Epidemiology of Clostridioides difficile infection at a tertiary care facility in Saudi Arabia: Results of prospective surveillance.

OBJECTIVES: To determine the incidence of Clostridioides difficile infection (CDI) and the frequency of known risk factors. METHODS: A prospective hospital-based surveillance for CDI, according to the Centers for Disease Control and Prevention criteria, was carried out from July 2019 to March 2022 for all inpatients aged more than one year in Prince Sultan Military Medical City, Riyadh, Saudi Arabia. RESULTS: A total of 139 cases of CDI were identified during the survey among 130 patients admitted in the hospital. Most cases were incident (n=130; 93.5%), and almost three-quarters (n=102; 73.4%) were hospital-onset (HO) CDI, with an incidence rate of 1.62 per 10,000 patient days (PD). The highest rates were noted in intensive care units with an incidence rate of 3 per 10,000 PD and wards for immunocompromised patients with an incidence rate of 2.72 per 10,000 PD. The most prevalent risk factor for CDI was acid-reducing drugs (72.6%). Vancomycin (48%) and ciprofloxacin (25%) were the most frequently prescribed antibiotics for patients with CDI. Clostridioides difficile infection complications were identified in 5.7% of the cases, with a reported 28-day mortality rate of 3.8%. CONCLUSION: In our hospital, HO-CDI incidence rate is lower than that in high-income countries. National multicenter surveillance is needed to evaluate the actual burden of CDI in Saudi Arabia.

An updated review on pathogenic coronaviruses (CoVs) amid the emergence of SARS-CoV-2 variants: A look into the repercussions and possible solutions.

SARS-CoV-2, responsible for COVID-19, shares 79% and 50% of its identity with SARS-CoV-1 and MERS-CoV, respectively. It uses the same main cell attachment and entry receptor as SARS-CoV-1, which is the ACE-2 receptor. However, key residues in the receptor-binding domain of its S-protein seem to give it a stronger affinity for the receptor and a better ability to hide from the host immune system. Like SARS-CoV-1 and MERS-CoV, cytokine storms in critically ill COVID-19 patients cause ARDS, neurological pathology, multiorgan failure, and increased death. Though many issues remain, the global research effort and lessons from SARS-CoV-1 and MERS-CoV are hopeful. The emergence of novel SARS-CoV-2 variants and subvariants raised serious concerns among the scientific community amid the emergence of other viral diseases like monkeypox and Marburg virus, which are major concerns for healthcare settings worldwide. Hence, an updated review on the comparative analysis of various coronaviruses (CoVs) has been developed, which highlights the evolution of CoVs and their repercussions.

Pattern and risk factors of sharp object injuries among health care workers in two tertiary hospitals, Al Taif-Kingdom of Saudi Arabia 2016-2018.

Occupational exposure of healthcare workers to blood and body fluids following skin injury constitutes a risk for transmission of blood-borne pathogens. The risk of exposure is greater as well. The present study aimed to determine the burden and risk factors of sharp object injuries in two tertiary hospitals in the Taif City KSA. Retrospective review of needle stick injury records was included from the two hospital's staff clinics. A Total of 131 health professionals (employees) recorded as exposed to sharp object injuries from both hospitals were enrolled during period 2016-2018. The collected data was cleaned, reviewed and analyzed using Statistical Package of Social Sciences SPSS ver. 25. The result of the study revealed that, the mean age for the 131 enrolled participants was 31 ± 6.6, Male to Female Ratio was 1:3. The most affected age group was 20-30 years (55.7%). Females were more affected 98 out of 131 (74.8%) than male (33out of 131 (25.2%). And there is increasing incidence rates of exposure from 2.89 /10.000 patient/day in 2016 to 3.42/ 10.000 patients'/day in 2017, with highest exposed nationalities; Filipino 42 (32.1%), Saudi 31 (23.7%), and Indians 26 (19.8%), the remaining 24.5% were from 10 mixed nationalities. The frequent affected divisions were: ER, surgical ward, operation room, ICU, laboratory, Medical W, Medical waste facilities (19.8%, 15%, 12.2%, 9.2%, 92% respectively). The most affected HCWs categories were nurses 74(56.5%), doctor 23(17.6%) and housekeeping 18 (13.7%). And the needle prick 104(79.4%) and cut wound 15(11.5%) constitute the highest type of injuries and were during operation 23 (17.6%), waste collection 15 (11.5%), cannulation 12 (9.2%) and giving injection 12 (9.2%). The common devices caused injuries were bore hole needle 63(48.1%), suture needle **(13.7%), cannula and insulin syringe 13 (9.9%) each. This study concluded that, as from 2016-2018, there was an increasing rate of reported accidental exposure to sharp needle injuries amongst HCWs from 3.0 to 3.4/10.000 patient/day, and the younger and nurses were mostly impacted. Workplace, distress, work types and load had influences on injuries rates and types. Fortunately, no exposure among employee with HBV, HCV and HIV seroconversion were documented.

Depression in a sample of Tunisian adolescents: prevalence, associated factors and comorbidity with anxiety disorders.

BACKGROUND: Adolescent depression is a significant health problem which can lead to detrimental consequences. This study aimed to determine the prevalence of the depression in a sample of secondary school students, to identify its associated factors and to explore the co-occurrence with symptoms of anxiety disorders. MATERIALS AND METHODS: We conducted, in March 2017, a cross-sectional study that included, using a cluster sampling technique, 386 students from five public secondary schools in El Kef (Tunisia). Data were collected using a socio-demographic questionnaire and the Arabic versions of the Beck Depression Inventory (13 items) and the Screen for Child Anxiety Related Disorders. Statistical analysis was performed using the Statistical Package for Social Sciences (SPSS) version 20. RESULTS: The prevalence of depression among participants was 75.9%. Of depressed students, 30.4% had mild depression, 48.8% had moderate depression and 20.8% had severe depression. The logistic regression analysis showed an association between the depression and the female gender [odds ratio (OR) = 2.59, 95% confidence interval (CI): 1.52-4.17], the 1st and 4th school grades (OR = 1.79, 95% CI: 1.09-2.94), the low and medium socioeconomic status (SES) (OR = 1.91, 95% CI: 1.14-3.18), the school dissatisfaction (OR = 2.77, 95% CI: 1.41-5.44) and the anxiety disorders (OR = 5.86, 95% CI: 3.54-9.70). The comorbidity "depression and anxiety" was found in 86.1% of students. CONCLUSION: This high prevalence of depressive symptoms reported in the present study seems to have many implications especially for school health-care services.

[Incidence of adverse events associated with the peripheral venous catheter in a Tunisian university hospital]. / Incidence des événements indésirables associés au cathéter veineux périphérique dans un service de cardiologie, Tunisie.

OBJECTIVE: To determine the incidence of peripheral venous catheters-related adverse events (PVCAEs). METHODS: We conducted a prospective observational study in the cardiology department over a period of 3 months. All inserted PVCs were monitored (every 12 hours) from insertion to up to 48 hours after removal. RESULTS: Data were analyzed for 148 patients with a mean age of 63.37±12.26 years and male predominance (n=76, 51.4%). The most common medical history was high blood pressure (56.1%) followed by obesity (39.2%). Intake of antibiotics was noted in 16.2% of cases where amoxicillin-clavulanic acid was the most prescribed molecule (4.1%). A total of 210 PVCs was studied (794 PVC-days). The mean maintenance time was 5.36±3.95 days. 38 PVCs resulted in 70 AEs with an incidence of 33.33 % (8.81 per 1000 PVC-days). The most common complication was pain (n=35, 50%), followed by mechanical PVCAEs (n=22, 31.42%). CONCLUSION: The incidence of PVCAEs remains high. The analysis of the main risk factors for these AEs would make better the identification of the preventive actions that should be undertaken.

[Perceptions of a healthcare-associated infections reporting system in a Tunisian university hospital]. / Perceptions d'un système de signalement des infections associées aux soins dans un hôpital universitaire tunisien.

Objective: The implementation of a healthcare-associated infections reporting system is a principal component of infection control and quality improvement policies in healthcare institutions. This study was designed to determine the perceptions of health professionals concerning implementation of a healthcare-associated infections reporting system and to analyse factors influencing these perceptions.Methods: A descriptive cross-sectional study conducted in 2012 using a predefined, pre-tested and self-administered questionnaire in 380 health professionals working in 16 different departments of Farhat Hached University Hospital, Tunisia.Results: The majority of respondents (71.8%) reported that no healthcare-associated infections surveillance procedure had been implemented in their departments. However, most respondents (93%) recognised the value of implementation of a healthcare-associated infections reporting system in order to provide them with corrective actions (77%), to support the investigation of epidemic and emerging phenomena (49%) and to share experiences about the prevalence of healthcare-associated infections and their risk factors (44%).Conclusion: Staff training and development of a regulatory framework are essential to implementation and correct functioning of a healthcare-associated infections reporting system.

Patient's safety culture among Tunisian healthcare workers: results of a cross sectional study in university hospital.

INTRODUCTION: Healthcare safety has become a public health priority in developed world. Development of safety culture care is fundamental pillar to any strategy for improving quality and safety care. The objective of this study is to measure level of patients' safety culture among healthcare professionals at university hospital, center Farhat Hached Sousse (Tunisia). METHODS: We conducted, in 2013, a descriptive study among all licensed physicians (n= 116) and a representative sample of paramedical staff (n= 203) exercising at university hospital center Farhat Hached Sousse (Tunisia). Measuring instrument used is a valid questionnaire containing ten safety care dimensions. Data were analyzed using SPSS version 19. RESULTS: The response rates were 74.1% for physicians and 100% for paramedical staff. Overall score of different dimensions varies between 32.7% and 68.8%. Dimension having most developed score (68.8%) was perception of "Frequency and reporting adverse events". Dimension with lowest score (32.7%) was "Management support for safety care". CONCLUSION: Our study has allowed us to conclude that all dimensions of patients' safety culture need to be improved among our establishment's professionals. Therefore, more efforts are necessary in order to develop a security culture based on confidence, learning, communication and team work and rejecting sanction, blame, criminalization and punitive reporting.

[Device-vigilance at University Hospital in Central Eastern Tunisia: a survey conducted among physicians]. / La matério-vigilance dans un Centre Hospitalo-Universitaire du Centre-Est tunisien: enquête auprès des médecins.

INTRODUCTION: The University Hospital Farhat Hached Sousse (Tunisia), has implemented a device-vigilance (DV) system, according to ANCSEP (National Agency of the Sanitary and Environmental Control of Products) guidelines, in order to manage the risk more effectively in hospital and to improve the quality and safety of patient care. In Tunisia the lack of regulation regarding device vigilance is the major obstacle to caregiver vigilance. The objective of this study is to establish the knowledge, attitudes, and clinical practice of University Hospital physicians regarding the implementation of the DV system. METHODS: We conducted a descriptive cross-sectional study of KAP (knowledge, attitudes and practices) among all the physicians working at the University Hospital Farhat Hached Sousse (Tunisia) who were users of medical devices (MDs) in the practice of their profession. A self-administered, pre-established and pre-testing questionnaire was developed. Data were collected and analyzed using SPSS20.0 software. RESULTS: The response rate was 51.9 % (183/95). A lack of knowledge about DV has been reported. More than half of the respondents didn't know the local correspondent of health establishment and the existence of a standardized vigilance reporting form. Regarding the attitudes, 89,5% express their interest in setting up a DV system and 37,5% acknowledged that the vigilance reporting form should be filled by the caregiver notifying the incident. Regarding the procedures, the majority of physicians confirmed the absence of an organized maintenance management of the MDs in the practice of their services. 90.5% express their wishes to receive information but few of them express their wishes to receive proper training (57.9%). CONCLUSION: A lack of information and training in a sensitive field which need to be heavily regulated has been a topic of discussion. The promulgation of regulatory texts is necessary in order to promote MD sector and guarantee the safety of patient and their users.

[Patient safety culture based on a non-punitive response to error and freedom of expression of healthcare professionals]. / Culture sécurité des patients par la réponse non-punitive à l’erreur et la liberté d’expression des soignants.

This study provided an overview of healthcare professionals’ perception of patient safety based on analysis of the concept of freedom of expression and non-punitive response in order to identify and correct errors in our health system. This concept is a cornerstone of the patient safety culture among healthcare professionals and plays a central role in the quality improvement strategy..

[Incidence of device-associated infections in a Tunisian intensive care unit]. / Incidence des infections associées aux dispositifs médicaux dans un service de réanimation tunisien.

INTRODUCTION: Healthcare-associated infections represent a real public health problem. They are particularly frequent and severe in intensive care units due to the serious diseases presented by patients and the almost systematic use ofvarious medical devices. A study of the incidence of device-associated infections was conducted in the ICU of CHU Farhat Hached Sousse (Tunisia) to estimate the incidence and to identify risk factorsfor DAI METHODS: This prospective incidence study was conducted during the first quarter of 2012, with anonymous and standardized data collection for all patients hospitalized for at least 48 hours. RESULTS: Out of a total of 105 patients hospitalizedfor more than 48 hours during the study period, 17 cases of DAI were identified. The incidence density was 16.9 infected patients / 1,000 days of hospitalization. The infections most frequently identified were central and peripheral venous catheter-associated infections. Independent riskfactorsfor DAI in the ICUwere length of ICU stays which increased the risk of DAI by 1.10 per day (95% CI [1.03 - 1.17]; p=0.002), and the use of CVC, which increased the risk by 3.29 (95% CI [1.36 - 7.95]; p=0.031). CONCLUSION: The implementation of continuous surveillance of healthcare-associated infection in the intensive care unit should be encouraged in order to guide the actions of prevention and control of nosocomial infection risk.

Risk of mortality due to device associated infection.

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.

Smoking prevalence in a factory in the region of Sousse- Tunisia.

BACKGROUND: Smoking is a public health problem because of its high prevalence and its serious consequences at all levels. AIM: The aim of this study was to determine the prevalence of smoking among workers in a private company and describe the characteristics of smokers to guide prevention efforts. METHODS: It is a cross-sectional study conducted in 2010 among all employees of a private company. Data collection was done by a questionnaire administered by interview. RESULTS: The participation rate was 90.4%. All smokers were men, with a prevalence of active smoking among men of 57.9%. The mean age of smokers was 33.2 ± 8 years, significantly lower than nonsmokers. The comparison between smokers and nonsmokers according to occupational category showed a statistically significant difference. Among smokers, 43.6% were in the contemplation stage and 46.3% at the stage of preparation for smoking cessation. CONCLUSION: An intervention for prevention and fight against smoking in the workplace should be established for the promotion of employee health.

Serotype distribution and antimicrobial resistance of invasive and noninvasive pneumococcal isolates in Tunisia.

Pneumococcal conjugate vaccines have not yet been introduced into the national program for childhood vaccination in Tunisia. The aim of this 7-year study was to obtain local data about serotype distribution and antimicrobial resistance of Streptococcus pneumoniae. A total of 203 isolates of culture confirmed that S. pneumoniae was evaluated. Invasive (n=108) and noninvasive (n=95) pneumococcal isolates were obtained from patients aged from 1 month to 85 years old. Considering all age groups, vaccine coverage was 40%, 62%, and 68% for PCV7, PCV10, and PCV13 serotypes, respectively. Overall, 31% of these isolates were penicillin G nonsusceptible. The most prevalent serotypes identified were those found in currently available pneumococcal conjugate vaccines, emphasizing the importance of implementing the vaccine in the routine immunization schedule at the national level.

[Measuring patient safety awareness among physicians in a Tunisian hospital]. / Mesure de la culture sécurité des soins auprès des médecins dans un hôpital tunisien.

AIMS: The objective of this study was to measure the level of awareness of patient safety among physicians at Farhat Hached hospital in Sousse (Tunisia). METHODS: A cross-sectional descriptive study was conducted in 2012 using a validated survey based on pervious studies. This self-administered questionnaire was distributed to 116 physicians working in 16 different departments of Farhat Hached university hospital. This survey explores 10 dimensions of patient safety and each of these dimensions is composed of several items. The percentage of positive (positive attitudes) and negative responses for each item was calculated and a score was calculated for each dimension, corresponding to the mean percentages of positive answers to the respective items of the dimension. RESULTS: The response rate was 74.1%. The overall positive response rate of patient safety awareness ranged from 13.9% to 84%. The dimensions with the lowest positive response rates were "Hospital management support for patient safety" (13.9%) and "Teamwork within units" (45.4%). The highest percentage of positive responses was observed for "Supervisor expectations and safety-promoting actions" (82.3%) and "Frequency of event reporting" (84%). CONCLUSION: This study measured the level of awareness of patient safety among physicians at Farhat Hached university hospital. The results obtained will be used to guide safety-promoting actions.