[Evaluation of hand hygiene in healthcare staff of Charles Nicolle hospital of Tunis by questionnaire]

Known to be reservoir of bacteria, hands are implicated in bacteria cross-transmission which enhances nosocomial-acquired infection rates [NI] and outbreaks. Hand washing is then considered the first mean with authentic efficiency to prevent NI. To describe the situation of the hand hygiene at Charles Nicolle hospital of Tunis in order to identify problems that can oppose to the good execution of this practice. A descriptive transverse study performed in October 2006 where 600 questionnaires were distributed to healthcare staff of the hospital. Only 434 questionnaires were responded [158 doctors and 276 nurses]. Analysis of data obtained showed that hand washing was essentially practiced after each contact presumed to be contaminant for the healthcare person himself [80%] and was principally done with water and soap [82%]. Hydro-alcoholic solutions were rarely mentioned [17.1%]. The main reasons evoked for the non observance were unavailability of the necessary means [84.8%] and default of awareness [61.3%]. So, these results show a poor perception of the healthcare staff of on the importance of hand hygiene which they share the responsibility with healthcare managers. Thus, implication of all healthcare actors is necessary to ensure the good practice and mainly the observance of hand hygiene

Prevalence, connaissance, traitement et controle de l'hypertension arterielle: Resultats d'une enquete populationnelle

The study objective was to assess the prevalence, level of awareness of treatment, and control of hypertension in a general population. We conducted a cross-sectional survey on 1837 adults 40-69 years old. Hypertension and control level are defined according to the WHO/ISH recommendations. HBP is defined as SBP> =140 and or DBP> = 90 mm Hg and the use of blood pressure-lowering medication. Hypertension is controlled by medication if SBP < 140 and DBP < 90 mm Hg. We conduct analysis by socio demographic variable, medical history and CHDs risk factors. 44,3% of adults was hypertensive. The prevalence of hypertension was higher among women [48,2% versus 38,7% on men.] and it increases in both genders with age, body mass index. Only 41,% of the hypertensive were aware of having hypertension, among them, 74,1%declare that they are treated but only 13.2% were controlled. The study highlights the problem of the hypertension in a developing country. It contributes to identify the huge iceberg of this CVDs risk factor. The national strategy must focus on the population life style and drugs management. The question is how much will be the cost of HBP and CVDs control for a country which has a limited resources

Prise en charge de l'hypertension arterielle: Resultats d'une enquete Tunisienne aupres des medicins generalistes

The control of arterial hypertension [HT] is an endlessly hoped objective but usually not reached. Several factors are determinants. The physician role is crucial in the HT prevention. In order to evaluate knowledge's, attitudes and behaviors of Tunisian physicians in HT management, we conducted a cross sectional study in 2002 using a self administered questionnaire addressed to physicians working in private and public sectors. 380 generalists participated to this study. 95,5% of them confirmed that HT constitutes a public health problem. 81,1% saw at least 4 patients with HT a week. 95% insisted on the importance of the primary prevention. 90% took care themselves patients. 71,5% confirmed the importance of a training and an entrainment for the measure of the blood pressure [BP]. 3,7% made diagnosis after a single visit and 10,9% confirmed it only from described symptoms. 20,4% of the generalists chose the old classification as objective level of BP thiazidic Diuretics and 13 blockers were most prescribed medicines in first intention. 9,4% stopped the treatment after stabilization of blood pressure. 60% of generalists had inadequate behavior facing a not stabilized BP Non observance of treatment by patients was indicated by 31% of the generalists, cost and break of the medicines' stock and disappearance of symptoms were the main causes advanced by the generalists. This study shows the existence of gaps in generalists' practical behavior treating this disease. Measures aiming the medical practice improvement turn out necessary in particular the sensitization of the generalists by an adequate university training and a continuous medical training, and a regular evaluation of the national program of hypertension prevention and management

Analyses des connaissances attitudes et pratiques du personnel soignant face aux accidents d'exposition au sang en chirurgie generale

In order to assess the degree of knowledge, attitudes and the personnel's practices exercising in a service of general surgery of the hospital Charles Nicolle of Tunis, concerning blood exposure accidents, we did a transverse survey during the month of January of the year 2002. A questionnaire has been addressed to 114 people while using the technique of the direct interview. The middle age of investigated is 35,7 years. The sex ratio is 0,7. Only the 2/3 declare have been vaccinated against the B hepatitis. The results show a good knowledge of the exposure risk to a communicable disease by blood [95,6%], but less good for the risk of contamination by the three viruses HBV, HCV and HIV. The resheathing of needles, considered like gesture to risk, is underestimated by 71,2% of investigated. the majority of investigated declare to know universal precaution principles [85,8%]. However, to the maximum 4 measures only on the 1 0 advisable have been mentioned by investigated. The conduct to hold in case of blood exposure accident seems insufficientiy known by our sample- It is represented, in 78,8% of cases, in the application of disinfectants Betadin' type or alcohol Iodized, whereas the practice of 0 serology to the patient source is ignored completely. 75% of investigated having had a blood exposure accident lasting the last 12 months [n = 44] didn't declare their blood exposure accident and only 11,4% declare to have undergone cares. Actions of information and Formation, to the intention of the whole of the personnel of the service, on risks incurred by the nursing, gestures and procedures to risk, the universal precaution respect, the conduct to hold in case of a blood exposure accident, the interest of the declaration and the interest of the vaccination against the B hepatitis, are primordial

Les me'thodes d'estimation du cout de l'infection nosocomiale

In order to locate the rate of positivity of the different markers of hepatitis that can be transmitted through blood [Ag HBs, anti- HB[c] Ab, anti-HCV Ab and transaminases [ALAT], we have conducted a study over 300 blood donors and who are sale, equally shared between the parts of age and of sex. The ALAT were superior to the normalcy in 10.66% of the cases, the male sex being 3 times more affected than that of the female. The Ag HB[s] was positive in 4.66% of the cases. The male sex is twice as affected as the female sex. One of three persons who donated blood [37.33%]hadanti-HBC Ab. Finally none of the 300 blood donors has the anti- HCV Ab. There's a very weak recovering between the presence of Ag HB[s] and of ALAT superior to the normalcy, a weak recovering between Ag HB[s] and anti HBC Ab and a certain recovering between ALAT superior to the normalcy and the pr‚sence of anti-HB[c] Ab. There is no recovering between the anti- HCV Ab and the indirect markers. Eventually the systematization of all these test over each donation engenders the elimination of more than 2/5 of the collected products

[Study of incidence of nosocomial infection in a general surgery service]

Nosocomiol infection incidence and its cost were studied. We have identified 61 infected patients and 75 infectious episodes, is an incidence of 9,4% infected for 100 hospitalized by trimester. Operative site infections are the most frequent [60%], operative site infection [9,1%], inferior respiratory ways infections [2,2%]. Incriminated germs are represented essentially by negative gram Bacillus [77,3%] with predominance of enterobacterias [59%]. Invasive technique usage, surgery types and contamination classes have been identified as risk factors of nosocomial infection occurrence. The supplementary stay duration estimated by simple comparison between infected group and non-infected one is 9,3% days, responsible of an over cost of 336 TD by infected patient and 273 TD by infectious episode. The curative antibiotic costs have been estimated at 70 TD by infected patient being equivalent to two hospitalization days and to 57 TD by infectious episode

[Death cause declaration in Tunisia]

We have led a study about 2251 death which are declared during 1996 in the Great-Tunis. Results are following :The hospital deaths are as many betters certified that the physician is a specialist. The cause mention rate is about 88,6% for death observed by specialists against 28,5% for those observed by internists. Paradoxically, a precise cause mention is best for deaths that are observed outside hospitals and when the physician is an internist. Badly define morbid states represent 17,1% of outside hospitals mentioned causes against 30,8% in the Hospital. They represent 12% of causes mentioned by internist against 30,1% of those mentioned by specialists. Despite death medical certificate obligation, the strong proportion of badly defined morbid states characterizes death causes. We hope that this situation will be improved by the new model usage of the which will be introduced since 2000. This certificate mentions death causes distinguished in initial, immediate and associated. This certificate has be the object of the decree n° 99 - 1043 of 17 May 1999

L'utilite du modele de rhame et sudderth bdans la surveillance des infections nosocomiales

The objective of the study is to test Rhame and Sudderth's model, to calculate cumulative incidence of nosocomial infection from prevalence and duration. We carried out a follow-up study in a surgical department in Charles Nicolle hospital on a sample of 643 patients admitted between October 1 and December 31.1992. We calculated the following parameters: Average length of hospital stay: 5.5 days. Estimated average duration of nosocomial infection 6.8 days. Prevalence rate of nosocomial infection: 11.7%. the observed cumulative incidence was 11.6%. While the expected cumulative incidence by the model of Rhame and Sudderth was 9.5%. Differences between observed and expected cmulative incidence were not significant

Desinfection des fibroscopes: resultats d'une enqu

We report the results of a survey performed in February 1995 concerning the disinfection procedures of fibroscopes in digestive endoscopy unit. Disinfection procedures used were observed between the examinations and at the end of the endoscopy session. Serial bacteriological samples were obtained before the first endoscopy and between two patients. Principal errors of disinfection procedures were: inadequate cleaning of internal channel using glutaraldehyde between each endoscopy. Bacteriological samples were positive in 6/57, exclusively in biopsy channel. However disinfection procedures of the fibroscopes were not used enough. A sensitization of a personnel for the respect of the cleaning and disinfection procedures, as well as the establishment of protocols proved to be necessary