Trend of healthcare-associated infections in a teaching hospital in Tunisia, 2014-2019

Background

National surveys on the prevalence of HAIs on a given day have regularly taken place in health facilities. During this period, actions to improve HAI prevention were implemented, including strengthened isolation measures; hand hygiene promotion using the World Health Organization multimodal strategy; and promotion of appropriate antimicrobial use. We aimed to examine trends in HAI in Sahloul Hospital over six years.

Methods

Annual prevalence surveys of healthcare-associated infections (HAIs) between 2014 and 2019 were conducted in the university hospital in Tunisia. It is a cross-sectional study of one-day prevalence with a single pathway. All departments were included in the survey, except emergency and hemodialysis services due to their very short length of stay. Data collection was carried out using NosoTun plug (national HAI prevalence survey).

Results

Over six years, prevalence of HAI ranged from 11.4% in 2014 to 9.5% in 2019. The prevalence of HAIs did not show a significant change across the six surveys. However, there were significant (P = 0.008) reductions in the prevalence of total HAIs in intensive care units, which had the highest frequencies of HAIs over those six years. In 2014, bacteriological analysis was performed in 55.8% of HAI cases. In 66.6% of cases (n = 16), isolated bacteria were gram negative bacilli, the most frequent were Pseudomonas aeroginosa. In 2019, 27 germs were identified, the most frequent were Gram Negative Bacilli (74%), mostly Escherichia coli.

Conclusions

This HAI prevention strategy was influential in decreasing infections among hospitalized patients in intensive care units. Challenges for the future are to minimize infection with gram-negative bacilli while limiting the emergence of antibiotic resistant organisms.

Key messages

Using prevalence surveys, we were able to have an insight into the most common isolates identified throughout the last six years. Repeated prevalence surveys are an effective tool for monitoring HAI frequency and contributing to the establishment of effective infection control.

Evolution of Healthcare-associated infections over five years: results of prevalence surveys

Background

Tunisia is not spared from the scourge of healthcare associated infections (HAIs). National surveys on the prevalence of HAIs on a given day have regularly taken place in health facilities. We aimed to describe bacteriological profile as well as treatment modalities of HAIs in Sahloul Hospital for the last five years.

Methods

We conduct every year a prevalence survey, as part of the program for the prevention and control of HAI at Sahloul Hospital. It is a cross-sectional study of one-day prevalence with a single pathway. All departments were included in the survey, except emergency and hemodialysis services due to their very short length of stay. Data collection was carried out using NosoTun plug (national HAI prevalence survey).

Results

Over five years, prevalence of HAI ranged from 11.4% in 2014 to 7.1% in 2018. In 2014, bacteriological analysis was performed in 55.8% of HAI cases. In 66.6% of cases (n = 16), isolated bacteria were gram negative bacilli, the most frequent were Pseudomonas aeroginosa. In 2015, 17 germs were identified, and in 88.2% of cases (n = 5), isolated pathogens were also gram-negative bacilli, the most frequent were Pseudomonas aeroginosa (n = 4) and Acinetoobacter baumanii (n = 3). Besides, cephalosporin 3rd generation was the most frequent antibiotic used for the treatment. However, in 2016, Klebsiella Pneumoniae was the most frequent germ isolated. Among those infected patients, 26 were treated (92.8%). In 2017, 26 germs were identified, the most frequent were Gram Negative Bacilli (53.8%), mostly Escherichia coli and Pseudomonas aerginosa, followed by Acinetobacter baumanii. in 2018, 16 germs were identified, the most frequent were Gram Negative Bacilli (55.5%), mostly Klebsiella Pneumoniae.

Conclusions

The challenges for the future are to minimize infection with gram-negative bacilli while limiting the emergence of antibiotic resistant organisms.

Key messages

Our study helped us to have an insight into the most common isolates identified throughout the last five years. An incidence survey was carried out to better highlight the impact of healthcare associated infections in our hospital.

Risk factors of healthcare associated infections: prevalence surveys over five years

Background

Healthcare associated infection (HAI) is alarmingly increasing in low income settings. In Tunisia, the burden of HAI is still not well described. We aimed to analyze risk factors independently associated with HAIs in hospitalized patients in Sahloul Hospital for the last five years.

Methods

We conduct every year a prevalence survey, as part of the program for the prevention and control of HAI at Sahloul Hospital. It is a cross-sectional study of one-day prevalence with a single pathway. All departments were included in the survey, except emergency and hemodialysis services due to their very short length of stay. Data collection was carried out using NosoTun plug (national HAI prevalence survey). Logistic regression was performed to identify independent risk factors of mortality among infected patients with p value less than .05.

Results

Over five years, prevalence of HAI ranged from 11.4% in 2014 to 7.1% in 2018. In 2014, independent risk factors of HAIs were the use of peripheral venous catheter, central venous catheter, and undergoing a surgery. Intensive care units and surgical departments were independently associated with the occurrence of HAIs. In 2015 and 2016, in addition to the factors already mentioned, antibiotic therapies for the last six months as well as parenteral feeding were also found as independent risk factors. In both 2017 and 2018, intrinsic factors were found in multivariate analysis; in fact diabetes as underlying disease was independently associated with HAIs.

Conclusions

Identifying risk factors that contribute to develop HAIs may support the implementation of strategies for their prevention, therefore maximizing patient safety.

Key messages

Identifying risk factors for HAIs may improve patient safety. Insertion of medical devices was the main risk factor for patients over the five years.

Risk factors of addictive behavior in adolescents in Tunisia

Background

Adolescence is a period of physical, psychological and sociocultural transformation, but also of curiosity and experimentation. In Tunisia, the levels of use of some psychoactive substances, especially alcohol, tobacco and cannabis, remain high among adolescents, despite progress in regulatory efforts to limit access to these products by minors, and regular prevention campaigns. We aimed to determine the prevalence of addictive behavior among students in the region of Sousse and to specify the risk factors.

Materials/Methods

We conducted a cross-sectional epidemiological study in two public schools in the governorate of Sousse during the 2017/2018 school year. All students in each class were included when they agreed to participate in the study. The data was collected by anonymous self-questionnaire, then processed and analyzed using the SPSS version 20 software.

Results

In total, 294 students participated in this study with a mean age of 17.03 ± 1.51 years. A female predominance was noted (56.1%). The prevalence of addictive behavior was 52% (95% CI = [45.9% - 57.8%]). In univariate analysis, male gender, advanced age, and repeating the study year were significantly associated with addictive behavior (p = 0.014, p < 10-3, p = 0.004 respectively). However, multivariate analysis showed that the probability of addictive behavior decreased in students who read books frequently (OR = 0.6, 95% CI = [0.37 - 0.96], p = 0.03). The only independent risk factor associated with addictive behavior was age (OR = 1.34, 95% CI = [1.14 - 1.59], p < 10-3).

Conclusions

The findings have implications for identifying protection factors and risk factors for addictive behaviors, and the development of primary prevention strategies derived from such factors.

Key messages

Our results highlight the need to better understand behaviors at risk in Tunisia and the perceptions of prevention policies among students. Knowledge of related factors is important for prevention program planning.

[Smoking attitudes and behavior of the hospital staff Sahloul (Sousse, Tunisia)]

BACKGROUND

Smoking is a major public health problem. Legislation banning smoking in public institutions exists but is not strictly enforced, particularly in health facilities. Therefore health workers have a crucial role to play in the control of smoking on account of their contact with patients and their credibility and moral authority in health matters. They can help patients by their advice and by abstaining from smoking in the hospital themselves. The aim of our study was to determine the prevalence of smoking among medical staff at the University Hospital of Sahloul in Sousse and their attitudes and behaviour with regard to smoking.

METHODS

The data came from a descriptive cross-sectional study conducted during the year 2013-2014 using a self-administered questionnaire and included the health personnel of all services and laboratories of the University Hospital of Sahloul in Sousse.

RESULTS

The participation rate was 71% (768/1081). Our study population was predominantly female (51%) with a mean age of 37.8 (±11.3) years. The overall prevalence of smoking was 21%. It was significantly higher among men (38.8%) than women (4.6%). This prevalence was higher among physicians/pharmacists (29.5%). More than half the smokers (58%) started smoking between the age of 19 and 25 years. Nicotine dependence was moderate among 27.4% and strong among 18.3% of smokers. The average dependence score was 4.1±2.4 [0-9] with a median of 4.0. Two-thirds of smokers (66.5%) reported smoking in the workplace.

CONCLUSION

Confronted with the problem of tobacco, health institutions should find solutions for the prevention of smoking in hospitals. It seems necessary to train and involve hospital staff in anti-tobacco measures and to help smokers to quit in order to make our hospital a tobacco smoke free space.

[Smoking behavior among nursing students in Sousse, Tunisia: a preliminary study]

INTRODUCTION

Smoking is an entirely preventable, man-made, epidemic. It is a major, worldwide, public health problem whose social costs are very high. Health care workers have an important role to play in tobacco control. We conducted a study among nursing students to examine their smoking behavior, their attitudes towards smoking, and their participation in prevention.

METHODS

This descriptive, transverse study was conducted in March 2011 during which an anonymous self-completion questionnaire was administered to nursing students.

RESULTS

The study included 150 students aged between 18 and 25 years with a sex ratio of 1:3. The prevalence of smoking was 32.6%. Male students began smoking at an earlier age (16.5±2.3 years vs 18.9±1.1 years). The main initiating factors were stress (55%), pleasure (46.9%) and peer influence (36.5%). The Fagerstrom score showed a high level of dependency in 26.5% of smokers. More than 75% of student smokers have tried to quit. Most of the students surveyed (93%) think that health care workers should set a good example by not smoking and 91% of them think they should help others quit smoking.

CONCLUSION

Health care workers should be well informed about the harmful effects of tobacco. They should be convinced of the need for their participation in smoking prevention and the fight against this medico-social scourge. It is essential that their training prepares them for this task and that their environment helps them fulfill their responsibility.