Incidence of surgical site infections and prediction of risk factors in a hospital center in Morocco.

INTRODUCTION: Surgical site infections (SSIs) remain the major cause of morbidity and mortality in the postoperative period and are important surgical and hospital quality indicators. In this context, our study aims to identify SSIs associated risk factors and to develop a predictive model. METHODOLOGY: 2521 patients who underwent surgery, between June 2018 and May 2019, in four surgery departments, at the Taza Provincial Hospital (Morocco) were diagnosed for SSI according to the standards of the Center for Disease Control and Prevention. The SSIs' risk factors were assessed by univariate statistical analysis and logistic regression using the Scikit Learn function of Python. RESULTS: The average age of the studied population was 35 ± 1 years. The overall SSI incidence was 6.3% (17.95%, 6.86%, 6.67% and 3.16% respectively in child, female, male and gynaecological-obstetrical surgeries. The univariate statistical analysis has shown a highly significant (p < 0.001) and a very significant (p < 0.01) relationship between SSIs and almost all risk factors; and the logistic regression model has revealed a strong association between SSI and people who have had previous surgery, urinary catheter, antibiotic use duration, co-morbidity, American Society of Anesthesiologists (ASA) score, duration of intervention, emergency preoperative and postoperative durations, service, specialty and age range. The prediction score exceeds 96% which justifies our model's quality. CONCLUSIONS: SSIs are generally frequent among postoperative patients. Therefore, pre-operative preparation, post-operative surveillance and the environment quality of the wards are necessary to reduce SSI rates in the hospital.

The Relationship between Nasal Carriage of Staphylococcus aureus and Surgical Site Infections in a Hospital Center in Morocco.

BACKGROUND: Surgical site infection is a major public health problem in the world. Nasal carriage is a major risk factor for the development of nosocomial Staphylococcus aureus infection, especially methicillin-resistant Staphylococcus aureus (MRSA). Our work aims to determine the prevalence of Staphylococcus aureus, methicillin-resistant Staphylococcus aureus, and the associated risk factors and to evaluate their sensitivity to 27 antibiotics. METHODS: A cross-sectional study was carried out on 100 patients, hospitalized in preoperative care of surgery units at the Taza Provincial Hospital Center in the Fez-Meknes region, from January to June 2019. Samples were taken from the patient's anterior nostril using single-use sterile dry or wet cotton swabs and then analyzed in the Provincial Public Health Laboratory in Taza. The carriage of Staphylococcus aureus was studied by conventional bacteriological methods by spreading nasal swabs on Chapman culture medium, while antibiotic resistance was determined by the Mueller-Hinton agar disc diffusion method according to the recommendations described by the Antibiogram Committee of the French Society of Microbiology 2019 (CA SFM 2019). RESULTS: Of the 84 patients found to be positive, 45.24% had coagulase-positive Staphylococcus aureus and 54.76% had coagulase-negative Staphylococcus. After surgery in the postoperative phase, 16 patients developed surgical site infections, of which two had a negative nasal culture and 14 had positive nasal culture. Among the Staphylococcus aureus-positive patients, 36.84% were colonized by a methicillin-resistant Staphylococcus aureus (MRSA) and 63.16% by a methicillin-sensitive Staphylococcus aureus (MSSA). Of these, 57.14% of MRSA colonized patients developed an infection of the surgical site and 42.85% showed no sign of SSI, while for patients colonized by MSSA, 16.67% developed SSI and 83.33% showed no sign of SSI. Moreover, children were the most affected by MRSA. Concerning antibiotic sensitivity, multiresistance of MRSA to more than 3 antibiotics has been found. CONCLUSION: To the best of our knowledge, this is the first study carried out in this hospital center with the aim of knowing the prevalence of nasal carriage of Staphylococcus aureus and MRSA and to identify the risk factors in order to prevent infections related to nasal carriage of Staphylococcus aureus and MRSA.

Microbiological Monitoring of the Environment Using the "Association Rules" Approach and Disinfection Procedure Evaluation in a Hospital Center in Morocco.

Background: The hospital environment, especially surfaces and medical devices, is a source of contamination for patients. Objective: This study carried out, to the best of our knowledge, for the first time at Taza Hospital in Morocco aimed to assess the microbiological quality of surfaces and medical devices in surgical departments and to evaluate the disinfection procedure in time and space. Methods: Samples were taken by swabbing after cleaning the hospital surface or medical device, to isolate and identify germs which were inoculated on semiselective culture media then identified by standard biochemical and physiological tests, using the analytical profile index (API) galleries. Moreover, the association rules extraction model between sites on the one hand and germs on the other hand was used for sampling. Results: The study showed that 83% of the samples have been contaminated after biocleaning. The most contaminated services have been men's and women's surgeries. 62% of isolated germs have been identified as Gram-positive bacteria, 29% as Gram-negative bacteria, and 9% as fungi. Concerning the association rules extraction model, a strong association between some contaminated sites and the presence of germ has been found, such as the association between wall and nightstand and door cuff, meaning that the wall and nightstand contamination is systematically linked to that of the door cuff. The disinfection procedure efficacy evaluation has enabled suggesting renewing it each 4 h. Conclusion: Microbiological monitoring of surfaces is necessary at hospital level through the use of the association rule extraction model, which is very important to optimize the sampling, cleaning, and disinfection site scenarios of the most contaminated ones.