Given the inherent autonomy, heterogeneity, and continuous evolution of Web services, mismatches usually exist between service protocols, and service interactions are typically conducted by means of ...adapters. A set of service protocols often can conduct multiple interactions, but a few, whose results fulfill the requestor's requirements, are expected. In this paper, we propose a technique to verify whether a certain expected interaction is adaptable. Then, a requestor can choose a suitable provide service from a set of functionally equivalent candidates according to her requirements. This technique complements the effort of adapter synthesization for achieving an expected service interaction.
Background
Surgical site infections (SSIs) are the most common hospital-acquired infections (HAIs) in low- and middle-income countries. Many reports have shown that surveillance and management of ...factors associated with SSI decreased rates and improved overall outcomes.This study aimed to appraise the prevalence trend and risk factirs of SSIs during 10-year period (2012 - 2021) in a Tunisian university hospital.
Methods
The SSI surveillance module is based on the National Healthcare Safety Network (NHSN), Centers for Disease Control and Prevention (CDC). For the current study, data collected over ten years through point prevalence surveys were analyzed. Univariate and multivariate logistic analysis were used to identify SSI risk factors.
Results
Overall, 2957 patients were observed; the mean age was 48.4 ± 23.5 years and 57.2% were male. We identified 289 infected patients (9.8%) and 319 HAIs (10.8%). SSIs were found in 21.6% of cases.The prevalence of SSI decreased from 27.9% in 2012 to 21.6% in 2021. However, this decrease was not statistically significant. The majority of the positive cultures were Staphylococcus aureus (14.3%) followed by Escherichia Coli (11.1%) and Klebsiella pneumoniae (9.5%). Antimicrobial resistance was found in 17.5% of cases. Univariable analysis found that lenght of stay (p < 10-3), obesity (p = 0.047), the use of antibiotic treatment in 6 months (p = 0.002), and the use of central line (p < 10-3) were associated with SSI. Independent risk factors significantly associated with SSIs were length of stay (aOR=8.6), the use of central line (aOR=3), and the use of antibiotic treatment in 6 months (aOR=2.2).
Conclusions
With continuous surveillance, the prevalence of SSIs decreased. In Sahloul university hospital, there has been a strengthening of the application of hygiene standard precautions during the two last years, and more particularly the respect of hand hygiene, combined with continued inpatient antimicrobial stewardship programs.
Key messages
* Active surveillance and management of factors associated with surgical site infection (SSI) decreased the incidence and improved overall outcomes.
* With continuous surveillance, the prevalence of SSIs decreased over the 10-year study period.
Introduction
Acinetobacter baumannii is an emerging pathogen that is increasingly resistant to antibiotics and is mainly responsible for pneumopathy in fragile patients. This germ is frequently ...responsible for epidemics in hospitals. We aimed to describe the steps of the investigation of an outbreak of Acinetobacter baumannii affected our hospital, the measures implemented and the follow-up of the actions.
Methods
Following alerts issued by the microbiology department concerning 5 swabs detecting Acinetobacter of the same strain and the same antibiotic resistance profile in 3 different departments of intensive-care units (ICU), a team of the prevention and healthcare security department went onsite for an investigation in the hospital.
Results
We identified five cases with identical strains of multi-resistant Acinétobacter. The field visit allowed to identify some deficiencies in professional practices. All the patients were hospitalized in ICU (medical and surgical). The synoptic table showed that there was an overlap of hospitalization periods.A crisis cell was set up to validate, coordinate and implement control measures in accordance with CTINILS recommendations. Indeed, we proceeded to a technical isolation of the cases in their hospitalization sector, reinforced the basic hygiene and bio-cleaning measures and sensitized the medical and paramedical. Given that the three ICU departments shared the same medical staff during night shifts, the assumption that the germ was carried by the caregivers was the most likely hypothesis. We proceeded with a swab of the elements of the environment in the services concerned. Results showed that Acinetobacter was found on the nursing cart (visibly clean). A training about bio-cleaning and hygiene standard precautions is programmed.
Conclusions
Continuous surveillance, continuous hygiene trainings, combined with a rapid reaction capacity in case of identification of a new case, is essential to control the spread of nosocomial germs.
Key messages
* Multidrug-resistant Acinetobacter baumannii (MRAB) is an emerging cause of intensive care unit (ICU) outbreaks.
* Enhanced infection control measures limited the outbreak.
Abstract
Background
Ventilator-Associated Pneumonia (VAP) continues to cause significant morbidity, mortality, and hospital costs, especially in the intensive care unit (ICU). This study aimed to ...determine incidence and factors associated with VAP in six ICUs of the University Hospital-Sahloul (Sousse, Tunisia) in 2018.
Methods
We conducted a prospective observational cohort study over a three months period in six ICUs of the University Hospital-Sahloul (Sousse, Tunisia) in 2018. All patients hospitalized with mechanical ventilation (MV) for more than 48 hours in the ICUs were included. Logistic regression with the stepwise method of Hosmer and Lemeshow was used to identify factors associated with VAP.
Results
Overall, 110 patients were enrolled. The mean age of patients was 44 ± 25 years. Of them, 66.4% were male. The median duration of MV was 5 days 2-16. The incidence of VAP was 32% and the density incidence was 33/1000 ventilator days. The most common organism were Pseudomonas aeruginosa (n = 14). Of them, 12 were ceftazidime-resistant and thee were resistant to imipenem. Independent risk factors associated with VAP in ICU were history of antibiotic therapy during last 6 months (p = 0.007), tracheotomy (p < 0.001) and reintubation (p < 0.001).
Conclusions
VAP rates in our ICUs were very high. Antimicrobial stewardship programs involving pharmacists and physicians must be elaborated to optimize the antibiotic prescribing. Mechanical ventilation require more-effective interventions control in our hospital.
Key messages
Ventilator-Associated Pneumonia rates were very high. Independent risk factors associated with Ventilator-Associated Pneumonia were history of antibiotic therapy during last 6 months, tracheotomy and reintubation.
Abstract
Background
We found a high incidence of Adverse Events (AEs) following a survey conducted at Sahloul Hospital. Therefore, a surveillance system of AEs was implemented as a part of the ...implementation of the quality and risk management approach at Sahloul hospital, since April 2018. The aim of this study was to describe results of this system between May 2018 and April 2019.
Methods
It is a descriptive longitudinal study conducted at the Sahloul Hospital for a period of one year from May 1st, 2018 to April 30, 2019. Each service is provided with a data sheet that allows staff to report each adverse event they have witnessed. This does not include AEs that are part of alertness, blood exposure accidents or occupational accidents, or nosocomial infections which are assessed by specific circuits already in place.
Results
During the follow-up period, 93 AEs were reported. These AEs predominate in the sterilization unit followed by medical resuscitation and nephrology department with respective rates of 17.2%, 12.9% and 11.8%. The most frequent AEs were for maintenance (21.5%), medical device disinfection (20.5%), material resources (16.1%), and human resources (8.6%). According to criticality, the majority of AEs are tolerable under control (41.9%), unacceptable in 33.3% of cases and acceptable in 24.7% of cases.
Conclusions
In order to ensure proper functioning of the AEs surveillance and reporting system, the awareness of health professionals and their training would be essential. Quality of the information to be reported represents a challenge to be met to enable the planning, implementation and evaluation of improvement actions. Experience feedback would be with considerable benefit to improve the quality of professional practices.
Key messages
Surveillance and reporting system data analysis allow to identify mecanisms of the occurence of adverse events. Experience feedback is with considerable benefit to improve the quality of professional practices.
Abstract
Background
The infections caused by emergent highly resistant bacteria (eHBR) that develop in intensive care units (ICUs) may result in significant patient illnesses and deaths, extend the ...duration of hospital stays and generate added costs. Facing this problem, the screening that emphasizes early identification of colonized patients, reduces the prevalence and incidence of infection, improves patient outcomes and reduces healthcare costs. In this context, we have implemented a screening for eHBR in ICUs of Sahloul university hospital of Sousse (Tunisia), which we report in this study the first six-months outcomes.
Methods
Rectal swab cultures were collected to detect Vancomycin resistant enterococcus (VRE) and Carbapenemase producing Enterobacteriaceae (CPE) among patients admitted in six ICUs of Sahloul university hospital of Sousse (Tunisia) and more than three times, at least one week apart, between 1 June and 31 December 2018.
Results
During the study period 174 patients were screened. Of them, 69.5% were male and 73.6% were admitted in surgical ICU. In total, 161 and 152 samples were realized respectively for the detection of CPE and VRE. These samples were positive in 15% and 8.5% respectively for CPE and VRE. Klebsiella pneumoniae OXA 48 was the most isolated CPE (80%).
Conclusions
Our screening program helped us in infection control by early identification of patients, thereby facilitating an informed decision about infection prevention interventions. Moreover, these results encouraged us to improve and generalize this program throughout the hospital.
Key messages
eHRB screening becomes an important axis in the prevention of eHRB infections in our facilities. eHRB screening allows the reinforcement of the basic infection prevention and control measures.
Background
Assessment of the quality of life of glaucoma is an essential basis for their management in order to prevent deterioration of the disease. The aim of the study was to describe through a ...systematic review the quality of life of patients with open angle glaucoma and identify its associated factors.
Methods
It was a systematic review conducted based on the preferred reporting items for Systematic Reviews and Meta-analyses (PRISMA).Criteria for eligibility were all published population-based primary literature in Pubmed and Embase interface, written in English, since January 2014 to 31 December 2019. Electronic research was done through the following documentary query (((‘glaucoma'MeSH Terms) AND (‘quality of life'MeSH Terms)) AND (‘open angle glaucoma'Title/Abstract)) AND (‘adult'MeSH Terms)) AND (‘risk factors'MeSH Terms).Level of evidence and grades of recommendation was assessed according to the Scottish Intercollegiate Guidelines Network (SIGN).
Results
Among 139 articles, 15 were selected. Most of them were descriptive cross-sectional studies using different measuring instruments. We found that the quality of life of glaucoma patients varies according to the regions in Asia, Europe, America and Africa. The highest scores were recorded in Asia, followed by North America and Europe, which have very close scores. The risk factors associated with the quality of life of glaucoma patients were: Age, sex, level of education, professional status, marital status, visual acuity and disability, anxiety and depression.
Conclusions
The level of quality of life in this type of patient varies considerably between regions and countries and even in the same country. Associated factors are predominantly socio-demographic.
Key messages
The level of quality of life in patients with glaucoma varies considerably between regions and countries.
Associated factors are predominantly socio-demographic.
Introduction
Heart failure (HF) represents a major public health issue in Tunisia due to its frequency and its consequences in terms of morbidity and mortality. Despite improved treatment, HF is ...still associated with high mortality and impaired quality of life. Therefore, improvement or maintenance of health-related quality of life (HRQoL) is important when caring for these patients. The aim of this study was to evaluate the health-related quality of life (HRQoL) and explore its associated factors and its relationship with social support.
Material and methods
A cross sectional study was conducted over a period of two months in the cardiology departments in the following university hospitals: Sahloul and Farhat Hached in Sousse, Fattouma Bourguiba in Monastir and Taher Sfar in Mandia. Overall, 92 participants were included. Data was collected using an interview administrated questionnaire in the Tunisian dialect. This questionnaire used the Tunisian version of the SF-36 and MSPSS.
Results
The mean age of the participants was 63.1 ± 10.4 with female predominance (53.3%). The overall score of the SF-36 was 45.1 ± 26.5. The physical component was more impaired than the mental component ((41.2 ± 29.1 VS51.3 ± 27). The two dimensions mental health and social functioning had obtained the highest averages (63.6 ± 22.4 and 51.4 ± 33.1; respectively). The MSPSS score was 52.5 ± 21. The ‘family' subscale had the highest mean (21 ± 8). HRQoL was positively associated with social support (p = 0.013; r = 0.257). The predictors of good HRQoL were: young age, university level of education, cohabitation with family, high socioeconomic level and one-sided HF.
Conclusions
Therapeutic education sessions should be implemented in order to improve the functional symptoms of HF, reduce the rate of readmissions and subsequently improve HRQOL. We also stress the importance of giving priority to strengthening social ties between the patient and their social circles.
Key messages
Heart failure is still associated with high mortality and impaired quality of life.
Therapeutic education sessions should be implemented in order to improve the Quality of life of HF patients.
Background
Alzheimer is a pathology that concers the patient and his family having a physical, social, economic and psychological impact. Research on family caregivers is still lacking and little is ...known about caregivers burden and ist associated factors in Tunisia. The aim of this study were to describe caregiver burden among Tunisian family caregivers of patients with alzheimeŕs disease, its associated factors and ist relationship to social support.
Methods
We conducted a cross-sectional study among 118 family caregivers during three months at the neurology outpatient departments of two university hospitals. Sahloul, Sousse and Taher Sfar, Mahdia. Using the Zarit Burden Interview-22 (ZBI)items and the Medical Outcome Study-Social Support Survey to assess burden and social support among the caregivers.
Results
We included 118 caregivers of patients with Alzheimeŕs disease,with an average age of 45±15 years. Women were more predominant with a sex ratio of 0.57.Half of caregivers were the descent of patients. The Mean years of caregiving was 5±3 years with an average of 13 hours ±3 of care assistance per day. The mean ZBI Score was 38.4±18.5 and 16.1% of caregivers percived a severe burden. The mean ZBI Score was higher in female, retired, lowmsocio economic status and in rural area with a statistically significance difference. We found that caregiver burden and social support were highly correlated (p < 0.001,r=-0.41)indicating that a high level of caregiver burden was asoociated with a less level of social support.
Conclusions
The level of burden in family caregivers who are caring for a patient with alzheimeŕs disease is high. A considerate help and support from helth care and social institutions is required by taking into account the factors that contribute to caregivers burden and considering the importance of social support in alleviating caregiver burden.
Key messages
The level of burden in family caregivers who are caring for a patient with alzheimeŕs disease is high.
High level of caregiver burden was asoociated with a less level of social support.
Introduction
Evidence-based practice (EBP) is a worldwide approach in optimizing quality of healthcare. As healthcare providers are increasingly more involved in clinical decision making, it is ...becoming important for them to use the best evidence to make effective and justifiable decisions. EBP is an important competency of undergraduate healthcare students that remains little known among Tunisian future healthcare professionals. This study aimed to describe health sciences students' attitudes. Knowledge and skills in EBP; to determine factors associated with these competencies and to identify perceived barriers regarding EBP.
Materials and Methods
A descriptive cross-sectional study was conducted at the Higher School of Health Sciences and Techniques of Sousse among 365 health sciences students enrolled during the second semester of the academic year 2017-2018. Data was collected using a self administrated questionnaire including a validated EBP-COQ questionnaire and focusing on identifying the perceived barriers to the usage of EBP.
Results
The response rate was 93.11%. Approximately, 61.6% of students were familiar with the term ‘EBP'. The overall score of EBP-COQ questionnaire was 3.26 ±0.53 out of 5. The mean scores of attitude, skills and knowledge subscales were 4.04 ±0.41; 3.05 ±0.77 and 2.70 ±0.74 respectively. A significant statistical association was found between the competencies in EBP and age; gender, academic degree, year of study for license degree, students' English-language reading skills, students' education in research methodology and statistics (p < 10-3). The top reported barriers hindering their adoption of EBP were: lack of training in EBP, difficulty in obtaining full-text papers and lack of time.
Conclusions
The strategic position of healthcare students may influence the adoption of EBP. It is necessary to understand students' attitudes, knowledge and skills in the subject to be able to develop effective strategies for EBP curricula.
Key messages
Evidence-based practice is a worldwide approach in optimizing quality of healthcare.
It is necessary to understand students' attitudes, knowledge and skills to develop effective learning strategies.
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