ABSTRACT
Introduction: Timely identification of COVID-19 patients at high risk of mortality is crucial to improve patient management and resource allocation in hospitals. Objectives: The aim of this study was to identify mortality risk factors at the COVID-19 Intensive Care Unit (ICU) in the region of Mahdia Methods: We conducted a prospective study including patients with severe COVID-19 infection admitted to the ICU of The University Hospital Tahar Sfar Mahdia. The survey was carried out between September 2020 and February 2021. We used “The RAPID CORE CASE REPORT FORM” developed by the World Health Organization. Results: We analyzed the records of 117 patients (59.8% were males). Mean age was 61.4 ± 12.2 years. Common symptoms were shortness of breath (82.6%), cough (71.1%) and fever (69.3%). The median length of stay in the unit was 18.3 days (IQR: 2-66). About 48.7% of patients had invasive ventilation, 30.3% required vasopressors intake and 51.4% required prone position. The overall mortality rate was 46.2%. Longer stay in the hospital (> 14 days) and longer intubation duration (≥ 7 days) were associated with a higher risk of mortality (61.8% vs 32.3%;p < 0.001 and 77.6% vs 20.6%;p < 0.001 respectively). Mortality was also related to acute respiratory distress syndrome (66.7% vs 13%;p < 0.001) and nosocomial infection (80.8%vs 17%;p < 0.01). Multivariable logistic regression analysis showed increasing odds of mortality with nosocomial infection (OR, 12.41 [95% CI, 3.3-46.57], respiratory distress syndrome (OR 7.52 [95% CI. 1.71-32,95]) and inotropes or vasopressors intake (OR 7.39 [95% CI, 1.57-34.69]). Higher oxygen saturation on admission was found to be a protective factor against mortality (OR 0.91 [95% CI, 0.85-0.97]). Conclusion: Interventions that prevent these risk factors are needed to improve the prognosis of Covid-19 patients.
ABSTRACT
Introduction: The ongoing Covid-19 pandemic provides the opportunity to demonstrate the potential benefit of the good hand hygiene practices (HHP) in controlling health care-associated transmission of Covid-19. Objectives: The present study aims at evaluating hand hygiene practices of health care workers (HCWs) during the first wave of Covid-19 pandemic at the university hospital Tahar Sfar Mahdia (Tunisia). Methods: We carried out an observation audit among HCWs staff at the university hospital Tahar Sfar Mahdia in Tunisia during the first wave of Covid-19 pandemic (April-May 2020) using four pretested and reliable audit sheets. The first one concerned the simple washing hand, the second and third sheet were used to evaluate respectively the hygienic washing and the hydro alcoholic friction and the fourth sheet to assess the compliance and conformity rates. We excluded the outpatients departments. Results: A total of 214 observations were enrolled of which 143 HCWs were observed. Approximately a quarter 24.6% were medical professionals and 53.2% were nursing personnel with a female predominance (sex-ratio = 0.33).Nearly two thirds of the observations 61.5% concerned high-risk departments and 56.6% were collected during the morning shift. The Half of HCWs observed 50.3% met the requirements of efficacy for hand hygiene. The majority 91.3% did not respect the technique of simple washing hand against 75% the technique of hydro alcoholic friction. The hand hygiene compliance rate before observation was 19% compared to 20.3% after. The overall conformity rate was 6.5%. Being male (p < 0.001), working at a high risk department (p < 0.01) and working during the morning shift (p = 0.003) were found to have significant relationship with good HHP. Conclusion: HCWs must modify their behaviors to face the risk propensity of the Covid-19 pandemic. However, to improve the poor compliance a culture of rigorous HHP should be established.
ABSTRACT
Introduction: In Tunisia, the Covid-19 pandemic threatens to overwhelm scarce clinical resources especially in Intensive Care Units (ICUs) Objectives: This study aims at analyzing clinical presentation on admission and the determinants associated with extended hospital stay in (ICUs). Methods: We carried out a prospective study on 117 hospitalized patients in ICUs at the university hospital Tahar Sfar Mahdia which is located in the Central-East part of Tunisia from September 2020 to February 2021 using a valid and reliable tool inspired from the WHO- 2019-nCOV-Clinical platform observation. Results: A total of 117 patients were recruited with a mean age of 61.4 ± 12.2 years. Males outnumbered (60%, sex ratio = 0.67).The majority 85.5% had pre-existing chronic diseases mainly hypertension 38.5% and Diabetes 42.2%. The median length of stay was 14 (IQR: 24-9) days. Approximately the half 47% had an extended stay (> 14 days). Of the 117 patients included, 46.2% died in hospital and almost the half 50.1% required mechanical ventilation. Our survey shows a significantly longer hospital stay among older patients (52.9%), patients having oxygen saturation < 90% (51%) and those who have developed a health care associated infection 63.5%. The main factor associated with extended hospital stay was invasive intubation (77.6%). Acquiring a nosocomial infection (p = 0.001), developing a complication (p < 0.001), resorting to invasive intubation (p < 0.001) and administering vasopressor drugs (p = 0.001) were found to have significant relationship with extended hospital stay. Conclusion: This close look at the length of Covid-19 IUCs stay could provide an overview and would improve the prognosis of Covid-19 patients.
ABSTRACT
Introduction: Hand hygiene is the most effective measure in reducing healthcare-associated infections. Accordingly, it has been recommended as an important strategy to prevent the spread of COVID-19 in health care settings. Objectives: We aimed to measure the adhesion and the relevance of hand washing during the first and the second COVID-19 waves at the University Hospital Taher Sfar Mahdia (Tunisia). Methods: We performed a prospective study recruiting a cohort of randomly selected health care professionals at the University Hospital Taher Sfar Mahdia. Direct hand hygiene observations were conducted on July 2020 (during the first wave of COVID-19 in Tunisia) and January 2021(during the second wave), then evaluated using the hand hygiene audit developed by WHO. Results: We performed 378 observations of hand hygiene (214 on July 2020 and 166 on January 2021) among 286 health workers with a female predominance (74.8% and 66.4%, respectively). About 26.6% and 37.1% of the sample were medical professionals during the first and the second waves respectively. The rate of health workers in Intensive Care Units (ICU) ranged from 38.5% to 36.4% between the two periods. From July 2020 to January 2021, the global relevance rate significantly increased from 6.5% to 21.3% (p < 0.001). Hand hygiene adherence 'before patient contact' improved from 19% to 31.4%, and 'after patient contact' from 20.3% to 31.9%. The correct execution of hand hygiene technique increased from 8.7% to 50% (p < 0.001). The rates of hand hygiene relevance were higher in males (p = 0.003), in ICU (p < 0.001) and the morning shift period (p = 0.01). Conclusion: Although the COVID-19 improved hand hygiene adhesion rates, relevance remains challenging. It is important to continue the promotion of hand washing with the same enthusiasm and commitment even after this outbreak.
ABSTRACT
Introduction: Hospital-acquired infections pose a serious challenge to healthcare workers during the COVID-19 pandemic. Objectives: We aimed at assessing associated factors to hospitalacquired infection in the COVID-19 Intensive Care Unit (ICU) in the region of Mahdia (Tunisia). Methods: We conducted a prospective study from September 2020 to February 2021 among COVID-19 patients in the ICU of the University Hospital Taher Sfar Mahdia from hospital admission to discharge or death. We used the “Rapid core case report form” developed by World Health Organization (WHO) for the COVID-19 data plateform. Results: A total of 114 patients were enrolled with a mean age of 61.28 ± 12.19 years and median length stay of 14 days (IQR 9-24). Diabetes (43.4%) and hypertension (38.6%) were the most frequent underlying diseases. Fifty-four patients (54.2%) developed nosocomial infection after a median of 7 days (IQR 4-11) of admission. Pneumonia (29.8%) and bacteremia (28%) were the most common infection sites. In 34.2% of cases, infection was related to resistant bacteria (100% of multi-resistance for Acinetobacter baumanii and 90.5% for Klebsiella pneumonia). Infection was significantly associated with severe acute respiratory distress syndrome (OR 4.4, 95% CI 1.3-10.9, p = 0.018) and longer invasive ventilation (more than 7 days) (OR 10.4, 95% CI 9.7-20.5, p < 0.001). Conclusion: Measures to reduce Hospital-acquired infections such as implementing antimicrobial stewardship programmes are needed in order to achieve better therapeutic outcomes.
ABSTRACT
Introduction: The high mortality among intubated COVID-19 patients in Intensive Care Unit (ICU) has given rise to a debate over risk factors related to a prolonged intubation period. Objectives: In this study, we aimed to identify individual risk factors associated with prolonged intubation (≥ 7 days) among patients with COVID-19. Methods: A prospective study was carried out between September 2020 and february 2021 among patients admitted in the COVID-19 ICU at the University Hospital Tahar Sfar Mahdia. The measurement tool was the “ RAPID CORE CASE REPORT FORM” developed by WHO. Results: A total of 114 participants were enrolled with an average age of 61.4 ± 12.2 years. About 51.4% of patients needed intubation. During the hospitalisation, 12 (21.1%) were eventually extubated and 45 (78.9%) died. Prolonged intubation was recorded in 43.8% of cases. Among them, 35.4% were diabetic, 30.6% have hypertension and 6.1% had chronic heart disease. The main factors significantly associated with longer intubation were: Nosocomial infection (80.8% vs 7.7%;p < 0.01), acute respiratory distress syndrome (60.6% vs 17.8%;p < 0.01), and ionotropic use during the first 24 h (82.4% vs 36%;p < 0.01). Multivariable logistic regression analysis identified nosocomial infection (OR, 20.54 [95% CI, 5.44-77.57] and early invasive intubation (during the first 24 h) (OR, 4.65[95% CI, 1.1-19.56]) as predictive factors of prolonged intubation. Conclusion: As COVID-19 infection continue to rapidly consume the health care system's limited resources, technicians consulted for airway management should consider these factors in their decision making.