Search results for: Asma Ben Brahim

Authors: Moncer Malika, Ben Brahim Mounir, Bel Hassen Malika, Hamza Asma

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During the last decades, microalgae communities have presented significant changes in their structure and taxa composition along the Mediterranean littoral shallow waters. The main purpose of this work was to evaluate possible changes, over a 17-year scale (1997–2013), in the diversity and abundance of three toxic and potentially toxic microalgae related to changes in environmental parameters on Sfax coasts, a pole of shellfish production in Tunisia. In this 17-year span, a chronological series of data showed that a clear disparity from one year to another was observed in the abundance of studied species. The distribution of these species has been subjected to a seasonal cycle. The studied microalgae, especially Prorocentrum lima, seem to have significant relationships with many physicochemicaland meteorological parameters.

Keywords: long-term monitoring HABs, physico-chemical parameters, meteorological parameters, Prorocentrum lima, Ostreopsis cf. ovata, Coolia monotis

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Authors: Brahim Dennai, Abdelhak Bentaleb, Rachid Khelfaoui, Asma Abdenbi

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The diffusion flux given by the Fick’s law characterizethe mixing rate. A passive mixing strategy is proposed to enhance mixing of two fluids through perturbed jet low. A numerical study of passive mixers has been presented. This paper is focused on the modeling of a micro-injection systems composed of passive amplifier without mechanical part. The micro-system modeling is based on geometrical oscillators form. An asymmetric micro-oscillator design based on a monostable fluidic amplifier is proposed. The characteristic size of the channels is generally about a few hundred of microns. The numerical results indicate that the mixing performance can be as high as 99 % within a typical mixing chamber of 0.20 mm diameter inlet and 2.0 mm distance of nozzle - spliter. In addition, the results confirm that self-rotation in the circular mixer significantly enhances the mixing performance. The novel micro mixing method presented in this study provides a simple solution to mixing problems in microsystem for application in chemistry.

Keywords: micro oscillator, modeling, micro mixture, diffusion, size effect, chemical equation

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Authors: Kamilia Ounaissa, Sarra Fennira, Asma Ben Brahim, Marwa Omri, Abdelmajid Abid

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The palm oil is the vegetable oil the most used by the food-processing industry in the world. It is chosen for its economic and technologic advantages. However, this oil arouses the debate because of its high content in saturated fatty acids, which are fats promoting atherosclerosis. Purposes of the work: To study the frequency and the rate of consumption of industrial products containing some palm oil and specify the rate of this oil in certain consummated products. Methodology: We proceeded to a consumer survey using a questionnaire collecting a list of food containing the palm oil, sold on the Tunisian market. We then analyzed the most consumed food to specify their fat content by “Soxhelt’s” method. Finally, we studied the composition in various fatty acids of the extracted fat using the chromatography in the gas phase (CPG) Results: Our results show that investigated individuals having a normal weight have a more important and more frequent consumption of products rich in palm oil than overweight subjects. The most consumed foods are biscuits, cakes, wafers, chocolates, chips, cereal, creams to be spread and canned pilchard. The content in palm oil of these products varies from 10 % to 31 %. The analysis by CPG showed an important content in saturated fatty acid, in particular in palmitic acid, ranging from 40 % to 63 % of the fat of these products. Conclusion: Our study shows a high frequency of consumption of food products, the analysis of which proved a high content in palm oil. Theses facts justifies the necessity of a regulation of the use of palm oil in food products and the application of a label detailing the type and fat rates used.

Keywords: palm oil, palmitic acid, food industry, fatty acids, atherosclerosis

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Authors: Asma Ammar, Nabiha Bouafia , Asma BenCheikh, Mohamed Mahjoub, Olfa Ezzi, Wadiaa Bannour, Radhia Helali, Mansour Njah

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Background: The objective of the present study was to identify factors associated with vaccination against Hepatitis B virus (HBV) among healthcare workers (HWs) in the University Hospital Center (UHC) Farhat Hached Sousse, Tunisia. Methods: We conducted a descriptive cross-sectional study all licensed physicians (n= 206) and a representative sample of paramedical staff (n= 372) exercising at UHC Hached Sousse (Tunisia) during two months (January and February 2014). Data were collected using a self-administered and pre-tested questionnaire, which composed by 21 questions. In order to determinate factors associated with vaccination against hepatitis B among HWs, this questionnaire was based on the Health Belief Model, one of the most classical behavior theories. Logistic regression with the stepwise method of Hosmer and Lemeshow was used to identify the determinants of the use of vaccination against HBV. Results: The response rates were 79.8%. Fifty two percent believe that HBV is frequent in our healthcare units and 60.6% consider it a severe infection. The prevalence of HWs vaccination was 39%, 95% CI [34.49%; 43.5%]. In multivariate analysis, determinants of the use of vaccination against HBV among HWs were young age (p=10-4), male gender (p = 0. 006), high or very high importance accorded to health (p = 0.035), perception membership in a risk group for HBV infection (p = 0.038) and very favorable or favorable opinion about vaccination against HVB (p=10-4). Conclusion: The results of our study should be considered in any strategy for preventing VHB infection in HWs. In the mean time, coverage with standard vaccines should be improved also by supplying complete information on the risks of VHB infection and on the safety and efficacy of vaccination.

Keywords: Hepatitis B virus, healthcare workers, prevalence, vaccination

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Authors: Mohamed Bendahmane, Brahim Elfalaki, Mohammed Benattou

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One of the major sources of learners' professional difficulties is their heterogeneity. Whether on cognitive, social, cultural or emotional level, learners being part of the same group have many differences. These differences do not allow to apply the same learning process at all learners. Thus, an optimal learning path for one, is not necessarily the same for the other. We present in this paper a model-oriented service to offer to each learner a personalized learning path to acquire the targeted skills.

Keywords: learning path, web service, trace analysis, personalization

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Authors: El Asnaoui Khalid, Aksasse Brahim, Ouanan Mohammed

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This paper presents an unsupervised color image segmentation method. It is based on a hierarchical analysis of 2-D histogram in RGB color space. This histogram minimizes storage space of images and thus facilitates the operations between them. The improved segmentation approach shows a better identification of objects in a color image and, at the same time, the system is fast.

Keywords: image segmentation, hierarchical analysis, 2-D histogram, classification

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Authors: Brahim Boukabcha, Amar Rebbouh

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The bootstrap method based on the idea of exploiting all the information provided by the initial sample, allows us to study the properties of estimators. In this article we will present a theoretical study on the different methods of bootstrapping and using the technique of re-sampling in statistics inference to calculate the standard error of means of an estimator and determining a confidence interval for an estimated parameter. We apply these methods tested in the regression models and Pareto model, giving the best approximations.

Keywords: bootstrap, error standard, bias, jackknife, mean, median, variance, confidence interval, regression models

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Authors: Riad Harouz, Brahim Mahfoud

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The threads and the circles on reinforced concrete are obtained by process of hot rolling with pebbles finishers in metal carbide which present a way of rolling around the outside diameter. Our observation is that this throat presents geometrical wear after the end of its cycle determined in tonnage. In our study, we have determined, in a first step, experimentally measurements of the wear in terms of thermo-mechanical parameters (Speed, Load, and Temperature) and the influence of these parameters on the wear. In the second stage, we have developed a mathematical model of lifetime useful for the prognostic of the wear and their changes.

Keywords: lifetime, metal carbides, modeling, thermo-mechanical, wear

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Authors: Abobkar Abrahem Mohamed Saad, Asma Abud Alsalam

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Closed flowers of Maerua crassifolia were cultured on Murashige and Skoog medium supplemented with benzyl amino purine BA (1.0 mg/l). The colour of flowers changed from green to pale brown after one week. They opened after two weeks. The anthers became clear which was observed after 3 weeks. Calluses are induced from sepals after one month. 19 anthers were observed with average length of 1.9 cm. The amount of calluses increased after 40 days. These calluses were fragmented and subcultured on MS+ 2-4D (1.0 mg/l) in order to increase growth.

Keywords: in vitro, Maerua, flowers, culture

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Authors: Mehdi Boukri, Mohammed Naboussi Farsi, Mounir Naili, Omar Amellal, Mohamed Belazougui, Ahmed Mebarki, Nabila Guessoum, Brahim Mezazigh, Mounir Ait-Belkacem, Nacim Yousfi, Mohamed Bouaoud, Ikram Boukal, Aboubakr Fettar, Asma Souki

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The seismic risk to which the urban centres are more and more exposed became a world concern. A co-operation on an international scale is necessary for an exchange of information and experiments for the prevention and the installation of action plans in the countries prone to this phenomenon. For that, the 1990s was designated as 'International Decade for Natural Disaster Reduction (IDNDR)' by the United Nations, whose interest was to promote the capacity to resist the various natural, industrial and environmental disasters. Within this framework, it was launched in 1996, the RADIUS project (Risk Assessment Tools for Diagnosis of Urban Areas Against Seismic Disaster), whose the main objective is to mitigate seismic risk in developing countries, through the development of a simple and fast methodological and operational approach, allowing to evaluate the vulnerability as well as the socio-economic losses, by probable earthquake scenarios in the exposed urban areas. In this paper, we will present the adaptation and application of this methodology to the Algerian context for the seismic risk evaluation in urban areas potentially exposed to earthquakes. This application consists to perform an earthquake scenario in the urban centre of Constantine city, located at the North-East of Algeria, which will allow the building seismic damage estimation of this city. For that, an inventory of 30706 building units was carried out by the National Earthquake Engineering Research Centre (CGS). These buildings were digitized in a data base which comprises their technical information by using a Geographical Information system (GIS), and then they were classified according to the RADIUS methodology. The study area was subdivided into 228 meshes of 500m on side and Ten (10) sectors of which each one contains a group of meshes. The results of this earthquake scenario highlights that the ratio of likely damage is about 23%. This severe damage results from the high concentration of old buildings and unfavourable soil conditions. This simulation of the probable seismic damage of the building and the GIS damage maps generated provide a predictive evaluation of the damage which can occur by a potential earthquake near to Constantine city. These theoretical forecasts are important for decision makers in order to take the adequate preventive measures and to develop suitable strategies, prevention and emergency management plans to reduce these losses. They can also help to take the adequate emergency measures in the most impacted areas in the early hours and days after an earthquake occurrence.

Keywords: seismic risk, mitigation, RADIUS, urban areas, Algeria, earthquake scenario, Constantine

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Authors: Brahim Sabir

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Psycho-Communication disorders negatively affect the academic curriculum for students in higher education. Thus, understanding these disorders, their causes and effects will give education specialists a tool for the decision, which will lead to the resolution of problems related to the integration of students with Psycho-Communication disorders. It is in this context that a statistical study was conducted, targeting the population object of study, namely Moroccan students. Pathological voice samples were recorded and analyzed acoustically with PRAAT software, in order to build a model that will be the basis for the objective diagnostic.

Keywords: psycho-communication disorders, acoustic analysis, PRAAT

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Authors: Barkaoui Asma

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In our article, we use the economic approach of measuring advertising effectiveness to show the margin of advertising spread gained through digital communication. For economists, profit maximization depends on determining the optimal advertising budget. For this, they use the theories of the marginalist current to determine when the maximum level of benefits is reached. Using the economic approach we show the significant return on investment for advertisers. We then discuss the risks of perception of advertising pressure by consumers.

Keywords: digital advertising, economic approach, effectiveness, pressure

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Authors: Samir Lecheb, Ahmed Chellil, Hamza Mechakra, Brahim Safi, Houcine Kebir

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In this paper we studied fracture and dynamic behavior of vertical axis wind turbine blade, the VAWT is a historical machine, it has many properties, structure, advantage, component to be able to produce the electricity. We modeled the blade design then imported to Abaqus software for analysis the modes shapes, frequencies, stress, strain, displacement and stress intensity factor SIF, after comparison we chose the idol material. Finally, the CTS test of glass epoxy reinforced polymer plates to obtain the material fracture toughness Kc.

Keywords: blade, crack, frequency, material, SIF

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Authors: Ammar Asma, Bouafia Nabiha, Ghammam Rim, Ezzi Olfa, Ben Cheikh Asma, Mahjoub Mohamed, Helali Radhia, Sma Nesrine, Chouchène Imed, Boussarsar Hamadi, Njah Mansour

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Background: Central venous catheter associated infections (CVC-AI) are among the serious hospital-acquired infections. The aims of this study are to determine the incidence of CVC-AI, and their risk factors among patients followed in a Tunisian medical intensive care unit (ICU). Materials / Methods: A prospective cohort study conducted between September 15th, 2015 and November 15th, 2016 in an 8-bed medical ICU including all patients admitted for more than 48h. CVC-AI were defined according to CDC of ATLANTA criteria. The enrollment was based on clinical and laboratory diagnosis of CVC-AI. For all subjects, age, sex, underlying diseases, SAPS II score, ICU length of stay, exposure to CVC (number of CVC placed, site of insertion and duration catheterization) were recorded. Risk factors were analyzed by conditional stepwise logistic regression. The p-value of < 0.05 was considered significant. Results: Among 192 eligible patients, 144 patients (75%) had a central venous catheter. Twenty-eight patients (19.4%) had developed CVC-AI with density rate incidence 20.02/1000 CVC-days. Among these infections, 60.7% (n=17) were systemic CVC-AI (with negative blood culture), and 35.7% (n=10) were bloodstream CVC-AI. The mean SAPS II of patients with CVC-AI was 32.76 14.48; their mean Charlson index was 1.77 1.55, their mean duration of catheterization was 15.46 10.81 days and the mean duration of one central line was 5.8+/-3.72 days. Gram-negative bacteria was determined in 53.5 % of CVC-AI (n= 15) dominated by multi-drug resistant Acinetobacter baumani (n=7). Staphylococci were isolated in 3 CVC-AI. Fourteen (50%) patients with CVC-AI died. Univariate analysis identified men (p=0.034), the referral from another hospital department (p=0.03), tobacco (p=0.006), duration of sedation (p=0.003) and the duration of catheterization (p=0), as possible risk factors of CVC-AI. Multivariate analysis showed that independent factors of CVC-AI were, male sex; OR= 5.73, IC 95% [2; 16.46], p=0.001, Ramsay score; OR= 1.57, IC 95% [1.036; 2.38], p=0.033, and duration of catheterization; OR=1.093, IC 95% [1.035; 1.15], p=0.001. Conclusion: In a monocenter cohort, CVC-AI had a high density and is associated with poor outcome. Identifying the risk factors is necessary to find solutions for this major health problem.

Keywords: central venous catheter associated infection, intensive care unit, prospective cohort studies, risk factors

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Authors: Wafa Halfaoui Mbarek, Khir Tahar, Ben Brahim Ammar

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This study reports a comparison from an exergetic point of view between three configurations of vapor compression industrial refrigeration systems operating with R134a as working fluid. The performances of the different cycles are analyzed as function of several operating parameters such as condensing temperature and inter stage pressure. In addition, the contributions of component exergy destruction to the total exergy destruction are obtained for each system. The results are estimated to be used in the selection of the most advantageous configuration from an exergetic view point.

Keywords: vapor compression, exergy, destruction, efficiency, R134a

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Authors: Brahim Fersadou, Henda Kahalerras

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This work deals with the problem of MHD mixed convection in a completely porous and differentially heated vertical channel. The model of Darcy-Brinkman-Forchheimer with the Boussinesq approximation is adopted and the governing equations are solved by the finite volume method. The effects of magnetic field and buoyancy force intensities are given by the Hartmann and Richardson numbers respectively, as well as the Joule heating represented by Eckert number on the velocity and temperature fields, are examined. The main results show an augmentation of heat transfer rate with the decrease of Darcy number and the increase of Ri and Ha when Joule heating is neglected.

Keywords: heat sources, magnetic field, mixed convection, porous channel

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Authors: Saria Abed, Tahar Khir, Ammar Ben Brahim

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A thermo-exergy optimization of a gas turbine cycle with two different regenerator designs is established. A comparison was made between the performance of the two regenerators and their roles in improving the cycle efficiencies. The effect of operational parameters (the pressure ratio of the compressor, the ambient temperature, excess of air, geometric parameters of the regenerators, etc.) on thermal efficiencies, the exergy efficiencies, and irreversibilities were studied using thermal balances and quantitative exegetic equilibrium for each component and for the whole system. The results are given graphically by using the EES software, and an appropriate discussion and conclusion was made.

Keywords: exergy efficiency, gas turbine, heat transfer, irreversibility, optimization, regenerator, thermal efficiency

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Authors: Asma Ahmed Aljohani, Mohammed Orif

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The concentration of polycyclic aromatic hydrocarbons (PAH) in clam (A. glabrata) was examined in samples collected from Alseef Beach, 30 km south of Jeddah city. Gas chromatography-mass spectrometry (GC-MS) was used to analyse the 14 PAHs. The concentration of total PAHs was found to range from 11.521 to 40.149 ng/gdw with a mean concentration of 21.857 ng/gdw, which is lower compared to similar studies. The lower molecular weight PAHs with three rings comprised 18.14% of the total PAH concentrations in the clams, while the high molecular weight PAHs with four rings, five rings, and six rings account for 81.86%. Diagnostic ratios for PAH source distinction suggested pyrogenic or anthropogenic sources.

Keywords: bivalves, biomonitoring, hydrocarbons, PAHs

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Authors: Farhat Hajer, Khir Tahar, Ammar Ben Brahim

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This work presents a study on the influence of the main operating variables on the gas turbine cycle. A numerical simulation of a gas turbine cycle is performed for a real net power of 100 MW. A calculation code is developed using EES software. The operating variables are taken in conformity with the local environmental conditions adopted by the Tunisian Society of Electricity and Gas. Results show that the increase of ambient temperature leads to an increase of Tpz and NO_x emissions rate and a decrease of cycle efficiency and UHC emissions. The CO emissions decrease with the raise of residence time, while NO_x emissions rate increases and UHC emissions rate decreases. Furthermore, both of cycle efficiency and NOx emissions increase with the increase of the pressure ratio.

Keywords: Carbon monoxide, Efficiency, Emissions, Gas Turbine, Nox, UHC

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Authors: Brahim Fares Zaidi

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Our work aims to improve our Automatic Recognition System for Dysarthria Speech based on the Hidden Models of Markov and the Hidden Markov Model Toolkit to help people who are sick. With pronunciation problems, we applied two techniques of speech parameterization based on Mel Frequency Cepstral Coefficients and Perceptual Linear Prediction and concatenated them with JITTER and SHIMMER coefficients in order to increase the recognition rate of a dysarthria speech. For our tests, we used the NEMOURS database that represents speakers with dysarthria and normal speakers.

Keywords: ARSDS, HTK, HMM, MFCC, PLP

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Authors: Djamila Aboutaleb, Brahim Safi

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In this paper, sodium borosilicates glasses were prepared by melting in air. These heat-resistant transparent glasses have subjected subsequently isothermal treatments at different times, which have transformed them at opaque glass (milky white color). Such changes indicate that these glasses showed clearly phase separation (immiscibility). The immiscibility region in a sodium borosilicate ternary system was investigated in this work, i.e. to determine the regions from which some compositions can show phase separation. For this we went through the conditions of thermodynamic equilibrium, which were translated later by mathematical equations to find an approximate solution. The latter has been translated in a simulation which was established thereafter to find the immiscibility regions in this type of special glasses.

Keywords: sodium borosilicate, heat-resistant, isothermal treatments, immiscibility, thermodynamics

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Authors: Farhat Hajer, Khir Tahar, Cherni Rafik, Dakhli Radhouen, Ammar Ben Brahim

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This paper presents the energy and exergy optimization of a real gas turbine power plant performance of 100 MW of power, installed in the South East of Tunisia. A simulation code is established using the EES (Engineering Equation Solver) software. The parameters considered are those of the actual operating conditions of the gas turbine thermal power station under study. The results show that thermal and exergetic efficiency decreases with the increase of the ambient temperature. Air excess has an important effect on the thermal efficiency. The emission of NOx rises in the summer and decreases in the winter. The obtained rates of NOx are compared with measurements results.

Keywords: efficiency, exergy, gas turbine, temperature

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Authors: Badrane Hasnaa, Bouzahir Brahim

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This article examines the impact of fintech technologies on crowdfunding, particularly their potential to enhance financial inclusion and promote responsible finance. It explores how the adoption of blockchain, artificial intelligence, and other fintech innovations is transforming crowdfunding by making it more accessible, transparent, and ethical. By analyzing case studies and recent data, the article illustrates how these technologies help overcome traditional barriers to financing while promoting sustainable financial practices. The findings suggest that integrating fintech into crowdfunding can not only broaden access to funding for marginalized populations but also encourage more responsible management of financial resources, contributing to a fairer and more resilient economy.

Keywords: crowdfunding, fintech, inclusion financière, finance responsible, blockchain, resilience financière

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Authors: Brahim Mahfoud, Ali Bendjaghlouli

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Natural convection is simulated in a truncated cone filled with nanofluid. Inclined and top walls have constant temperature where the heat source is located on the bottom wall of the conical container which is thermally insulated. A finite volume approach is used to solve the governing equations using the SIMPLE algorithm for different parameters such as Rayleigh number, inclination angle of inclined walls of the enclosure and heat source length. The results showed an enhancement in cooling system by using a nanofluid, when conduction regime is assisted. The inclination angle of inclined sidewall and heat source length affect the heat transfer rate and the maximum temperature.

Keywords: heat source, truncated cone, nanofluid, natural convection

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Authors: Brahim Merdas, Abdelhak Boutaleb

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Polymetallic mineralizations with Zn, Sb, Pb boxed in miopliocene limestones of Hammam N’bails’s basin are regarded as the youngest mineralizations of North East of Algeria and are characterized by the presence of rather rare mineral phases throughout the world such as nadorite and flajolotite. Mineralization seems to have a bond with thermal springs emergent within the basin and with the faults which limit the basin. The comparison between mineralizations and similar ore deposits known in the world and which are characterized by the presence of the noble metals such as gold and the discovery of traces of this metal (1.4g/t) enables us to start again the problems of the noble metals of the type “low sulfidation” related to the thermal springs in the area in particular and in all Algerian North generally.

Keywords: Nadorite, galana, gold, dolomitisation, epigenétic, hot springs, , miopliocene, Hammam N’bails, algeria

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Authors: Asma Bentaifa

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This paper investigates the effect of ownership concentration and especially the presence of controlling shareholders on the firm’s payout decisions. Using a sample of 870 French companies during 2007 to 2012, we find that the share of dividends in total payout is negatively correlated with the size of cash flow held by controlling shareholder, and positively related to the divergence between voting rights and cash flow rights of largest shareholders. We also document that controlled firms tend to prefer dividends over repurchases to mitigate conflicts between controlling shareholders and minority shareholders related to the presence of control enhancing devices.

Keywords: ownership, payout policy, dividend, minority expropriation

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Authors: Omyma Alosaimi, Asma Alsumait

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The website developer and designer should follow usability guidelines to provide a user-friendly interface. Many guidelines and heuristics have been developed by previous studies to help both the developer and designer in this task, but E-government websites are special cases that require specialized guidelines. This paper introduces a set of eighteen guidelines for evaluating the usability of e-government websites in general and Arabic e-government websites specifically, along with a check list of how to apply them. The validity and effectiveness of these guidelines were evaluated against a variety of user characteristics. The results indicated that the proposed set of guidelines can be used to identify qualitative similarities and differences with user testing and that the new set is best suited for evaluating general and e-governmental usability.

Keywords: e-government, human computer interaction, usability evaluation, usability guidelines

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Authors: Brahim Berbaoui

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In this paper, a new particle swarm optimization (PSO) based method is proposed for the implantation of optimal harmonic power flow in power systems. In this algorithm approach, proportional integral controller for reference compensating currents of active power filter is performed in order to minimize the total harmonic distortion (THD). The simulation results show that the new control method using PSO approach is not only easy to be implanted, but also very effective in reducing the unwanted harmonics and compensating reactive power. The studies carried out have been accomplished using the MATLAB Simulink Power System Toolbox.

Keywords: shunt active power filter, power quality, current control, proportional integral controller, particle swarm optimization

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Authors: El Asnaoui Khalid, Aksasse Brahim, Ouanan Mohammed

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In this paper, we are interested in the problem of finding similar images in a large database. For this purpose we propose a new algorithm based on a combination of the 2-D histogram intersection in the HSV space and statistical moments. The proposed histogram is based on a 3x3 window and not only on the intensity of the pixel. This approach can overcome the drawback of the conventional 1-D histogram which is ignoring the spatial distribution of pixels in the image, while the statistical moments are used to escape the effects of the discretisation of the color space which is intrinsic to the use of histograms. We compare the performance of our new algorithm to various methods of the state of the art and we show that it has several advantages. It is fast, consumes little memory and requires no learning. To validate our results, we apply this algorithm to search for similar images in different image databases.

Keywords: 2-D histogram, statistical moments, indexing, similarity distance, histograms intersection

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Authors: Ben Cheikh Asma, Bouafia Nabiha, Ammar Asma, Ezzi Olfa, Meddeb Khaoula, Chouchène Imed, Boussarsar Hamadi, Njah Mansour

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Background: Hospital Acquired Infection (HAI) constitutes an important worldwide health problem. It was associated with high mortality rate in intensive care units (ICU). This study aimed to determine HAI mortality rate in Tunisian intensive care units and identify its risk factors. Methods: We conducted a prospective observational cohort study over a 12 months period (September 15th 2015 to September 15 th 2016) in the adult medical ICU of University Hospital-Farhat Hached (Sousse-Tunisia). All patients admitted in the ICU for more than 48 hours were included in the study. We used an anonymous standardized survey record form to collect data by a medical hygienist assisted by an intensivist. We adopted definitions of Center for Diseases Control and prevention of Atlanta to detect HAI, Kaplan Meier survival analysis and Cox proportional hazard regression to identify independent risk factor of HAI mortality. Results: Of 171 patients, 67 developed ICU-acquired infection (global incidence rate=39.2%). The mean age of patients was 59 ± 21.2 years and 60.8% were male. The most frequently identified infections were pulmonary acquired infection (ventilator associated pneumonia (VAP) and infected atelectasis with density rates 21.4 VAP/1000 days of mechanical ventilation and 9.4 infected atelectasis /1000 days of mechanical ventilation; respectively) and central venous catheter associated infection (CVC - AI) with density rate 28.4 CVC-AI / 1000 CVC-days). HAI mortality rate was 66.7% (n=44). The median survival was 20 days 3.36, 95% Confidential Interval [13.39 – 26.60]. Specific mortality rates according to infectious site were 65.5%, 36.4% and 4.5% respectively for VAP, CVC associated infection and infected atelectasis. In univariate analysis, a significant associations between mortality and cardiovascular history (p=0.04) tracheotomy (p=0.00), peripheral venous catheterization (p=0.04), VAP (p=0.04) and infected atelectasis (p=0.04) were detected. Independent risk factors for HAI mortality were VAP with Hazard Ratio = 3.14, 95% Confidential Interval [1.63 – 6.05] (p=0.001) and tracheotomy (Hazard Ratio=0.22, 95% Confidential Interval [0.10 – 0.44], p=0.000). Conclusions: In the present study, hospital acquired infection mortality rate was relatively high. We need to intensify the fight against these infections especially ventilator-associated pneumonia that is associated with higher risk of mortality in many studies. Thus, more effective infection control interventions were necessary in our hospital.

Keywords: hospital acquired infection, intensive care unit, mortality, risk factors

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