ABSTRACT
Background: Intensive care unit -acquired infections constitute an important worldwide health problem
Aim: Our aim was to determine the incidence and risk factors of device-associated infection and those of mortality in a Tunisia ICU.
Methods:We conducted a prospective observational cohort study over a six months period in the adult medical intensive care unit of University Hospital-Farhat Hached [Sousse-Tunisia]. Patients admitted to the unit were included in the study if they stayed in the ICU for more than 48 hours
Results: During the study period, 105 patients were surveyed; 16 of them [15.2%] developed 17 episodes of device associated infections [16.9 DAI/1000 days of hospitalization]. The most frequently identified infections were central and peripheral venous catheter -associated infection [respectively, 21.4 CVC-AI/ 1000 CVC-days and 10.2 PVCAI / 1000 PVC-days]. At ICU discharge, overall mortality was 40%. Independent risk factors for acquiring infection in ICU were the use of central venous catheter [p=0.031] and length stay [0.002], those of mortality in ICU were immunosuppression [p=0.013], DAI [p=0.002] and the use of central venous catheter [p = 0.001]
Conclusion: Even if DAI rates in Tunisian ICU were lower than those published in some reports from other North African countries, DAI data and mortality rate, dominated by the use of catheter associated infections show the need for more-effective infection control interventions in our hospital
ABSTRACT
Handwashing is the most effective method of preventing the spread of nosocomial infection. Despite its simplicity, handwashing is frequently omitted by health care personnel. In order to promote hand hygiene at Farhat Hached hospital [Sousse - Tunisia], the team of hygiene sets up a programme of hand hygiene programme. This work enters within the framework of the evaluation of the program's impact relatively on the healthcare worker's hand decontamination practices [physicians and nurses]. Our aim is to determine the evolution of hand washing rates, specific compliance [per unit and category of healthcare workers] and adapted compliance. Our study is experimental with comparison of the results of 2 audits, the first carried out before the installation of the program [winter 2003] and the second after [winter 2006]. The study was conducted in 4 units: two medical units [internal medicine and pneumology], a surgical unit [general surgery] and intensive care unit. On the whole, 208 and 319 acts of care were observed respectively during the first and the second audit. The rate of total observance and that of correct observance of handwashing doubled and passed respectively from 28% to 46,4% [p = 2 x 10[-5]] and from 13,9% to 23,5% [p = 4 x l0[-5]]. Failures causes observed at washing hands time [2006] are mainly related to a later recontamination of the hands. The observance of handwashing increased only for nurses, from 34% to 47.5% [p < 10[-2]]. With the aim to improve hand washing compliance, hand hygiene programme must target even more the physicians and provide alcohol hand rubs
Subject(s)
Humans , Hand , Health Personnel , Cross Infection , Nurses , Physicians , Hand DisinfectionABSTRACT
Drugs occupies a strategic place in health care expenses however, irrational practices characterize its utilization by all actors and particularly the population. The objective of this populational study is to identifiy attitudes and practices of the households of the sanitary region of sousse [Tunisia] in the domain of medicine use. It is a descriptive survey concerning a representative sample of 402 households distributed in four localities [two urban, one semi-urban and one rural]. Data have been collected through a questionnaire managed during an interview with the family's member [most often the chief of the household]. We found that beliefs of the population are often erroneous [the expensive medicines are considered more efficient by 52% of interrogated persons and practices were often maladjusted [self medication, insufficient comliance]. A community mobilization via an education of health oriented by results of this exploratory survey would be an important component of the global strategy of promotion of the rational use of drugs in our country
Subject(s)
Humans , Male , Female , Pharmaceutical Preparations , Self Medication , RationalizationABSTRACT
Chronic renal failure and periodic hemodialysis, by the physical reach and the therapeutic imperatives that they mislead disrupt by several ways the universe of the patient. This one is confronted to changes, or even to aggressions that undergo his body, his domestic and socio professionnal life, which is accepted in general with difficulty. Indeed, our survey that concerned 109 patients on chronic hemodialysis shows that the minor psychiatric pathology is frequent and can represent a source of problems as well for the patients that for the medical and nursing staff. Besides the analysis of minor psychiatric specificities revealed by a known measure instrument [the GHQ], this work insists on the importance to take account of this aspects with the aim to enhance management and holistic care of these patients