Incidence and risk factors of peripheral venous catheter-related adverse events in cardiology department of a Tunisian university hospital: A prospective observational study.

AIM: The purpose of our study was to determine the incidence and risk factors of Peripheral Venous Catheter-Related Adverse Events (PVCAEs) in a cardiology department of a university hospital. PATIENTS AND METHODS: We carried out a prospective observational study from Mars 2017 to May 2017 in the cardiology department of the University Hospital of Farhat Hached in Sousse, Tunisia. During this period, we actively followed-up all inserted PVCs (every 12hours) from insertion up to 48hours after removal. Regression analyses were applied and significance limits were set at P<0.05. RESULTS: Data were analysed for 210 PVCs (794 PVC-days) in 148 patients. The incidence of PVCAEs was 33.33% with density of incidence of 8.81/1000 PVC-days. PVCAEs were mainly pain (50%) and mechanical events (31.42%). Infections accounted for 11.42%. The most frequent mechanical PVCAEs, was haematoma (15.71%). Multivariate analysis revealed as independent factors for the occurrence of PVCAEs: the hydro electrolytic nature of the injected product (OR=13.42, P<10-3), the medicinal nature of the injected product (OR=5.08, P=0.003), bad cutaneous state (OR=8.08, P=0.003), admission during nightshift (OR=3.76; P=0.014) and advanced age (OR=1.04, P=0.042). CONCLUSION: Multicenter studies would be very useful to better analyze risk factors associated with PVCAEs.

[Epidemiology of high risk pregnancy in Sousse, Tunisia]. / Profil épidémiologique des grossesses à risque à Sousse (Tunisie).

This descriptive study assessed the frequency of selected risk factors for high risk pregnancy (HRP) among women in Sousse region. All pregnant women (beyond 28 weeks gestation) giving birth in 4 public maternity hospitals between 15 February 2005 and 15 August 2005 and who had at least 1 risk factorwere enrolled. Data were collected within 24 hours of birth from obstetric and antenatal records and by interview. Of 4660 pregnant women, 1194 (25.6%) had at least 1 risk factor and were considered at-risk pregnancies. Mean age of the at-risk women was 31.3 (SD 5.4) years, 73% were urban residents, 38% had secondary education or higher and 75% were housewives. The mean number of risk factors was 1.5 per woman. The majority of women (59.3%) had 1 risk factor and 30.4% had 2. The mean number of prenatal visits was 4, 68.6% were seen by an obstetrician and 43% used the private sector. Certain factors were inadequately screened: age >35 years, parity >4, previous low birth weight and neonatal death, excessive fundal height and anaemia.

Epidemiology of high risk pregnancy in Sousse, Tunisia

This descriptive study assessed the frequency of selected risk factors for high risk pregnancy [HRP] among women in Sousse region. All pregnant women [beyond 28 weeks gestation] giving birth in 4 public maternity hospitals between 15 February 2005 and 15 August 2005 and who had at least 1 risk factor were enrolled. Data were collected within 24 hours of birth from obstetric and antenatal records and by interview. Of 4660 pregnant women, 1194 [25.6%] had at least 1 risk factor and were considered at-risk pregnancies. Mean age of the at-risk women was 31.3 [SD 5.4] years, 73% were urban residents, 38% had secondary education or higher and 75% were housewives. The mean number of risk factors was 1.5 per woman. The majority of women [59.3%] had 1 risk factor and 30.4% had 2. The mean number of prenatal visits was 4, 68.6% were seen by an obstetrician and 43% used the private sector. Certain factors were inadequately screened: age > 35 years, parity > 4, previous low birth weight and neonatal death, excessive fundal height and anaemia

L'hygiene des mains en milieu de soin : la frequence mais aussi la qualite !

Le lavage des mains est reconnu depuis plus d'un siecle comme une mesure efficace de prevention des infections associees aux soins.L'objectif de notre travail est d'evaluer l'adhesion du personnel soignant au lavage des mains ainsi que l'observance et la pertinence de cette pratique permettant ainsi de juger de sa conformite aux recommandations. Il s'agit d'une etude prospective realisee a l'hopital universitaire FARHAT HACHED de Sousse aupres du personnel soignant de 4 services qui ont ete choisi au hasard parmi les services classes a haut risque infectieux et ceci par l'observation directe des pratiques professionnelles visant a mesurer l'adhesion et la pertinence du lavage des mains. Au total 254 observations ont ete realisees durant les deux semaines de l'etude. 18;9des personnels observes se lavent les mains avant et apres un acte; alors que 24des personnes auditees se sont laves les mains avant d'effectuer un acte seulement. La conformite avant et apres soin etait uniquement de 16;1. Ce travail nous a permis de faire un constat global sur les pratiques de lavage des mains. Il apparait important de determiner les obstacles au lavage des mains et les moyens de l'amelioration de l'observance des professionnels de la sante

Multicentre study on hand hygiene facilities and practice in the Mediterranean area: results from the NosoMed Network.

Hand hygiene literature is scarce in the southern Mediterranean area. In order to establish a baseline position, a study was performed in four Mediterranean countries. Seventy-seven hospital wards in 22 hospitals were enrolled and information on hand hygiene practice and facilities were collected. The overall compliance rate was very low (27.6%), and was significantly higher where the perceived risk was considered to be high. Intensive care units showed the highest level of compliance. Analysis by country indicated higher compliance in Egypt (52.8%) and Tunisia (32.3%) compared with Algeria (18.6%) and Morocco (16.9%). Facilities for hand hygiene, particularly consumables, were shown to be deficient. Multi-approach programmes combining the production of official local recommendations, education and regular evaluation of hand hygiene practice are much needed to improve the present situation.

[Costs of basic health services in a health district in Tunisia]. / Coût des soins de santé de base dans une circonscription sanitaire en Tunisie.

Information on the cost of health services is essential for good planning and management and the efficient use of resources. We calculated the total costs incurred in running primary health services for one year (1995) in the health district of Enfidha (Tunisia). The yearly operating expenditure for the health district was 1 219 099 Tunisian dinars and the cost per inhabitant was 17.494 dinars (US dollar 1 = Tunisian dinar 0.950 in 1995); 65.37% of total costs went on staff and 17.03% on drugs. Looked at another way, 84,96% went on curative services and 14.04% on preventive services. The cost of a consultation for curative care was 6.847dinars, for perinatal care was 2.764 dinars, for immunization was 3.680 and for school visit was 6.680 dinars. The study helps to identify ways in which cost analysis can be used to explore efficiency and resource adequacy in the district.

[Costs of basic health services in a health district in Tunisia]

Information on the cost of health services is essential for good planning and management and the efficient use of resources. We calculated the total costs incurred in running primary health services for one year [1995] in the health district of Enfidha [Tunisia]. The yearly operating expenditure for the health district was 1 219 099 Tunisian dinars and the cost per inhabitant was 17.494 dinars [US dollar 1 = Tunisian dinar 0.950 in 1995]; 65.37% of total costs went on staff and 17.03% on drugs. Looked at another way, 84,96% went on curative services and 14.04% on preventive services.The cost of a consultation for curative care was 6.847dinars, for perinatal care was 2.764 dinars, for immunization was 3.680 and for school visit was 6.680 dinars. The study helps to identify ways in which cost analysis can be used to explore efficiency and resource adequacy in the district

[Transfusion practice and attitudes]. / Pratiques et attitudes transfusionnelles.

During last years, blood transfusion and transfusion security were domains which have preoccupied health authorities, the population and health professionals. Beginning with the principle that blood transfusion is a care that must be under medical responsibilities, authors analyse physician's implication in this field. To reach this objective, a study interested 199 young physicians, working in two university hospitals in Tunisia. Results indicate that physician's knowledge about blood transfusion is insufficient to guarantee quality of this medical act. In terms of attitudes and practices, physicians are not really always implicated in the different stages of blood transfusion process. Intervention is limited to prescription and blood transfusion record card writing. Transfusion herself and monitoring were, in particular, delegated to nurses. So transfusion incidents were under--declared. Transfusion medicine must occupy important place in physicians curriculum. At hospital level, quality insurance process, based on audit, have to be implemented to obtain transfusion good practices, in a domain were risks are unfortunately not yet totally circumscribed.

[Influence of socio-professional factors on absenteeism of hospital personnel]. / Influence des facteurs socio-professionnels sur l'absenteisme du personnel hospitalier.

The goal of this work is to analyze the different reasons of absenteeism in hospital and to identify the socioprofessional characteristics of absentees, what would permit to guide a strategy on modes and content of a preventive action. The adopted methodology is a retrospective descriptive investigation carrying on absenteeism of the personnel working in academic hospital Farhat Hached of Sousse (Tunisia) during 1997. So, on the 1433 salaried employees, 1028 (71.7%), left once or more for different reasons. The global absenteeism rate is 4.03% and the mean absence by agent is equal to 14.7 days. Among the absences motives, illness predominate extensively with 55% of the whole. Maternity and postnatal leave constitute 30%, 8% for "Industrial accidents" of work stops. Whatever is the reason, we observes more absent women than absent men. This survey shows the importance of socioprofessional factors in genesis of absenteeism and, to reduce the problem, the necessity to improve conditions of work, moreover in his ergonomic, social and psychological aspects.

[Health program and use of community health workers: the example of scorpion envenomation in Tunisia]. / Programme de santé et recours aux agents de santé communautaire: l'exemple de l'envenimation scorpionique en Tunisie.

Scorpion envenomation is a public health problem in Tunisia (40.000 cases/year), particularly in the zone of central Tunisia (region of Sidi Bouzid). The size of the province, its low rate of urbanization and the relatively limited health ressources required an anti-scorpion approach based on the implication of community health workers. During the year 1997, the 338 health workers who assure 76% of the emergency points treated 42% of scorpion envenomation cases. In spite of the success of the experience, authors discuss "the specialization" of these agents whose the contribution to others aspects of primary care could be improven. These health workers don't constitute a basic component of the organization of health care, but an exceptional measure for special geographical considerations.

[Anxiety and depression in the hemodialysis patient]. / Morbidité anxio-dépressive chez le patient hémodialysé.

Terminal renal failure and haemodialysis are precarious statute which put to the test capacities of adaptation of all patients. In this context, authors tempted to evaluate, using several instruments of measure, the importance and features of minor psychiatric disorders among 109 patients on chronic haemodialysis. Results of Goldberg test (GHQ) confronted to those of the medical interview reveal that anxio-depressive morbidity is frequent. According to results of the adaptation test to stress, our patients preserve a good mood but are often invaded by black ideas. In the field of the personal life, dissatisfaction concerns by decreasing order the lodging and the environment of the patient, the relation with parents, friends, the conjoined and medical care. This work, if it raises problems relatively unknown as much by the psychiatrist that by nephrology specialist, insist on the importance of multidisciplinary in order to assure holistic care and to improve the quality of life of patients on dialysis.

[Psychological aspects and details of care of patients on hemodialysis]. / Aspects psychologiques et particularites du soin chez l'hemodialyse.

Chronic renal failure and periodic hemodialysis, by the physical reach and the therapeutic imperatives that they mislead disrupt by several ways the universe of the patient. This one is confronted to changes, or even to aggressions that undergo his body, his domestic and socio-professional life, which is accepted in general with difficulty. Indeed, our survey that concerned 109 patients on chronic hemodialysis shows that the minor psychiatric pathology is frequent and can represent a source of problems as well for the patients that for the medical and nursing staff. Besides the analysis of minor psychiatric specificities revealed by a known measure instrument (the GHQ), this work insists on the importance to take account of this aspects with the aim to enhance management and holistic care of these patients.

[Conditions of midwifery practice in Tunisia rural areas and maternal transfer]. / Conditions de pratique des sages-femmes en milieu rural tunisien et transfert maternel.

OBJECTIVES: This survey analyzed the conditions of midwife practice in rural maternity hospitals and their influence on maternal transfer in a sanitary region of northwestern Tunisia, an underprivileged region where transfer rate is the highest in the country. METHODS: The study concerned midwives in 8 rural maternity hospitals. The survey included the files of 1,065 women transferred to the regional maternity hospital over a one year period. RESULTS: The hospitals surveyed operated without a gynecologist. Conditions of practice varied from one hospital to another and had a clear influence on transfer rate. DISCUSSION: Our findings illustrated the importance of certain remediable insufficiencies including technical facilities, the level of midwife supervision, physician responsibility within the sanitary area, and assignment of gynecologists to the rural hospitals where a large volume of activity occurs. Improvements can be made in use of maternity hospitals to reassure women and midwives.

[Determinant factors in the choice of site of delivery and the role of peripheral maternity units in a semi-urban environment in Tunisia]. / Facteurs déterminants du choix du lieu d'accouchement et place des maternités périphériques. En milieu semi-urbain tunisien.

The authors analyse, in the context of a developing country, a number of factors which can determine the choice of site of delivery in a population with access to several possibilities. The role of peripheral (or local) maternity units is considered in particular, in view of the utilisation problems which they raise. This leads to the conclusion of a degree of irrationality in the choice of health care services and the characteristics of women interacting with those of professionals when explaining the choice of site of delivery. Better management of available services is desirable in order to render peripheral maternity units more useful, and improve the medical performance at the time of delivery. Sensitization of the public and above all of health professionals nevertheless remains essential.

[Cancer of the breast and uterine cervix: knowledge level and preventive practices in a segment of the Tunisian population]. / Cancers du sein et du col utérin: profil éducatif et pratiques de prévention dans une partie de la population tunisienne.

Women get most of their information about gynaecological cancers from their encourage. Breast cancer is more frequently recognised than cervical cancer. Nevertheless, for both cancers, risk factors and opportunities for screening are rarely identified by women. Generally, most women would like information about cancer and the majority is in favour of screening. However, the absence of preventive practice by health professionals is a problem. Changes in health professionals' attitudes are required to enhance women's participation in screening programmes, particularly in primary health care.

[Breast self-examination practice in Tunisia based on a survey of first-line patients]. / La pratique de l'auto-examen des seins en Tunisie à travers une enquête chez les consultantes en première ligne.

As the first phase of a breast cancer screening campaign in central Tunisia, a survey aimed at evaluating the frequency of self-examination of the breasts (SEB) and identifying factors which might influence this practice took place in the Kalâa Kbira region of Tunisia, involving 300 first-line out-patients. Women answered a questionnaire presented by a resident in medicine during the course of the visit. The survey showed that the use of SEB remains slight (28%). Discriminant analysis enabled identification of parameters influencing this practice. Thus age of the patient, educational level of the woman and/or spouse and the source of information were the most significant parameters, in increasing order of importance. The results of this survey should enable definition of the content and form of information to be given to women in order to obtain their participation in a breast cancer screening campaign in central Tunisia.

[Knowledge, attitude and behavior of Tunisian women apropos of gynecological cancers]. / Connaissances, attitudes et comportements des femmes tunisiennes a propos des cancers gynécologiques.

With the aim to analyze population needs in the field of cancer screening (cervical and breast cancer), attitudes, behaviors and knowledge of a Tunisian women group of health service user's were studied. Results clearly demonstrate the necessity to inform the concerned population about risk factors particularly concerning breast cancer (the most frequent cancer in Tunisia) but also early symptoms and available screening methods. This role is alloted to health professionals, more for general practitioners and midwives than for gynaecologists. Health education for women and groups, however, have to go hand in hand with training of health professionals in matter of test screening.

[Using prenatal care in the Tunisian context: barriers and motivation factors]. / Recours aux visites prénatales dans le contexte tunisien: barrières et facteurs de motivation.

Several barriers to and motivators of antenatal care are analysed in the context of a developing country. The authors found that socio-cultural factors are as important as organizational factors in motivating women to seek antenatal care. While social and economic development may improve the quality of life in the long term, it is important to respond now to the needs of pregnant women in order to encourage them to use such services. A comprehensive analysis of certain organizational factors would be useful in achieving this goal.

[Urinary tuberculosis and bladder tumors. A case report]. / Tuberculose urinaire et tumeurs de vessie. A propos d'un cas.

The authors report the case of a patient presenting with both a bladder tumor and urinary tract tuberculosis. The bladder tumor was treated by transurethral resection and instillation of mitomycin C. The author describes this case and discusses this unusual association.