Search results for: Imed Mezghani
17 Germination Behavior of Tricholaena teneriffae L. a perennial Grass Species
Authors: Imed Mezghani, Yousra Ben Salah, Mohamed Chaieb
Abstract:
Tricholaena teneriffae L. is a xerophytic perennial herb that belongs to the Poaceae family likely to be used for ecological restoration programs. It's a dominant and economically important species widely distributed in the Bou-Hedma National Park, Tunisia. Reintroduction and expansion of T. teneriffae depend solely on sexual reproduction. This makes the understanding of its germination requirements vital for conservation and management. To provide basic information for its conservation and reintroduction, we studied the influence of environmental factors on seed germination patterns. The germination responses of seeds were determined over a wide range of constant temperatures (15–35°C), polyethylene glycol solutions of different osmotic potentials (0 to −2 MPa) and salt solution (0 to 150 mM of NaCl). Results indicated that the optimum temperature germination was attained at 25°C which corresponds to temperatures prevailing during mid spring season in the Mediterranean area. Seeds germinated in Polyethylene Glycol solutions exhibited significantly lower germination than control especially when water potential fell below -0.6 MPa. Germination percentage and rate decreased with an increase NaCl concentration. Seeds germination was substantially delayed and reduced with an increase in NaCl to levels above 50 mM. T. teneriffae is moderately salt tolerant at germination stage.Keywords: germination, temperature, Tricholaena teneriffae L., salt stress, water stress, rehabilitation
Procedia PDF Downloads 29316 Adherence Induced Formwork Removal in Small-Scale Pull-Off Tensile Tests
Authors: Nicolas Spitz, Nicolas Coniglio, Mohamed El Mansori, Alex Montagne, Sabeur Mezghani
Abstract:
Nowadays buildings' construction is performed by pouring concrete into molds referred to as formworks that are usually prefabricated metallic modules. Defects such as stripping may possibly form during the removal of the formwork if the interfacial bonding between the concrete and the formwork is high. A new pull-off tensile test was developed in our laboratory to simulate small-scale formwork removals. The concrete-to-formwork adherence force was measured on bare and coated formworks with different surface signatures. The used concrete was a mixture largely used on building sites and contains CEM I Portland cement and calcareous filler. The concrete surface appearance and the type of failures at the concrete-formwork interface have been investigated. The originality of this near-to-surface test was to compare the laboratory-measured adherence forces to the on-site observations. Based upon the small-scale laboratory test results, functional formwork specifications with low adherence to concrete was proposed in terms of superficial signature characteristics.Keywords: concrete-formwork adherence, interfacial bonding, skin formwork functionality, small-scale pull-off tensile test
Procedia PDF Downloads 24515 Dynamic Synthesis of a Flexible Multibody System
Authors: Mohamed Amine Ben Abdallah, Imed Khemili, Nizar Aifaoui
Abstract:
This work denotes an insight into dynamic synthesis of multibody systems. A set of mechanism parameters design variable are synthetized based on a desired mechanism response, such as, velocity, acceleration and bodies deformations. Moreover, knowing the work space, for a robot, and mechanism response allow defining optimal parameters mechanism handling with the desired target response. To this end, evolutionary genetic algorithm has been deployed. A demonstrative example for imperfect mechanism has been treated, mainly, a slider crank mechanism with a flexible connecting rod. The transversal deflection of the connecting rod has been chosen as response to identify the mechanism design parameters.Keywords: dynamic response, evolutionary genetic algorithm, flexible bodies, optimization
Procedia PDF Downloads 32014 Numerical Study of Heat Transfer in Silica Aerogel
Authors: Amal Maazoun, Abderrazak Mezghani, Ali Ben Moussa
Abstract:
Aerogel consists of a ramified and inter-connected solid skeleton enclosing a very important number of nano-sized pores filled with air that occupies most of the volume and makes very low density. The thermal conductivity of this material can reach lower values than those of any other material, and it changes with the type of the aerogel and its composition. So, in order to explain the causes of the super-insulation of our material and to determine the factors in which depends on its conductivity we used a numerical simulation. We have developed a numerical code that generates random fractal structure of silica aerogel with pre-defined concentration, properties of the backbone and the gas in the pores as well as the size of the particles. The calculation of the conductivity at any point of domain shows that it is not constant and that it depends on the pore size and the location in the pore. A numerical method based on resolution by inversion of block tridiagonal matrices is used to calculate the equivalent thermal conductivity of the whole fractal structure. The average conductivity calculated for each concentration is in good agreement with those of typical aerogels. And we found that the equivalent thermal conductivity of a silica aerogel depends strongly not only on the porosity but also on the tortuosity of the solid backbone.Keywords: aerogel, fractal structure, numerical study, porous media, thermal conductivity
Procedia PDF Downloads 29013 Evaluation of Heterogeneity of Paint Coating on Metal Substrate Using Laser Infrared Thermography and Eddy Current
Authors: S. Mezghani, E. Perrin, J. L. Bodnar, J. Marthe, B. Cauwe, V. Vrabie
Abstract:
Non contact evaluation of the thickness of paint coatings can be attempted by different destructive and nondestructive methods such as cross-section microscopy, gravimetric mass measurement, magnetic gauges, Eddy current, ultrasound or terahertz. Infrared thermography is a nondestructive and non-invasive method that can be envisaged as a useful tool to measure the surface thickness variations by analyzing the temperature response. In this paper, the thermal quadrupole method for two layered samples heated up with a pulsed excitation is firstly used. By analyzing the thermal responses as a function of thermal properties and thicknesses of both layers, optimal parameters for the excitation source can be identified. Simulations show that a pulsed excitation with duration of ten milliseconds allows to obtain a substrate-independent thermal response. Based on this result, an experimental setup consisting of a near-infrared laser diode and an Infrared camera was next used to evaluate the variation of paint coating thickness between 60 µm and 130 µm on two samples. Results show that the parameters extracted for thermal images are correlated with the estimated thicknesses by the Eddy current methods. The laser pulsed thermography is thus an interesting alternative nondestructive method that can be moreover used for non conductive substrates.Keywords: non destructive, paint coating, thickness, infrared thermography, laser, heterogeneity
Procedia PDF Downloads 63912 Geostatistical and Geochemical Study of the Aquifer System Waters Complex Terminal in the Valley of Oued Righ-Arid Area Algeria
Authors: Asma Bettahar, Imed Eddine Nezli, Sameh Habes
Abstract:
Groundwater resources in the Oued Righ valley are represented like the parts of the eastern basin of the Algerian Sahara, superposed by two major aquifers: the Intercalary Continental (IC) and the Terminal Complex (TC). From a qualitative point of view, various studies have highlighted that the waters of this region showed excessive mineralization, including the waters of the terminal complex (EC Avg equal 5854.61 S/cm) .The present article is a statistical approach by two multi methods various complementary (ACP, CAH), applied to the analytical data of multilayered aquifer waters Terminal Complex of the Oued Righ valley. The approach is to establish a correlation between the chemical composition of water and the lithological nature of different aquifer levels formations, and predict possible connection between groundwater’s layers. The results show that the mineralization of water is from geological origin. They concern the composition of the layers that make up the complex terminal.Keywords: complex terminal, mineralization, oued righ, statistical approach
Procedia PDF Downloads 38711 Evolution of Chemistry in the Waters of Superposed Aquifer System Terminal Complex in the Valley of the Oued Righ - Arid Area Algeria
Authors: Asma Bettahar, Imed Eldine Nezli, Sameh Habes
Abstract:
Groundwater resources in the Oued Righ valley are represented like the parts of the eastern basin of the Algerian Sahara, superposed by two major aquifers: the Intercalary Continental (IC) and the Terminal Complex (TC). From a qualitative point of view, various studies have highlighted that the waters of this region showed excessive mineralization, including the waters of the terminal complex (EC Avg equal 5854.61 S/cm). The present article is a statistical approach by two multi methods various complementary (ACP CAH), applied to the analytical data of multilayered aquifer waters Terminal Complex of the Oued Righ valley. The approach is to establish a correlation between the chemical composition of water and the lithological nature of different aquifer levels formations, and predict possible connection between groundwater’s layers. The results show that the mineralization of water is from geological origin. They concern the composition of the layers that make up the complex terminal.Keywords: oued righ, complex terminal, infill continental, mineralization
Procedia PDF Downloads 45010 A Review of Different Studies on Hidden Markov Models for Multi-Temporal Satellite Images: Stationarity and Non-Stationarity Issues
Authors: Ali Ben Abbes, Imed Riadh Farah
Abstract:
Due to the considerable advances in Multi-Temporal Satellite Images (MTSI), remote sensing application became more accurate. Recently, many advances in modeling MTSI are developed using various models. The purpose of this article is to present an overview of studies using Hidden Markov Model (HMM). First of all, we provide a background of using HMM and their applications in this context. A comparison of the different works is discussed, and possible areas and challenges are highlighted. Secondly, we discussed the difference on vegetation monitoring as well as urban growth. Nevertheless, most research efforts have been used only stationary data. From another point of view, in this paper, we describe a new non-stationarity HMM, that is defined with a set of parts of the time series e.g. seasonal, trend and random. In addition, a new approach giving more accurate results and improve the applicability of the HMM in modeling a non-stationary data series. In order to assess the performance of the HMM, different experiments are carried out using Moderate Resolution Imaging Spectroradiometer (MODIS) NDVI time series of the northwestern region of Tunisia and Landsat time series of tres Cantos-Madrid in Spain.Keywords: multi-temporal satellite image, HMM , nonstationarity, vegetation, urban
Procedia PDF Downloads 3549 Correlation of IFNL4 ss469415590 and IL28B rs12979860 with the Hepatitis C Virus Treatment Response among Tunisian Patients
Authors: Khaoula Azraiel, Mohamed Mehdi Abassi, Amel Sadraoui, Walid Hammami, Azouz Msaddek, Imed Cheikh, Maria Mancebo, Elisabet Perez-Navarro, Antonio Caruz, Henda Triki, Ahlem Djebbi
Abstract:
IL28B rs12979860 genotype is confirmed as an important predictor of response to peginterferon/ribavirin therapy in patients with chronic hepatitis C (CHC). IFNL4 ss469415590 is a newly discovered polymorphism that could also affect the sustained virological response (SVR). The aim of this study was to evaluate the association of IL28B and IFNL4 genotypes with peginterferon/ribavirin treatment response in Tunisians patients with CHC and to determine which of these SNPs, was the stronger marker. A total of 120 patients were genotyped for both rs12979860 and ss469415590 polymorphisms. The association of each genetic marker with SVR was analyzed and comparison between the two SNPs was calculated by logistic regression models. For rs12979860, 69.6% of patients with CC, 41.8% with CT and 42.8% with TT achieved SVR (p = 0.003). Regarding ss469415590, 70.4% of patients with TT/TT genotype achieved SVR compared to 42.8% with TT/ΔG and 37.5% with ΔG /ΔG (p = 0.002). The presence of CC and TT/TT genotypes was independently associated with treatment response with an OR of 3.86 for each. In conclusion, both IL28B rs12979860 and IFNL4 ss469415590 variants were associated with response to pegIFN/RBV in Tunisian patients, without any additional benefit in performance for IFNL4. Our results are different from those detected in Sub-Saharan Africa countries.Keywords: Hepatitis C virus, IFNL4, IL28B, Peginterferon/ribavirin, polymorphism
Procedia PDF Downloads 3388 An Adaptive Dimensionality Reduction Approach for Hyperspectral Imagery Semantic Interpretation
Authors: Akrem Sellami, Imed Riadh Farah, Basel Solaiman
Abstract:
With the development of HyperSpectral Imagery (HSI) technology, the spectral resolution of HSI became denser, which resulted in large number of spectral bands, high correlation between neighboring, and high data redundancy. However, the semantic interpretation is a challenging task for HSI analysis due to the high dimensionality and the high correlation of the different spectral bands. In fact, this work presents a dimensionality reduction approach that allows to overcome the different issues improving the semantic interpretation of HSI. Therefore, in order to preserve the spatial information, the Tensor Locality Preserving Projection (TLPP) has been applied to transform the original HSI. In the second step, knowledge has been extracted based on the adjacency graph to describe the different pixels. Based on the transformation matrix using TLPP, a weighted matrix has been constructed to rank the different spectral bands based on their contribution score. Thus, the relevant bands have been adaptively selected based on the weighted matrix. The performance of the presented approach has been validated by implementing several experiments, and the obtained results demonstrate the efficiency of this approach compared to various existing dimensionality reduction techniques. Also, according to the experimental results, we can conclude that this approach can adaptively select the relevant spectral improving the semantic interpretation of HSI.Keywords: band selection, dimensionality reduction, feature extraction, hyperspectral imagery, semantic interpretation
Procedia PDF Downloads 3547 A Review on 3D Smart City Platforms Using Remotely Sensed Data to Aid Simulation and Urban Analysis
Authors: Slim Namouchi, Bruno Vallet, Imed Riadh Farah
Abstract:
3D urban models provide powerful tools for decision making, urban planning, and smart city services. The accuracy of this 3D based systems is directly related to the quality of these models. Since manual large-scale modeling, such as cities or countries is highly time intensive and very expensive process, a fully automatic 3D building generation is needed. However, 3D modeling process result depends on the input data, the proprieties of the captured objects, and the required characteristics of the reconstructed 3D model. Nowadays, producing 3D real-world model is no longer a problem. Remotely sensed data had experienced a remarkable increase in the recent years, especially data acquired using unmanned aerial vehicles (UAV). While the scanning techniques are developing, the captured data amount and the resolution are getting bigger and more precise. This paper presents a literature review, which aims to identify different methods of automatic 3D buildings extractions either from LiDAR or the combination of LiDAR and satellite or aerial images. Then, we present open source technologies, and data models (e.g., CityGML, PostGIS, Cesiumjs) used to integrate these models in geospatial base layers for smart city services.Keywords: CityGML, LiDAR, remote sensing, SIG, Smart City, 3D urban modeling
Procedia PDF Downloads 1356 A Spatial Hypergraph Based Semi-Supervised Band Selection Method for Hyperspectral Imagery Semantic Interpretation
Authors: Akrem Sellami, Imed Riadh Farah
Abstract:
Hyperspectral imagery (HSI) typically provides a wealth of information captured in a wide range of the electromagnetic spectrum for each pixel in the image. Hence, a pixel in HSI is a high-dimensional vector of intensities with a large spectral range and a high spectral resolution. Therefore, the semantic interpretation is a challenging task of HSI analysis. We focused in this paper on object classification as HSI semantic interpretation. However, HSI classification still faces some issues, among which are the following: The spatial variability of spectral signatures, the high number of spectral bands, and the high cost of true sample labeling. Therefore, the high number of spectral bands and the low number of training samples pose the problem of the curse of dimensionality. In order to resolve this problem, we propose to introduce the process of dimensionality reduction trying to improve the classification of HSI. The presented approach is a semi-supervised band selection method based on spatial hypergraph embedding model to represent higher order relationships with different weights of the spatial neighbors corresponding to the centroid of pixel. This semi-supervised band selection has been developed to select useful bands for object classification. The presented approach is evaluated on AVIRIS and ROSIS HSIs and compared to other dimensionality reduction methods. The experimental results demonstrate the efficacy of our approach compared to many existing dimensionality reduction methods for HSI classification.Keywords: dimensionality reduction, hyperspectral image, semantic interpretation, spatial hypergraph
Procedia PDF Downloads 3065 Incidence and Risk Factors of Central Venous Associated Infections in a Tunisian Medical Intensive Care Unit
Authors: Ammar Asma, Bouafia Nabiha, Ghammam Rim, Ezzi Olfa, Ben Cheikh Asma, Mahjoub Mohamed, Helali Radhia, Sma Nesrine, Chouchène Imed, Boussarsar Hamadi, Njah Mansour
Abstract:
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
Procedia PDF Downloads 3614 A New Method Separating Relevant Features from Irrelevant Ones Using Fuzzy and OWA Operator Techniques
Authors: Imed Feki, Faouzi Msahli
Abstract:
Selection of relevant parameters from a high dimensional process operation setting space is a problem frequently encountered in industrial process modelling. This paper presents a method for selecting the most relevant fabric physical parameters for each sensory quality feature. The proposed relevancy criterion has been developed using two approaches. The first utilizes a fuzzy sensitivity criterion by exploiting from experimental data the relationship between physical parameters and all the sensory quality features for each evaluator. Next an OWA aggregation procedure is applied to aggregate the ranking lists provided by different evaluators. In the second approach, another panel of experts provides their ranking lists of physical features according to their professional knowledge. Also by applying OWA and a fuzzy aggregation model, the data sensitivity-based ranking list and the knowledge-based ranking list are combined using our proposed percolation technique, to determine the final ranking list. The key issue of the proposed percolation technique is to filter automatically and objectively the relevant features by creating a gap between scores of relevant and irrelevant parameters. It permits to automatically generate threshold that can effectively reduce human subjectivity and arbitrariness when manually choosing thresholds. For a specific sensory descriptor, the threshold is defined systematically by iteratively aggregating (n times) the ranking lists generated by OWA and fuzzy models, according to a specific algorithm. Having applied the percolation technique on a real example, of a well known finished textile product especially the stonewashed denims, usually considered as the most important quality criteria in jeans’ evaluation, we separate the relevant physical features from irrelevant ones for each sensory descriptor. The originality and performance of the proposed relevant feature selection method can be shown by the variability in the number of physical features in the set of selected relevant parameters. Instead of selecting identical numbers of features with a predefined threshold, the proposed method can be adapted to the specific natures of the complex relations between sensory descriptors and physical features, in order to propose lists of relevant features of different sizes for different descriptors. In order to obtain more reliable results for selection of relevant physical features, the percolation technique has been applied for combining the fuzzy global relevancy and OWA global relevancy criteria in order to clearly distinguish scores of the relevant physical features from those of irrelevant ones.Keywords: data sensitivity, feature selection, fuzzy logic, OWA operators, percolation technique
Procedia PDF Downloads 6053 Risk Factors of Hospital Acquired Infection Mortality in a Tunisian Intensive Care Unit
Authors: Ben Cheikh Asma, Bouafia Nabiha, Ammar Asma, Ezzi Olfa, Meddeb Khaoula, Chouchène Imed, Boussarsar Hamadi, Njah Mansour
Abstract:
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
Procedia PDF Downloads 4842 Healthcare Associated Infections in an Intensive Care Unit in Tunisia: Incidence and Risk Factors
Authors: Nabiha Bouafia, Asma Ben Cheikh, Asma Ammar, Olfa Ezzi, Mohamed Mahjoub, Khaoula Meddeb, Imed Chouchene, Hamadi Boussarsar, Mansour Njah
Abstract:
Background: Hospital acquired infections (HAI) cause significant morbidity, mortality, length of stay and hospital costs, especially in the intensive care unit (ICU), because of the debilitated immune systems of their patients and exposure to invasive devices. The aims of this study were to determine the rate and the risk factors of HAI in an ICU of a university hospital in Tunisia. Materials/Methods: A prospective study was conducted in the 8-bed adult medical ICU of a University Hospital (Sousse Tunisia) during 14 months from September 15th, 2015 to November 15th, 2016. Patients admitted for more than 48h were included. Their surveillance was stopped after the discharge from ICU or death. HAIs were defined according to standard Centers for Disease Control and Prevention criteria. Risk factors were analyzed by conditional stepwise logistic regression. The p-value of < 0.05 was considered significant. Results: During the study, 192 patients had admitted for more than 48 hours. Their mean age was 59.3± 18.20 years and 57.1% were male. Acute respiratory failure was the main reason of admission (72%). The mean SAPS II score calculated at admission was 32.5 ± 14 (range: 6 - 78). The exposure to the mechanical ventilation (MV) and the central venous catheter were observed in 169 (88 %) and 144 (75 %) patients, respectively. Seventy-three patients (38.02%) developed 94 HAIs. The incidence density of HAIs was 41.53 per 1000 patient day. Mortality rate in patients with HAIs was 65.8 %( n= 48). Regarding the type of infection, Ventilator Associated Pneumoniae (VAP) and central venous catheter Associated Infections (CVC AI) were the most frequent with Incidence density: 14.88/1000 days of MV for VAP and 20.02/1000 CVC days for CVC AI. There were 5 Peripheral Venous Catheter Associated Infections, 2 urinary tract infections, and 21 other HAIs. Gram-negative bacteria were the most common germs identified in HAIs: Multidrug resistant Acinetobacter Baumanii (45%) and Klebsiella pneumoniae (10.96%) were the most frequently isolated. Univariate analysis showed that transfer from another hospital department (p= 0.001), intubation (p < 10-4), tracheostomy (p < 10-4), age (p=0.028), grade of acute respiratory failure (p=0.01), duration of sedation (p < 10-4), number of CVC (p < 10-4), length of mechanical ventilation (p < 10-4) and length of stay (p < 10-4), were associated to high risk of HAIS in ICU. Multivariate analysis reveals that independent risk factors for HAIs are: transfer from another hospital department: OR=13.44, IC 95% [3.9, 44.2], p < 10-4, duration of sedation: OR= 1.18, IC 95% [1.049, 1.325], p=0.006, high number of CVC: OR=2.78, IC 95% [1.73, 4.487], p < 10-4, and length of stay in ICU: OR= 1.14, IC 95% [1.066,1.22], p < 10-4. Conclusion: Prevention of nosocomial infections in ICUs is a priority of health care systems all around the world. Yet, their control requires an understanding of epidemiological data collected in these units.Keywords: healthcare associated infections, incidence, intensive care unit, risk factors
Procedia PDF Downloads 3691 Ventilator Associated Pneumonia in a Medical Intensive Care Unit, Incidence and Risk Factors: A Case Control Study
Authors: Ammar Asma, Bouafia Nabiha, Ben Cheikh Asma, Ezzi Olfa, Mahjoub Mohamed, Sma Nesrine, Chouchène Imed, Boussarsar Hamadi, Njah Mansour
Abstract:
Background: Ventilator-associated pneumonia (VAP) is currently recognized as one of the most relevant causes of morbidity and mortality among intensive care unit (ICU) patients worldwide. Identifying modifiable risk factors for VAP could be helpful for future controlled interventional studies aiming at improving prevention of VAP. The purposes of this study were to determine the incidence and risk factors for VAP in in a Tunisian medical ICU. Materials / Methods: A retrospective case-control study design based on the prospective database collected over a 14-month period from September 15th, 2015 through November 15th, 2016 in an 8-bed medical ICU. Patients under ventilation for over 48 h were included. The number of cases was estimated by Epi-info Software with the power of statistical test equal to 90 %. Each case patient was successfully matched to two controls according to the length of mechanical ventilation (MV) before VAP for cases and the total length of MV in controls. VAP in the ICU was defined according to American Thoracic Society; Infectious Diseases Society of America guidelines. Early onset or late-onset VAP were defined whether the infectious process occurred within or after 96 h of ICU admission. Patients’ risk factors, causes of admission, comorbidities and respiratory specimens collected were reviewed. Univariate and multivariate analyses were performed to determine variables associated with VAP with a p-value < 0.05. Results: During the period study, a total of 169 patients under mechanical ventilation were considered, 34 patients (20.11%) developed at least one episode of VAP in the ICU. The incidence rate for VAP was 14.88/1000 ventilation days. Among these cases, 9 (26.5 %) were early-onset VAP and 25 (73.5 %) were late-onset VAP. It was a certain diagnosis in 66.7% of cases. Tracheal aspiration was positive in 80% of cases. Multi-drug resistant Acinerobacter baumanii was the most common species detected in cases; 67.64% (n=23). The rate of mortality out of cases was 88.23% (n= 30). In univariate analysis, the patients with VAP were statistically more likely to suffer from cardiovascular diseases (p=0.035) and prolonged duration of sedation (p=0.009) and tracheostomy (p=0.001), they also had a higher number of re-intubation (p=0.017) and a longer total time of intubation (p=0.012). Multivariate analysis showed that cardiovascular diseases (OR= 4.44; 95% IC= [1.3 - 14]; p=0.016), tracheostomy (OR= 4.2; 95% IC= [1.16 -15.12]; p= 0.028) and prolonged duration of sedation (OR=1.21; 95% IC= [1.07, 1.36]; p=0.002) were independent risk factors for the development of VAP. Conclusion: VAP constitutes a therapeutic challenge in an ICU setting, therefore; strategies that effectively prevent VAP are needed. An infection control-training program intended to all professional heath care in this unit insisting on bundles and elaboration of procedures are planned to reduce effectively incidence rate of VAP.Keywords: case control study, intensive care unit, risk factors, ventilator associated pneumonia
Procedia PDF Downloads 395