Knowledge, attitudes and practices towards standard precautions (SP) among caregivers at Hassan II University Teaching Hospital in Fes, Morocco.

This survey aims at assessing knowledge, attitudes and practices towards standard precautions (SP) among caregivers at Hassan II University Teaching Hospital in Fes. This is a cross-sectional prospective and evaluative study that covers a two-month period. Data were collected using an anonymous and selfadministered questionnaire. Sampling population was divided into 307 nurses (53.8%), 210 hospital doctors (36.77%) and 57 support staff (9.45%), belonging to other various categories working in different departments. This is a young population since 79.7% are under 30 years old. The results have shown that only 28.72% of health care professionals had received training in SP. Moreover, 87.7% claimed to practice hands' hygiene while moving from one patient to another. In contrast, 75.7% emphasized the need to change gloves each time they work on a new patient. However, individual protection measures were rarely mentioned in several risky situations.

Acinetobacter baumannii Carbapenemase Producers in Morocco: Genetic Diversity.

INTRODUCTION:  Carbapenem resistance in Acinetobacter baumannii (A. baumannii) is a public health problem worldwide. Although carbapenem resistance is emerging in Morocco, few studies have shown the epidemiological profile of carbapenemase genes in Moroccan healthcare facilities. The aim of this study was to characterize the molecular profile of the carbapenemase enzyme in Acinetobacter baumannii from clinical isolates. METHODS: Clinical strains isolated in the laboratory from various samples were subjected to several phenotypic tests. Antibiotic susceptibility and identification were tested using Phoenix 100 (Becton Dickinson Co., Sparks, MD, USA) and Api 20 (bioMérieux, Marcy-l'Etoile, France). Simple phenotypic assays were used to detect carbapenemase oxacillinase (OXA) and metallo-ß-lactamase (MBL) production, including the modified Hodge test (MHT) and ethylenediaminetetraacetic acid (EDTA) test. The detection of carbapenemase genes was performed by multiplex and simple polymerase chain reaction (PCR). RESULTS: A total of 140 strains or 100% of isolates contained OXA-51 and ISbA1 sequences, 89% contained OXA-23 and OXA-58 sequences, and 1% contained OXA-24 sequence. The MBL genes were predominated by Verona integron-encoded metallo-ß-lactamase (VIM) (56%), followed by Seoul imipenemase (SIM) (39%), German imipenemase (GIM) (37%), São Paulo metallo-ß-lactamase (SPM) (13%), imipenemase (IMP) (11%), and New Delhi metallo-ß-lactamase (NDM) (4%). Guyana extended-spectrum ß-lactamase (GES) was not found in any isolation. CONCLUSION: Our study shows a high frequency of carbapenem resistance in Acinetobacter baumannii, as it reports a high molecular diversity of carbapenemase-encoding genes, mainly dominated by the carbapenemase ISaba1/OXA-23, which represents an emerging threat in our hospital.

Microbiological Profile and Hygienic Quality of Foodstuffs Marketed in Collective Catering in Central Morocco.

Food hygiene is important both for its impact on the health of citizens and also for the cost of the infections that it can generate. In Morocco, it has become a concern of authorities. This work, realized for the first time in the center of Morocco, is aimed at describing the microbiological quality of foodstuffs marketed in collective catering in central Morocco. This study was conducted retrospectively from January 2015 to December 2019 in Fez city, central Morocco. The samples collected by the competent authority during official control from restaurants and food outlets were analyzed. Non-conformity was chosen as an indicator of food quality according to the official Moroccan standards. The samples were presented according to several variables: year/month/season, category/subcategory, communes, and establishment. The statistical processing of the results was done by SPSS 25. The Chi2 statistical test was calculated to determine a relationship between non-conformity and the type of analyzed matrix (year, season, and food category). The test was considered statistically significant for a p value < 0.05. A total of 2223 food samples were investigated, with an annual average of 445 samples. Overall, the rate of non-compliance during 2015-2019 was 31%, reaching its maximum in 2017 (36.4%) and its minimum in 2018 (27.5%).This rate varies by food type. Juices/drinks and meat products are the most contaminated with 71.7% and 58.1%, respectively, followed by milk and derivatives with 43.2%, seasoning sauces with 28.6%, pastries and pastry creams with 21.4%, and 14.4% for ready meals. The main causes of food non-conformity were fecal contamination germs with 67% positive fecal coliforms and 15% of total coliforms followed by total germs (7%), Staphylococcus aureus (5%), yeasts and molds (3%), sulfite-reducing anaerobes (2%), and Salmonella (1%). Given the obtained results, improving the hygienic quality of foods is necessary to ensure better consumer safety.

E-learning experience during Convid-19 pandemic management:Perception of secondary schools teachers' in Morocco.

Around the world, the COVID-19 pandemic quickly led to the closure of educational institutions in the hope of reducing infections and fatalities due to this disease. Distant education is becoming a policy priority, although institutions and teachers are neither experienced nor accustomed to its use. The purpose of this study is to determine secondary school teachers' perceptions and requirements of distance education during confinement. To our knowledge, none of the similar studies conducted in this area has approached this issue in Morocco. To determine teachers' perceptions regarding distance education, we conducted an analytical and descriptive survey among secondary school teachers in May, June, and July 2020.The chi-square test has been used to test the association between all variables. The association was considered significant when the p-value < 0.05. The calculation of the chi² (X²) and the p-value is performed using R software. The grouping of responses show that most teachers have been teaching remotely during confinement using Whatsapp. They confirmed that this is a useful way to ensure pedagogical continuity during the break from classroom teaching, and they also indicated a preference for both face-to-face and hybrid tutoring.Statistical analysis showed a significant correlation between the subjects taught and distance education (X2= 67.4 with p = 0.01), and a low correlation between training follow-up and distance education during the confinement period r = 0.12. This national study, focused in the secondary school teachers, is pertinent and has showen the extent of the problems of continuous teacher training, as well as strategies that are not evaluated and which do not take into account the perceptions of the actors, including the teacher. This data will be valuable and can be used to establish appropriate measures for improving distance learning tools and the quality and competencies of the actors.

Intense intestinal carriage and subsequent acquisition of multidrug-resistant enterobacteria in neonatal intensive care unit in Morocco.

This study was conducted in order to know the colonization rate of MDR enterobacteria in neonates during their hospitalization in neonatal intensive care unit (NICU). Furthermore, we investigated risk factors for potential colonization and molecular epidemiology of isolated resistant bacteria. This prospective study was carried out in the neonatology and intensive care unit department of the University Hospital of Fez (Morocco) from February 2013 to July 2015. All consecutive admitted newborns were screened for intestinal and nasal carriage of MDR enterobacteria at admission of the babies and during the hospitalization. During the study period, a total of 641 Enterobacteriaceae were isolated and Klebsiella pneumoniae was the predominated bacteria. Bacterial identification and antibiograms were performed according to the international standards. On admission, 455 newborns were screened. A median age of these newborns was 1 day with an extended 147 days and their average weight was 2612 ± 1023 grams. 22.4% of neonates were found colonized by an ESBL producing Enterobacteriaceae (ESBL-E), 8.7% by a carbapenemases producing Enterobacteriaceae (CPE). During hospitalization, 207 of newborns were included in the acquisition study. 59.4% of newborns acquired an ESBL-E during their stay, 12.5% has acquired CPE. The blaCTXM-15 gene was the most frequently detected (81.2%) among ESBL-E. While, all CPE has expressed the blaOXA-48 gene exclusively. Two risk factors have been significantly associated with MDR enterobacteria colonization at admission which are newborns admission from maternity of the university hospital (95% CI, 1.859-5.129, P = 0.000) and neurological distress (95% CI, 1.038 to 4.694, P = 0.040). During hospitalization, the none risk factor was significantly associated with the carriage of MDR-E. The high rate of colonization, the MDR enterobacteria and the resistance genes found represent good indicator of cross-transmission in the NICU. An active strategy to control the spread of MDR enterobacteria should be applied.

Molecular Serotyping and Antibiotic Resistance Patterns of Escherichia coli Isolated in Hospital Catering Service in Morocco.

Escherichia coli is related to foodborne disease and outbreaks worldwide. It mainly affects persons at high risk as newborns, infants, and individuals with impaired immune system in hospitals. Multidrug-resistant E. coli is currently spreading both in community and hospital settings. Our study aims to evaluate the presence of E. coli and the incidence of its antibiotic resistance in samples obtained from various cooked and raw foods (N = 300), food contact surfaces (N = 238), and food handlers (N = 40) in Moroccan hospital catering service. E. coli was identified using API 20E, and the antibiotic resistance patterns were obtained using the agar disk diffusion methods. However, PCR method was used for O157 and H7 typing. The samples analysis showed that 14.33%, 24.16%, and 45% of food, surfaces, and food handlers harbored E. coli, respectively, with the highest rates obtained in raw meats (34.88%) and salads (34.88%). Molecular amplification shows that 14 E. coli isolates carried the flagellar antigen H7, while there are no isolates showing amplification for O157. The high rate of resistance was noted against ampicillin (100%), amoxicillin-clavulanate acid (100%), nalidixic acid (61.62%), and cefotaxime (59.49%), and isolates obtained from food handler's hands showed the highest rates of resistance. None of the isolates are extended-spectrum beta-lactamases producing, while 27.7% of the isolates were metallo-beta-lactams producing. This first study conducted on Moroccan hospital catering services may draw the authorities' attention to the necessity of setting up a surveillance system to monitor the food preparation process and the safety of prepared food in healthcare settings.

Evaluation of Antibacterial Activity of Three Quaternary Ammonium Disinfectants on Different Germs Isolated from the Hospital Environment.

BACKGROUND: The microbiological risk of the hospital environment, including inert surfaces, medical devices, and equipment, represents a real problem. OBJECTIVE: This study is aimed at demonstrating and assessing the antibacterial activity of three synthetic disinfectants classified as quaternary ammoniums on different bacterial strains (Gram-negative and Gram-positive like Escherichia coli, Klebsiella pneumoniae, Enterobacter cloacae, Pseudomonas aeruginosa, Acinetobacter baumannii, and Staphylococcus aureus) isolated from the hospital environment. The reference strains included Escherichia coli ATCC 25922, Staphylococcus aureus ATCC 29213, and Pseudomonas aeruginosa ATCC 27853 used as negative control strains. METHOD: Three quaternary ammonium disinfectants were tested: DDN9® (0.5%) which contains didecylmethylpolyoxyethylammonium propionate as an active substance, spray (0.4%) containing quaternary ammonium compounds, and Phagosurf ND® (0.4%) with didecyldimethylammonium chloride. Their effect was evaluated using the disk diffusion technique and the broth dilution methods, allowing the Minimum Inhibitory Concentration (MIC) and then the Minimum Bactericidal Concentration (MBC). RESULT: Only the growth of Gram-positive bacteria and some strains of Gram-negative bacteria were inhibited by the three synthetic disinfectants. NDD9® demonstrated an antibacterial effect only against the Gram-positive strains (S. aureus and S. aureus ATCC 29213) with a MIC of 0.25 mg/ml. The disinfectant spray showed effect against all four strains including E. coli (9), S. aureus, E. coli ATCC 25922, and P. aeruginosa ATCC 27853 with an inhibitory concentration of 4 mg/ml, while the growth of S. aureus ATCC 29213 was inhibited at 2 mg/ml. The third disinfectant, Phagosurf ND®, inhibited only the growth of S. aureus ATCC 29213 at a MIC of 4 mg/ml. CONCLUSION: This study is the first here in Morocco to evaluate the bacterial activity of products intended for the control of the healthcare environment. The results obtained on the three disinfectants tested reveal an ineffectiveness against some isolated strains from the hospital environment.

Evaluation of hygienic conditions of food contact surfaces in a hospital kitchen in Morocco.

BACKGROUND AND OBJECTIVES: Food in healthcare settings are complementary to medical treatment, hence it should be produced in good sanitary conditions. In fact, hospitalized and immune-compromised patients are more likely to have foodborne infections than the rest of the community. The aim of our study is to evaluate the microbiological quality of food contact surfaces in a hospital kitchen in Morocco. MATERIALS AND METHODS: A total of 238 samples was collected from kitchen surfaces and analyzed for total aerobic mesophilic bacteria (AMC), Enterobacteriaceae and Staphylococcus aureus count and the presence of Salmonella spp., Pseudomonas spp. and Listeria monocytogenes. RESULTS: The bacteriological analysis shows that the highest rates of compliance with good hygienic conditions were obtained in baking worktops (77%) and serving meal worktops (50%) and the vegetables cutting boards (45.83%). In contrary, some surfaces show a low level of compliance, such as the raw meat cutting boards (96%). The isolated bacteria were S. aureus, coagulase-negative staphylococci, Escherichia coli, Serratia marcescens, Serratia odorifera, Raoultela ornithiaolytica and Pseudomonas aeroguinosa. CONCLUSION: The actual results indicate that the high levels of bacterial counts on kitchen surfaces, presents an evident need to improve the hygienic process and adopt an HACCP system in this facility.

Knowledge, attitudes and practices towards standard precautions [SP] among caregivers at Hassan II University Teaching Hospital in Fes, Morocco / Connaissances, attitudes et pratiques vis-à-vis des précautions standard chez les soignants du Centre hospitalier universitaire Hassan II de Fès (Maroc)

This survey aims at assessing knowledge, attitudes and practices towards standard precautions [SP] among caregivers at Hassan II University Teaching Hospital in Fes. This is a cross-sectional prospective and evaluative study that covers a two-month period. Data were collected using an anonymous and self-administered questionnaire. Sampling population was divided into 307 nurses [53.8%], 210 hospital doctors [36.77%] and 57 support staff [9.45%], belonging to other various categories working in different departments. This is a young population since 79.7% are under 30 years old. The results have shown that only 28.72% of health care professionals had received training in SP. Moreover, 87.7% claimed to practice hands' hygiene while moving from one patient to another. In contrast, 75.7% emphasized the need to change gloves each time they work on a new patient. However, individual protection measures were rarely mentioned in several risky situations

La présente enquête avait pour objectif d'évaluer le niveau de connaissances, les attitudes et pratiques vis-à-vis des précautions standard [PS] parmi le personnel soignant du Centre hospitalier universitaire Hassan II de Fès. Il s'agit d'une étude d'évaluation, transversale et prospective, sur une période de deux mois. Les données ont été recueillies au moyen d'un questionnaire auto-administré. La population étudiée était répartie en 307 infirmiers [53,8%], 210 médecins [36,77%] et 57 personnels d'appui [9,45%] appartenant aux autres catégories travaillant dans différents services. Cette population est très jeune puisque 79,7% ont moins de 30 ans. Les résultats ont montré que seulement 28,72% du personnel soignant avait reçu une formation aux PS. D'autre part, 87,7% déclarent pratiquer le lavage des mains entre deux patients et 75,7% reconnaissent la nécessité de changer de gants entre deux patients. Par contre, les mesures de protection individuelle ont été faiblement citées dans plusieurs situations à risqué

كان الهدف من هذا المسح هو تقييم مستوى المعلومات والاتجاهات والممارسات العملية مقابل الاحتياطات القياسية لدىالقائمن عى تقديم الرعاية في مستشفى الحسن الثاني الجامعي بفاس. فهي دراسة تقييمية مقطعية دامت شهرين. وقد تم جمع،)% البيانات من خال استبيان يملؤه المستجيبون بأنفسهم. وأخذت عينات من مجموعة الدراسة الذي شمل 307 ممرضة ) 53.8210 طبيباً ) 36.77 %( و 57 من موظفي الدعم ) 9.45 %( الذين يعملون في فئات أخرى في الخدمات المختلفة. إن عينة هذه الدراسةكانت شابة، إذ تقل أعار 79.7 % منهم عن 30 عاماً. وأظهرت النتائج أن 28.72 % فقط من العاملن في مجال الصحة قد تلقوا تدريباًعى الاحتياطات القياسية. ومن ناحية أخرى، أفاد 87.7 % من عينة الدراسة أنهم يلتزمون بممارسة غسل الأيدي عند الانتقال منمريض لآخر، وفي المقابل أفاد 75.7 % منهم أنه من الروري تغير القفازات عند الانتقال من مريض لآخر. وخلاصة القول، فإنالالتزام بتدابر الحماية الشخصية كانت ضعيفة في العديد من الحالات المعرَّضة للمخاطر