This study showed that the level of the PSC needs to be improved not only in public hospitals but also in private ones. The obtained results highlight the importance of implementing quality management systems and developing PSC.

Background: Ensuring patient safety and health-care quality remain priorities and challenges worldwide and the role of nurses is essential to meet these challenges. Developing patient safety culture is a key component to improve patient safety and health-care quality. Aims: To assess nurses' patient safety culture in primary health-care centres in Tunisia and to determine its associated factors. Methods: This was a multicentre, cross-sectional descriptive study conducted across 30 primary health-care centres in Tunisia, using the French validated version of the Hospital Survey on Patient Safety Culture questionnaire. All the nurses working in these centres were invited to participate in the study (n = 158). Results: The response rate for participation in the study was 87.3%. The dimension of "teamwork within units" had the highest score (70.6%). Three safety dimensions had low scores: "frequency of event reporting" (27.6%), "staffing" (34.76%) and "nonpunitive response to errors" (36.5%). Two factors were associated with patient safety culture: participation in risk management committees, and district of the primary care centre. Conclusions: The level of nurses' patient safety culture needs to be improved in primary health-care centres in Tunisia. Strategies to nurture patient safety culture should focus upon building leadership capacity that supports open communication, blame-free environment, teamwork and continuous organizational learning.

The pandemic spread of multidrug-resistant (MDR) bacteria (i.e., methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum b-lactamase-producing Enterobacteriaceae (ESBLPE), vancomycin-resistant enterococci, carbapenemase-producing Enterobacteriaceae (CPE), multiresistant Pseudomonas aeruginosa and multiresistant Acinetobacter baumannii) pose a threat to healthcare Worldwide. We found limited data of MDR bacteria in pediatric patients hospitalized in Tunisian tertiary healthcare.The aim of the study is to evaluate the acquisition rate of MDR acquisition during hospitalization and to explore some of the associated risk factors for both carriage and acquisition at the pediatric department, Sahloul University Hospital. During September and October 2016, newly admitted patients were screened, at admission, during care and at discharge. Risk factors for colonization were explored by multivariate analysis. Of 112 newly admitted patients, 8.92% were colonized with at least one MDR. No risk factor was identified at admission. During hospitalization, five newly acquisition MDR (4.9%) were detected and eight (7.84%) at discharge. The specie most frequently detected on admission was Escherichia coli (50%), whereas, on discharge, Escherichia coli and K. pneumoniae were the species most frequently detected (52.7%). The pediatric intensive care unit (PICU) hospitalization, the length of hospital stay (more than 3days) and age under 2 years were identified as risk factor for acquisition of MDR during hospitalization. We identified several independent risk factors for contracting MDR bacteria during hospitalization in a tertiary pediatric department. The incidence of symptomatic MDR Infection among those colonized should be under close surveillance and long-term screening for those children is required. An institutional screening program for MDR especially in PICU might be discussed in regards to cost effectiveness.

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