Quality and safety of care: Moroccan experience.

Background: The Ministry of Health and Social Protection (MOHSP) of the Moroccan Kingdom acknowledges the crucial need to improve the quality and safety of care provided to patients. As a result, they have launched a process that involves, developing a conceptual framework and implementing national health policies aimed to enhance services offered to hospital users. Objective: The aim of this study is to identify all the approaches developed by the MOHSP since 1990 to enhance the quality and safety of care. Materials and Methods: This study is a descriptive qualitative analysis. The data was collected over a six-month period, through semi-structured interviews with professionals reporting to the MOHSP, and through a document analysis. Results: The results provide a comprehensive description of approaches to quality and safety of care in the Moroccan health system, the findings reveal that these approaches are based on three complementary strategies: continuous quality improvement, standardization, and safety of care. Conclusions: The Moroccan health system has implemented various strategies to improve the quality and safety of care. However, these strategies have not been sustained due to several factors. To ensure sustainability, the system needs to invest in capital and resources, involve quality experts in hospitals, use processbased approaches, strengthen legislation and regulations related to quality of care, and translate them into implementing decrees.

Mitigating the risk of COVID-19 infection in the operating room: Using healthcare failure mode and effect analysis.

Context: The process of caring for patients requiring surgery exposes them to a high risk of COVID-19 infection during the pre-operative, operative, and post-operative phases, as these procedures are known to be modes of transmission for the virus. Objective: We conducted this study to prevent the risk of COVID-19 infection by identifying potential failure modes during the patient care process, determining critical activities, and defining mitigation measures to reduce transmission. Materials and methods: Through a quality and a priori risk management method, which is Healthcare Failure Mode and Effect Analysis (HFMEA), applied in the patient care process in the Central Operating Room of Mohammed VI University Hospital in Morocco. Results: We identified 38 potential failure modes in the patient care process during the three phases (preoperative, operative, and postoperative) that could increase the risk of COVID-19 infection. Of these, 61% are classified as critical, and we have identified all their possible causes. To reduce the risk of transmission, we have proposed 16 mitigation actions. Conclusion: The use of HFMEA has been effective in the new pandemic context, improving patient safety during the care process in the operating room and reducing the risk of COVID-19 infection.

Antimicrobial and Antioxidant Properties of Total Polyphenols of Anchusa italica Retz.

Anchusa italica Retz has been used for a long time in phytotherapy. The aim of the present study was to determine the antioxidant and antibacterial activities of extracts from the leaves and roots of Anchusa italica Retz. We first determined the content of phenolic compounds and flavonoids using Folin-Ciocalteu reagents and aluminum chloride (AlCl3). The antioxidant activity was determined using three methods: reducing power (FRAP), 2.2-diphenyl-1-picrylhydrazyl (DPPH), total antioxidant capacity (TAC). The antimicrobial activity was investigated against four strains of Escherichia coli, two strains of Klebsiella pneumoniae and coagulase-negative Staphylococcus, and one fungal strain of Candida albicans. The results showed that the root extract was rich in polyphenols (43.29 mg GAE/g extract), while the leave extract was rich in flavonoids (28.88 mg QE/g extract). The FRAP assay showed a strong iron reduction capacity for the root extract (IC50 of 0.11 µg/mL) in comparison to ascorbic acid (IC50 of 0.121 µg/mL). The DPPH test determined an IC50 of 0.11 µg/mL for the root extract and an IC50 of 0.14 µg/mL for the leaf extract. These values are low compared to those for ascorbic acid (IC50 of 0.16 µg/mL) and BHT (IC50 0.20 µg/mL). The TAC values of the leaf and root extracts were 0.51 and 0.98 mg AAE/g extract, respectively. In vitro, the extract showed inhibitory activity against all strains studied, with diameters of zones of inhibition in the range of 11.00-16.00 mm for the root extract and 11.67-14.33 mm for the leaf extract. The minimum inhibitory concentration was recorded for the leaf extract against E. coli (ATB:57), corresponding to 5 mg/mL. Overall, this research indicates that the extracts of Anchusa italica Retz roots and leaves exert significant antioxidant and antibacterial activities, probably because of the high content of flavonoids and polyphenols.

Chemical Composition and Antibacterial Activities of Eight Plant Essential Oils from Morocco against Escherichia coli Strains Isolated from Different Turkey Organs.

The aim of the present study was to determine the chemical composition of eight plant essential oils and evaluate their antibacterial activity against Escherichia coli strains isolated from different turkey organs. The essential oils were extracted by hydrodistillation and analyzed using gas chromatography-mass spectroscopy. All essential oil yielded high in a range between 2.2 and 3.12%. Gas chromatography-mass spectroscopy (GC-MS) revealed that the major constituents of Thymus vulgaris, Ocimum basilicum, Artemisia herba-alba, and Syzygium aromaticum oils were thymol (41.39%), linalool (37.16%), camphor (63.69%), and eugenol (80.83%), respectively. Results of the E. coli sensitivity evaluated by the standard antimicrobial sensitivity method varied depending on the organ of isolation. Similarly, the essential oils antimicrobial activity determined by the disc diffusion method varied all along within the organs of isolation. T. vulgaris essential oil showed the highest effective antibacterial activity against E. coli isolated from the throat with an inhibition zone diameter value of up to 23.33 mm. However, all the essential oils showed antibacterial activity and the MIC and MBC values were in the range of 1/3000 to 1/100 (v/v) and the ratios MBC/MIC were equal to 1. In conclusion, this study showed that the essential oils could be promising alternatives to overcome E. coli multiresistance in turkey.