Asma Ben Cheikh

Healthcare-associated infections in a Tunisian university hospital: from analysis to action.

Introduction Our study was conducted, in university hospital center (UHC) Farhat Hached of Sousse (city in Tunisian center-east), within healthcare-associated infections (HAI) epidemiological surveillance (ES) program, based, among others, on HAI regular prevalence surveys. Our objectives are to resituate HAI prevalence rate and to identify their risk factors (RF) in order to adjust, in our hospital, prevention programs. Methods It is a transversal descriptive study, including all patients who had been hospitalized for at least 48 hours, measuring prevalence of HAI a “given day”, with only one passage by service. Risk factors were determined using Epiinfo 6.0, by uni-varied analysis, then, logistic regression stepwise descending for the variables whose p Results The study focused on 312 patients. Infected patients prevalence was 12.5% and that of HAI was 14.5%. Infections on peripheral venous catheter (PVC) dominated (42.2%) among all HAI identified. HAI significant RF were neutropenia (p < 10−4) for intrinsic factors, and PVC for extrinsic factors (p = 0,003). Conclusion Predominance of infections on PVC should be subject of specific prevention actions, including retro-information strategy, prospective ES, professional practices evaluation and finally training and increasing awareness of health personnel with hygiene measures. Finally, development of a patient safety culture with personnel ensures best adherence to hygiene measures and HAI prevention.

Etude sur le diabète aigu cétosique inaugural dans un hôpital du Centre-Est Tunisien

La cétose est une complication aiguë du diabète qui consiste en une accumulation de corps cétoniques sanguins. Malgré la haute prévalence du diabète cétosique décrite, il existe très peu d’informations concernant l’épidémiologie de cette complication inaugurale du diabète en Tunisie. L’objectif était de déterminer les caractéristiques épidémiologiques et clinico-biologiques des cétoses inaugurales dans un hôpital du Centre-Est tunisien. Il s’agit d’une étude rétrospective, transversale et exhaustive, à propos de patients admis pour une cétose inaugurale sur une période allant de janvier 2010 à août 2016. La population d’étude a été divisée en 2 groupes selon la présence ou pas d’une auto-immunité anti pancréatique: groupe DAI (diabète de type 1 auto-immun) regroupe tous les patients avec une auto-immunité, et le groupe DNAI (diabète cétosique non auto-immuns) sans auto-immunité. Il s’agit de 391 patients, de sex ratio 266 hommes/125 femmes, d’âge moyen de 34±14,33 ans. La prédominance masculine était nette: 68% dans la population générale. L’âge de la cétose était significativement plus précoce dans le groupe DAI. Un facteur précipitant la cétose était retrouvé chez 77,7% de la population globale d’étude, significativement plus fréquent dans le groupe DAI que dans le groupe DNAI. Le facteur le plus retrouvé était les infections virales. Les Anticorps anti thyroïdiens étaient significativement importants dans le groupe DAI. La cétose est un facteur de décompensation inaugurale fréquent du diabète en Tunisie. La population la plus importante a été décrite chez l’adulte jeune masculin, avec l’absence d’une auto-immunité, et un profil clinique du diabète de type 2.

L'ostéotomie fémorale de varisation par ouverture externe pour les gonarthroses fémoro-tibiales latérales sur genuvalgum idiopathique: étude rétrospective de 10 cas

Femoral varus osteotomy is a conservative treatment for external single-compartment gonarthrosis. This surgical procedure is little used and outcomes are little studied.This study aimed to assess the clinical and radiological results of femoral varising osteotomy in subjects with external femorotibial gonarthrosis associated with idiopathic genu valgum whose data were recorded over a period of 21 years (1992- 2013) in the Department of Orthopedics at Sahloul University Hospital, Sousse. The clinical evaluation of patients was performed using the IKS score (International Knee Society). Radiological assessment was based on pre-operative work-up and final follow-up assessment. We here report a case series of 9 patients (and 10 knees) whose average age was 45.2 years, with a sex ratio of 0.5. Mean follow-up was 99-months. Average knee score ranged from 48.4 points preoperatively to 73.5 points at the final follow-up assessment, with a statistically significant improvement (p<10-3). Medium functional score significantly improved, with a preoperative value of 49.5 points and a value of 72 points at the final follow-up assessment. Final correction helped to reduce valgus condition with an average of 3.7° and a preoperative value of 14°. This study, as well as the analysis of literature, indicates that femoral varising osteotomy is the treatment of choice for invalidating genu valgum of femoral origin, without any rheumatoid arthritis, overweight, internal femorotibial nor severe femoropatellar arthritis.

Perceptions of a Healthcare-associated Infections Reporting System in a Tunisian University Hospital

Objective: The implementation of a healthcare-associated infections reporting system is a principal component of infection control and quality improvement policies in healthcare institutions. This study was designed to determine the perceptions of health professionals concerning implementation of a healthcare-associated infections reporting system and to analyse factors influencing these perceptions.Methods: A descriptive cross-sectional study conducted in 2012 using a predefined, pre-tested and self-administered questionnaire in 380 health professionals working in 16 different departments of Farhat Hached University Hospital, Tunisia.Results: The majority of respondents (71.8%) reported that no healthcare-associated infections surveillance procedure had been implemented in their departments. However, most respondents (93%) recognised the value of implementation of a healthcare-associated infections reporting system in order to provide them with corrective actions (77%), to support the investigation of epidemic and emerging phenomena (49%) and to share experiences about the prevalence of healthcare-associated infections and their risk factors (44%).Conclusion: Staff training and development of a regulatory framework are essential to implementation and correct functioning of a healthcare-associated infections reporting system.

Patient’s safety culture among Tunisian healthcare workers: results of a cross sectional study in university hospital

Introduction Healthcare safety has become a public health priority in developed world. Development of safety culture care is fundamental pillar to any strategy for improving quality and safety care. The objective of this study is to measure level of patients’ safety culture among healthcare professionals at university hospital, center Farhat Hached Sousse (Tunisia). Methods We conducted, in 2013, a descriptive study among all licensed physicians (n= 116) and a representative sample of paramedical staff (n= 203) exercising at university hospital center Farhat Hached Sousse (Tunisia). Measuring instrument used is a valid questionnaire containing ten safety care dimensions. Data were analyzed using SPSS version 19. Results The response rates were 74.1% for physicians and 100% for paramedical staff. Overall score of different dimensions varies between 32.7% and 68.8%. Dimension having most developed score (68.8%) was perception of “Frequency and reporting adverse events”. Dimension with lowest score (32.7%) was “Management support for safety care”. Conclusion Our study has allowed us to conclude that all dimensions of patients’ safety culture need to be improved among our establishment’s professionals. Therefore, more efforts are necessary in order to develop a security culture based on confidence, learning, communication and team work and rejecting sanction, blame, criminalization and punitive reporting.

Prevalence et facteurs associes au tabagisme parmi les etudiants de la ville de Sousse (Tunisie)

Within the framework of the fight against tobacco among young people, we conducted a descriptive cross-sectional study in 2013 to estimate the prevalence of smoking and to identify associated factors among students in Sousse. A questionnaire was administered to a representative sample of 556 students in 5 academic institutions in Sousse randomly drawn. The age of the participants was between 17 and 35 years. The prevalence of tobacco consumption in the past 12 months was 22.1% and consumption during the past 3 months was 65.3%. The average age of starting smoking was 17 years. Smoking prevalence was significantly higher for males (P < 0.001) and those aged over 25 years (P = 0.002). Students from 2 of the institutions were using more tobacco than their colleagues in the other institutions (P = 0.027). The high prevalence of smoking found among the students means that prevention measures are essential; this requires increasing self-esteem and evaluating intervention programmes implemented before smoking the first cigarette. كلذب ةطبترلما لُماوعلاو سنوتب ةسوس ةنيدم في بلاطلا ينب ينخدتلا رُاشتنا يمجعلا ايرث ،يوايرطلما ليع ،وُّ لدرغلا ميرم ،ليحاسلا ناهيج ،ماملإا لانم ،ليوللما لانم ،خيشلا نب ءماسأ ،ينيديزلا بيكش نـب نـخدتلا راـشتنا لدـعم رـيدقتل 2013 ماـع في ةـيعطقم ةـيفصو ةـسارد اـنيرجأ بابـشلا نـب غـبتلا كلاهتـسا ةـحفاكم راـطإ في :ةـصلالخا ةـيميداكأ تاـسسؤم 5 في اًـبلاط 556 نـم ةـن َّ وكم ةـلِّ ثمم ةـنيعل نايبتـسا مادختـسا مـتف .كـلذب ةـطبترلما لـماوعلا دـيدتحو ةـسوس في بلاـطلا ةقباـسلا 12 ــلا رهـشلأا في غـبتلا كلاهتـسا راـشتنا ناكـف .اًـماع 35 و 17 نـب نكراـشلما رماـعأ تـناكو .ةيئاوـشع ةـقيرطب اويرـتخا ةـسوس في نـخدتلا راـشتنا ناكو .اًـماع 17 نـخدتلا في ءدـبلا رـمع طـسوتم ناكو .65.3% ةـيضالما رهـشأ 3 ــلا للاـخ كلاهتـسلاا ناكو ،22.1% ثـحبلل نتـسسؤم ذيملات ىدـل غـبتلا كلاهتـسا ناكو .)P = 0.002( اًـماع 25 ــلا مـهرماعأ تزواـتج نـمَ ىدـلو )P < 0.001( روـكذلا ىدـل يرـثكب ىـعأ يرـبادت ذاـتخا نأ يـنعي بلاـطلا ىدـل دـجوُ يذـلا نـخدتلا راـشتنا لدـعم عاـفترا نإ .)P = 0.027( ىرـخلأا تاـسسؤلما في مـنهارقأ نـم ىـعأ .لىولأا ةراجيـسلا نـخدت لـبق ذـ َّ فنت يـتلا لـخدتلا جـمارب مـييقتو ،تاذـلا مارـحا ةـيمنت بـلطتي اذـهو .يروضر رـمأ ةـيئاقو طسوتلما قشرل ةيحصلا ةلجلما نوشرعلا و نياثلا دلجلما لولأا ددعلا