pharmaceutically active compounds (PhACs) in notable concentrations in the aquatic environment. Further determinations found the effluents of sewage treatment plants (STPs) to be significant sources for the entry of pharmaceutical residuals to rivers, streams and surface waters. Due to those pathways the knowledge about the elimination of these substances and their behaviour in wastewater treatment plants (WWTP) is elementary for protection of an intact aquatic environment. Since the sludge retention time (SRT) is the most important parameter for the design of STPs, its influence on the reduction rate of these PhACs in the wastewater treatment process was investigated. To study this influence of the SRT on the elimination of PhACs, lab scale plants have been operated with different sludge retention times. The results of the laboratory experiments have been validated analysing various STPs within a wide capacity range and operating at different SRTs. This report describes the determinations observed on the antiepileptic drug Carbamazepine, the two antiphlogistics and analgesics Diclofenac and Ibuprofen and the lipid regulator Bezafibrate.

Two-Photon Spectroscopy of Jet-Cooled Benzonitrile: New Results for a Charge Transfer Molecule

We compare the first jet-cooled two-photon fluorescence excitation spectrum of benzonitrile with its one-photon spectrum measured by resonance-enhanced multi-photon ionization (REMPI). Both spectra include the pure electronic transition and one vibrationally induced transition. The inducing mode is the ν

Doppler-free Two-Photon Spectroscopy of Benzene in a Cold Supersonic Beam

Doppler-free two-photon absorption is demonstrated for cold molecules in a supersonic beam with a spectral resolution of 10 MHz. It was realized using a frequency stabilized tunable external concentric resonator placed within the vacuum chamber and crossed by the molecular beam. The achieved high resolution allows us to resolve single rotational lines in the S