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This retrospective study compared central line-associated bloodstream infection (CLABSI) rates per 1 000 central line days, and overall mortality before and during the COVID-19 pandemic in adult, paediatric, and neonatal ICU patients at King Abdul-Aziz Medical City-Riyadh who had a central line and were diagnosed with CLABSI according to the National Healthcare Safety Network standard definition. The study spanned between January 2018 and December 2019 (pre-pandemic), and January 2020 and December 2021 (pandemic). SARS-CoV-2 was confirmed by positive RT-PCR testing. The study included 156 CLABSI events and 46 406 central line days; 52 and 22 447 (respectively) in pre-pandemic, and 104 and 23 959 (respectively) during the pandemic. CLABSI rates increased by 2.02 per 1 000 central line days during the pandemic period (from 2.32 to 4.34, p < 0.001). Likewise, overall mortality rates increased by 0.86 per 1 000 patient days (from 0.93 to 1.79, p = 0.003). Both CLABSI rates (6.18 vs. 3.7, p = 0.006) and overall mortality (2.72 vs. 1.47, p = 0.014) were higher among COVID-19 patients compared to non-COVID-19 patients. The pandemic was associated with a substantial increase in CLABSI-associated morbidity and mortality.
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COVID-19 , Infecciones Relacionadas con Catéteres , Cateterismo Venoso Central , Centros de Atención Terciaria , Humanos , Arabia Saudita/epidemiología , COVID-19/epidemiología , COVID-19/mortalidad , Estudios Retrospectivos , Centros de Atención Terciaria/estadística & datos numéricos , Masculino , Femenino , Infecciones Relacionadas con Catéteres/epidemiología , Infecciones Relacionadas con Catéteres/mortalidad , Persona de Mediana Edad , Adulto , Cateterismo Venoso Central/efectos adversos , Anciano , Unidades de Cuidados Intensivos/estadística & datos numéricos , SARS-CoV-2 , Niño , Recién Nacido , Lactante , Adolescente , Preescolar , Adulto JovenRESUMEN
BACKGROUND: Competency of the staff working in infection prevention and control (IPC) is the cornerstone of successful IPC programs. The objective was to assess competency level and associated factors among IPC staff working in the Middle East and North Africa (MENA) region. METHODS: A cross-sectional study was carried out in 2019 among active IPC staff who were members of the Arab Countries Infection Control Network. The questionnaire covered demographic and professional characteristics of IPC staff and characteristics of work facilities and IPC programs. A competency score was created from self-perceived responses to 8 competency domains. The competency score was then transformed into 100-scale and categorized into two groups (≥ median and < median). RESULTS: A total of 176 participants completed the survey. Participants were mostly female (65.7%), and the mean age was 40.2 ± 8.3 years. The mean competency score was 61.4%. It was slightly variable between domains, being highest with preventing transmission of infection (65%) and lowest with sterilization and disinfection (59%). Higher (≥ median) competency score was associated with having CBIC certification (p < 0.001). It was also associated with facilities having IPC plan (p = 0.005), IPC committee (p = 0.049), regular meetings of IPC committee (p < 0.001), and IPC plan included communications with healthcare workers (p < 0.001). Domain-specific competency scores were significantly associated with receiving same domain-specific training (p < 0.05 for all). CONCLUSIONS: The competency levels of IPC staff in the MENA region is still suboptimal. The current finding calls for more regional and national investment in IPC staff by providing up-to-date customized educational and training opportunities.
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Control de Infecciones , Humanos , Medio Oriente , Femenino , Estudios Transversales , Masculino , África del Norte , Adulto , Control de Infecciones/normas , Persona de Mediana Edad , Encuestas y Cuestionarios , Personal de Salud/psicología , Personal de Salud/estadística & datos numéricos , Competencia ProfesionalRESUMEN
BACKGROUND: The general human immune responses similarity against different coronaviruses may reflect some degree of cross-immunity, whereby exposure to one coronavirus may confer partial immunity to another. The aim was to determine whether previous MERS-CoV infection was associated with a lower risk of subsequent COVID-19 disease and its related outcomes. METHODS: We conducted a retrospective cohort study among all patients screened for MERS-CoV at a tertiary care hospital in Saudi Arabia between 2012 and early 2020. Both MERS-CoV positive and negative patients were followed up from early 2020 to September 2021 for developing COVID-19 infection confirmed by RT-PCR testing. RESULTS: A total of 397 participants followed for an average 15 months during COVID-19 pandemic (4.9 years from MERS-CoV infection). Of the 397 participants, 93 (23.4%) were positive for MERS-CoV at baseline; 61 (65.6%) of the positive cases were symptomatic. Out of 397, 48 (12.1%) participants developed COVID-19 by the end of the follow-up period. Cox regression analysis adjusted for age, gender, and major comorbidity showed a marginally significant lower risk of COVID-19 disease (hazard ratio = 0.533, p = 0.085) and hospital admission (hazard ratio = 0.411, p = 0.061) in patients with positive MERS-CoV. Additionally, the risk of COVID-19 disease was further reduced and became significant in patients with symptomatic MERS-CoV infection (hazard ratio = 0.324, p = 0.034) and hospital admission (hazard ratio = 0.317, p = 0.042). CONCLUSIONS: The current findings may indicate a partial cross-immunity, where patients with symptomatic MERS-CoV have a lower risk of future COVID-19 infection and related hospitalization. The present results may need further examination nationally using immunity markers.
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COVID-19 , Coronavirus del Síndrome Respiratorio de Oriente Medio , Humanos , COVID-19/epidemiología , Estudios Retrospectivos , Pandemias , Riesgo , Arabia Saudita/epidemiologíaRESUMEN
BACKGROUND: Active involvement of students in class using technology is associated with effective learning and understanding. This work intended to analyze the impact of interactive teaching on medical students' engagement, learning, performance, understanding and attendance in virtual classes of physiology, pathology, and pharmacology during COVID-19 pandemic. METHODS: A descriptive cross-sectional study was carried out at college of medicine at King Saud bin Abdulaziz University for Health Sciences (KSAU-HS) in Riyadh during January-April 2022. Third- and fourth-year medical students filled a self-reported questionnaire that assessed students' engagement, understanding, performance, and attendance during the sessions of three courses within the curriculum. The Chi-square test or Fisher's exact test was used to compare the difference between the survey responses. RESULTS: A total of 184/234 questionnaires were completed and returned, with an overall response rate of 78.6%. Fifty-five percent of the participants were involved at least more than 5 times in polls during the class. Majority (86.9%), of the students agreed on enjoying participation in polls during the class, and 88.9% recommended the utilization of the polls again. Participation in polls improved understanding and performance of 88%, and 63% of students respectively. In addition, 38% were neutral regarding attendance improvement and spending more time for the class. Around 53% students agreed that polls improved their grades. CONCLUSION: In conclusion, this study showed that there is an impact of using interactive polls in virtual classes in medical students at KSAU-HS. It is recommended to continue using polls in all subjects in on-site sessions. This will be a great preface step toward switching the traditional teaching to the interactive teaching using flipped classroom strategy in the future.
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COVID-19 , Estudiantes de Medicina , Humanos , Estudios Transversales , Universidades , PandemiasRESUMEN
BACKGROUND: Several studies reported that Inter-professional Education (IPE) plays a major role in creating an effective collaborating environment in healthcare settings to achieve high-quality patient care. This study measured the College of Applied Medical Sciences (CAMS) students' readiness for and perceptions of IPE. METHODS: A cross-sectional study was conducted with 232 undergraduate students in Riyadh, using a stratified random sampling method. All the undergraduate students of CAMS were included. Two previously validated questionnaires, the Interdisciplinary Education Perception Scale (IEPS) and the Readiness for Interprofessional Learning Scale (RIPLS) were used in the study. RESULTS: The mean score for the RIPLS was 86.8. The Tukey post-hoc test score was significantly higher comparing the Occupational Therapy and the Respiratory Therapy programs. There was no difference between the overall RIPLS and subscales between male and female students as well as senior and junior students. For the IEPS, the mean score was 77.7. The Tukey post-hoc test score was significantly higher in the Occupational Therapy and Respiratory Therapy programs. CONCLUSION: The current study indicated that the Applied Medical Sciences' students demonstrated readiness for IPE as an important element in creating collaborative teamwork in their programs. The early incorporation of IPE in the pre-professional years will enhance collaboration in management and patient care.
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Estudiantes del Área de la Salud , Estudiantes de Medicina , Actitud del Personal de Salud , Conducta Cooperativa , Estudios Transversales , Femenino , Humanos , Relaciones Interprofesionales , Masculino , PercepciónRESUMEN
PURPOSE: To determine the prevalence and pattern of proton pump inhibitor (PPI) prescription and the practices employed to reduce PPI use in the UK general population. METHODS: The UK's Clinical Practice Research Database was used to identify individuals who were issued with ≥1 PPI prescription during the period 1990-2014. Point and period prevalence of PPI use were estimated annually. Additionally, new users of PPI therapy who had 5 years of follow-up data were included in a cohort analysis to describe patterns of cessation and duration of PPI use. RESULTS: Both the period and point prevalence of PPI use increased between 1990 and 2014 (period prevalence increased from 0.2 to 15.0% and point from 0.03 to 7.7%). A total of 596 334 new users of PPI therapy in the cohort study received 8 784 272 prescriptions. Of these, 26.7% used PPI therapy long term (≥1 year continuously), while 3.9% remained on PPI therapy for 5 years. Clear attempts to step down dose were identified in 39.9% of long-term users, while this was 47% in patients whose initial indication did not mandate long-term use. CONCLUSION: A considerable increase in PPI use was observed in UK general practice. Of long-term PPI users, 60% did not have an attempt to discontinue or step down. Considerable opportunities may therefore exist to reduce the cost and side effects of PPI use through improving adherence to recommended withdrawal strategies. Copyright © 2016 John Wiley & Sons, Ltd.
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Pautas de la Práctica en Medicina/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Inhibidores de la Bomba de Protones/administración & dosificación , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Estudios de Cohortes , Bases de Datos Factuales , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Tiempo , Reino Unido , Adulto JovenRESUMEN
AIM: The aim of the study was to assess adherence to asthma controller therapy and factors that influence asthma control and to determine the association between asthma knowledge of the caregiver and asthma control among admitted children with asthma. SETTINGS AND DESIGN: A cross-sectional study was conducted between November 2022 and May 2023 in a tertiary care hospital. Children with a diagnosis of asthma aged 2-14 years, who were admitted to the hospital with an exacerbation of asthma were identified. METHODS: Caregivers of the admitted children were interviewed using the Asthma Knowledge Questionnaire and Pediatric Inhaler Adherence Questionnaire. STATISTICAL ANALYSIS USED: Demographic and clinical data were described using descriptive analyses, where mean and standard deviation were used for normally distributed continuous variables, median and interquartile range (IQR), if otherwise. A P < 0.05 was set as a cutoff for statistical significance. RESULTS: A total of 144 caregivers completed the survey. Median score for parents' knowledge of asthma was 64%, with an IQR of 59-67. Both mother's and father's educational levels were associated with a good level of knowledge: odds ratio (OR) = 2.48, 95% confidence interval (CI) = 1.1-5.6, and OR = 5.33, 95% CI = 2.23-12.7, respectively. Median adherence to metered dose inhaler (MDI) was 4 (IQR = 2-6). Children who had been admitted to the general ward in the last 6 months were three times more likely to be nonadherent to MDI (OR = 3.03, 95% CI = 1.18-7.82). Forty-three percent of children who were nonadherent to MDI were less likely to have their asthma controlled (OR = 0.43, 95% CI = 0.17-1.06). CONCLUSION: This study revealed that a low level of knowledge among caregivers of asthma patients is linked to inadequate adherence to asthma controller therapy. As medication adherence is crucial for achieving desirable asthma control and improving the quality of life for this population, efforts need to be made to enhance the knowledge level of parents of children with asthma.
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BACKGROUND: COVID-19 is the largest recorded pandemic in history. It causes several complications such as shock, pneumonia, acute respiratory distress syndrome, and organ failure. The objective was to determine COVID-19 outcomes and risk factors in the intensive care (ICU) setting. METHODS: A retrospective review of prospectively collected data was conducted. Adult patients with a positive RT-PCR test for COVID-19 admitted to ICUs of a tertiary care hospital between 2020 and 2022 were included. Patients who had severe complex trauma were excluded. The outcomes examined included ventilation use and duration, length of stay (LOS), and mortality. RESULTS: A total of 964 patients were included. The mean ( ± standard deviation, SD) age was 63.7 ± 16.9 years. The majority of the patients were males (59.0 %) and Saudi (75.7 %). Ventilation use was documented in 443 (57.1 %) patients, with a mean ( ± SD) ventilation duration of 9.7 ± 8.4 days. Death occurred in 361 (37.4 %) patients after a mean ( ± SD) of 33.3 ± 44.5 days from infection. The mean ( ± SD) LOS was 30.6 ± 54.1 days in hospital and 5.2 ± 5.4 days in ICU. Ventilation use was associated with older age, males, longer ICU LOS, mortality, and admission to medical-surgical ICU. Crude mortality use was associated with older age, longer ICU LOS, use of ventilator, shorter ventilation duration, and admission to medical-surgical or respiratory ICUs. CONCLUSIONS: COVID-19 patients admitted to adult ICUs are at high risk of death and mechanical ventilation. The crude risks of both outcomes are higher in older age and longer ICU LOS and are very variable by ICU type.
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COVID-19 , Unidades de Cuidados Intensivos , Tiempo de Internación , Respiración Artificial , Humanos , Masculino , COVID-19/mortalidad , COVID-19/epidemiología , COVID-19/terapia , Persona de Mediana Edad , Femenino , Unidades de Cuidados Intensivos/estadística & datos numéricos , Estudios Retrospectivos , Anciano , Tiempo de Internación/estadística & datos numéricos , Respiración Artificial/estadística & datos numéricos , Factores de Riesgo , Adulto , Arabia Saudita/epidemiología , SARS-CoV-2 , Anciano de 80 o más Años , Centros de Atención Terciaria/estadística & datos numéricos , Mortalidad Hospitalaria , Hospitalización/estadística & datos numéricos , PandemiasRESUMEN
BACKGROUND: Surveillance of healthcare-associated infections (HAIs) is a cornerstone for effective infection prevention and control (IPC) programs. The objective was to evaluate the coverage and methods of HAI surveillance in Middle Eastern and North African (MENA) countries. METHODS: A cross-sectional study targeted IPC staff working in MENA countries using the Infection Control Network electronic database of the Arab countries. The study focused on self-reported surveillance-related characteristics of IPC staff, facilities, and the IPC program. RESULTS: A total of 269 IPC staff were included. They were mainly females (68%), nurses (63%), and working in GCC countries (83%). Approximately 69% of covered facilities had surveillance activities. Hand hygiene, multidrug-resistant organisms, central line-associated bloodstream infections, and catheter-associated urinary tract infections were the most common surveillance activities (>90%). The surveillance workload consumed 27% of the average weekly working time. The scores of performing multiple surveillance, with appropriate methods and tools, were 83%, 67%, and 61% (respectively). Appropriate surveillance methods and/or tools were linked to GCC region, CBIC qualifications, surveillance training, specific setting (acute care and long term), staff-to-bed ratio, presence and active function of IPC committee, presence of IPC annual plan, communications with health care workers, and leadership support. CONCLUSIONS: While most health care facilities in the MENA region perform multiple surveillance, surveillance methods and tools are still suboptimal and their optimization should be a priority.
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Infección Hospitalaria , Femenino , Humanos , Masculino , Infección Hospitalaria/epidemiología , Infección Hospitalaria/prevención & control , Estudios Transversales , Atención a la Salud , Control de Infecciones/métodos , África del Norte , Medio OrienteRESUMEN
Objective: This study aimed to determine the clinical characteristics and factors associated with neonatal hypoxic-ischaemic encephalopathy (HIE) and its neurodevelopmental outcomes. Methods: We conducted retrospective case-control research to investigate the clinical and labour-related risk factors for HIE. In addition, a single-centre cohort study was conducted on infants with HIE to describe their neurodevelopment from birth to 24 months. For this investigation, cases with a diagnosis of HIE who were born at King Abdullah Children's Specialist Hospital (KASCH), Riyadh, Saudi Arabia, between 2015 and 2019 were identified and matched with controls from the same facility (1:4). Each case's clinical information was extracted using electronic medical records. In addition, 24-month follow-up HIE cases were included in a cohort study to describe their neurodevelopmental outcomes. Results: The sample includes 60 infants diagnosed with HIE and 234 infants serving as controls, with a mean gestational age of 38.8 weeks (SD 1.6) and a predominance of males (56.4%). Around one-third of the HIE cases (36.6%) had moderate HIE (stage 2), whereas 35.1% of infants had severe HIE (stage 3), according to Sarnat staging. Compared to the control group, children with HIE were twice as likely to be born to mothers with maternal comorbidities and more likely to have prepartum and intrapartum complications. A 24-month follow-up of neurodevelopmental outcomes for HIE babies revealed that approximately 24% exhibited delays in gross motor skill development, 22% in fine motor skill development, 33% in language skill development, and 22% in social skill development. Conclusion: In the HIE group, maternal comorbidities and prepartum or intrapartum complications were more common. The severity grade of HIE can be used to predict neurodevelopmental consequences. Enhancing patient care and rehabilitation requires a minimum of 24 months of neurodevelopmental follow-up.
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BACKGROUND: Pediatric out-of-hospital cardiac arrest is associated with high morbidity and mortality rates. Cardiopulmonary resuscitation (CPR), the practice of chest compressions combined with rescue breathing, is crucial for the success of out-of-hospital resuscitation after sudden cardiac arrest. Thus, imparting the requisite knowledge and skills to parents/caregivers can significantly enhance survival rates. This study investigated parental awareness of the impact of out-of-hospital pediatric CPR on survival rates in Saudi Arabia. METHODS: This cross-sectional study was conducted using an online questionnaire administered to Saudi parents from all regions of the Kingdom of Saudi Arabia. Data were collected using the convenience sampling method, as the questionnaire was distributed via social media platforms. The questionnaire consisted of five parts: (1) demographic data, (2) questions about parents' perception of basic life support (BLS), (3) evaluation of parents' knowledge of the impact of prehospital CPR on survival rates, (4) measurement of parents' competency in performing pediatric CPR, and (5) assessment of whether parents' confidence was affected by prior training. Statistical analyses were conducted using the chi-squared test or Fisher's exact test, and the t-test was used to compare the mean scores of the groups of parents with medical and non-medical professional backgrounds. RESULTS: A total of 1,065 individuals responded to the survey. The respondents' mean age was 41 ± 0.2 years and 46.5% were men. We found that 73.9% of respondents had no prior experience with BLS, 87% had never taken a BLS course, and 61% did not know where to find one. The majority of participants agreed that bystander CPR contributes to overall survival rates, and 77% agreed to the importance of BLS training. Medical professionals showed a higher percentage of agreement on the importance of BLS than those from non-medical backgrounds (90% vs. 76%, p = 0.036), especially parents of high-risk children. CONCLUSION: This study showed evidence of interest in CPR and BLS training in Saudi parents, despite the low levels of knowledge regarding BLS training.
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Background: Portable computerized devices represent a potential source of healthcare infections. The objective was to assess the knowledge, attitudes, and practices (KAP) of healthcare workers (HCWs) toward infection control practices used with Close Loop Medication Administration (CLMA) devices. Additionally, to quantify the impact of education and training on the bacterial burden on CLMA devices. Methods: The study design consisted of two steps: a cross-sectional study was conducted among HCWs working in a tertiary care center in Riyadh, Saudi Arabia. A 32-item questionnaire was used to assess KAP information. The second step was environmental samples collected from the surfaces of CLMA devices before and after implementing a multifaceted intervention. Result: A total of 325 HCWs were included in the study. The mean age was 32.6±7.4 years. The majority were females (92%) and nurses (91.3%). The overall KAP score was 74.8%, 74.2% adequate knowledge, 79.3% positive attitude, and 71.3% appropriate practices. KAP score was better (≥ median KAP score) among HCWs working in laboratory and organ transplant units (P<0.001). It was also better among those with a longer duration of work experience (P<0.001) and those who received related training (P<0.001). Approximately 75% of HCWs expressed their need for more information about CLMA. Post-interventional samples had much lower bacterial burden, with the positive rate reduced from 51.4% before intervention to 16.8% after intervention (P<0.001). Conclusions: Awareness and behavior of HCWs about appropriate infection control practices related to portable devices is still inadequate. A multifaceted intervention including education and training significantly reduces the bioburden on portable devices.
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Introduction Septic shock remains a leading cause of mortality in pediatric patients. Corticosteroids have been used in the management of sepsis and septic shock, but there is conflicting evidence on the potential benefit of corticosteroid therapy. This study assessed the risk of mortality and length of stay in the pediatric intensive care unit (PICU) among pediatric patients admitted with a septic shock diagnosis. Method A retrospective cohort study was conducted among pediatric patients (up to 14 years old) admitted with a septic shock diagnosis to the PICU of King Abdullah Specialist Children's Hospital in Riyadh from January 2016 to December 2021. The clinical outcomes of patients receiving corticosteroid therapy were compared to those of control patients who were not given corticosteroids. Electronic medical records provided clinical data, severity scores, and the management given for each patient. The patients were followed up from the date of sepsis diagnosis to hospital discharge. Proportional hazard ratios (HRs) were calculated to compare the risk of mortality, length of PICU stay, and length of hospital stay. Results A total of 182 pediatric patients were included in the study, and 86 (47%) received corticosteroid therapy. The median age of the study population was 15 months (interquartile range [IQR]: 2-72 months). Compared to the controls, the patients who received corticosteroids had a higher total Sequential Organ Failure Assessment (SOFA) score (mean±SD: 5.5±3 vs. 7.1±3.3, respectively; p <0.01) and required more ventilation support (72% vs. 28%, respectively) and the use of inotropes and vasopressors (74% vs. 34% and 32% vs. 6%, respectively). In-hospital mortality did not significantly differ between the groups (adjusted HR: 2.66; 95% confidence interval [CI]: 0.66-10.28). Those patients who received corticosteroids had 42% less risk of staying in the PICU for over six days than those not receiving steroids (HR: 0.35; 95% CI: 0.13-0.98) Conclusion After adjusting for baseline characteristics, severity scores, and medical intervention, no association was found between receiving corticosteroids and mortality (p=0.492). Furthermore, patients who received corticosteroids had less risk of a prolonged stay in the PICU than those who did not.
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Malnutrition could profoundly affect older adults' oral health and quality of life, whereas oral health might, in turn, impact dietary intake and nutritional status. The present study aimed to investigate the association between general and oral health and nutritional status among older adults attending nutrition clinics at two main medical centers in Riyadh, Saudi Arabia. A cross-section study was carried out among adult patients (≥60 years) who attended a geriatric clinic or nutrition clinic at King Khalid University Hospital or King Abdulaziz Medical City, Riyadh. A validated clinician's Mini Nutritional Assessment Short-Form (MNA-SF), Oral Health Impact Profile-5 (OHIP-5), and 36-Item Short Form Survey (SF-36) were collected from each participant. A total of 261 participants with a mean age of 72.14 (±8.97) years were recruited. Diabetes (71%) and hypertension (80%) were present in the majority of patients. The overall MNA-SF score was (10 ± 3). Based on the categorization of the MNA-SF score, 65.9% were classified as malnourished or at risk of malnutrition. Participants with OHIP-5 scores higher than the median (>5) were more likely to be malnourished than those with scores at or lower than 5 (p < 0). The adjusted odd ratio for the MNA-SF score categories indicated that for a one-unit increase in the total SF-36 score, the odds of the malnourished category are 0.94 times less than the risk of malnutrition and normal nutritional status, with OR 0.97 (95% CI 0.94-0.95). Malnutrition or being at risk of malnutrition is likely associated with poor general and oral health. Healthcare providers need to incorporate dietitians into care plans to promote the nutritional health of older adults.
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Desnutrición , Estado Nutricional , Humanos , Anciano , Estudios Transversales , Arabia Saudita/epidemiología , Calidad de Vida , Desnutrición/epidemiología , Hospitales UniversitariosRESUMEN
BACKGROUND: The higher risk of COVID-19 in health care workers (HCWs) is well-known. However, the risk within HCWs is not fully understood. The objective was to compare the COVID-19 risk in intensive care unit (ICU) vs non-ICU locations. METHODS: A prospective surveillance study was conducted among HCWs at a large tertiary care facility in Riyadh between March 1st to November 30th, 2020. HCWs included both clinical (provide direct patient care) and nonclinical positions (do not provide direct patient care). RESULTS: A total 1,594 HCWs with COVID-19 were included; 103 (6.5%) working in ICU and 1,491 (93.5%) working in non-ICU locations. Compared with non-ICU locations, ICU had more nurses (54.4% vs 22.1%, P < .001) and less support staff (2.9% vs 53.1%, P < .001). COVID-19 infection was similar in ICU and non-ICU locations (9.0% vs 9.8%, P = .374). However, it was significantly higher in ICU nurses (12.3% vs 6.5%, P < .001). Support staff had higher risk than other HCWs, irrespective of ICU working status (15.1% vs 7.2%, P < 0.001). The crude relative risk of COVID-19 in ICU vs non-ICU locations was 0.92, 95% confidence interval ( was 0.76-1.11 (P = .374). However, relative risk adjusted for professional category was significantly increased to 1.23, 95% confidence interval 1.01-1.50 (P = .036). CONCLUSIONS: ICU had a significantly higher risk of COVID-19 infection only after adjusting for the distribution and risk of different professional categories. The latter is probably determined by both exposure level and protection practices. The finding underscores the importance of strict implementation of preventive measures among all HCWs, including those performing nonclinical services.
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COVID-19 , COVID-19/epidemiología , Cuidados Críticos , Personal de Salud , Humanos , Estudios ProspectivosRESUMEN
BACKGROUND: To recruit poorly ventilated lung areas by providing active and adequate oxygenation is a core aspect of treating patients with acute respiratory distress syndrome (ARDS). The airway pressure release ventilation (APRV) mode is increasingly accepted as a means of supporting patients with ARDS. This study aimed to determine whether the APRV mode is effective in improving oxygenation, compared to conventional ventilation, in adult ARDS patients. METHODS: We conducted the study according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We searched for clinical trials in PubMed, Embase, Web of Science, and the Cochrane Library until April 2019. We included all studies comparing APRV and other conventional mechanical ventilation modes for adult ARDS patients. Our primary outcome was oxygenation status (defined as the day 3 PaO2/FiO2 ratio). The secondary outcomes were the length of stay (LOS) in the intensive care unit (ICU) and mortality. Sensitivity analyses were performed including studies with conventional low-tidal volume ventilation as a comparator ventilation strategy. RESULTS: We included six clinical trials enrolling a total of 375 patients. The day 3 PaO2/FiO2 was reported in all the studies, and it was significantly higher in patients receiving APRV (mean difference [MD] 51.9 mmHg, 95% confidence intervals (CI) 8.2-95.5, P = 0.02, I 2= 92%). There was no significant difference in mortality between APRV and the other conventional ventilator modes (risk difference 0.07, 95% CI: -0.01-0.15, P = 0.08, I 20%). The point estimate for the effect of APRV on the LOS in ICU indicated a significant reduction in the ICU LOS for the APRV group compared to the counter group (MD 3.1 days, 95% CI 0.4-5.9, P = 0.02, I 2= 53%). CONCLUSION: In this study, using the APRV mode may improve oxygenation on day 3 and contribute to reducing the LOS in ICU. However, it is difficult to draw a clinical message about APRV, and well-designed clinical trials are required to investigate this issue.
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BACKGROUND: All-terrain vehicle (ATV) accidents have a substantial impact on the pediatric population in Saudi Arabia; however, few local studies are available. An in-depth study of this issue and adequate implementation of regulations are required to prevent additional casualties. The aim of this study was to describe the epidemiology of ATV injuries in the pediatric population and the outcomes associated with the injuries. METHODS: We conducted a retrospective chart review at a Level 1 trauma center in Riyadh. All patients, aged ≤14 years and admitted due to an ATV accident, from 2004 to 2018 were included in this study. Demographic information, hospital course, and injury outcomes were extracted from the King Abdulaziz Medical City trauma registry. Each medical record was reviewed for short-term complications and the mechanism of injury. The primary outcome measure was the type of injury associated with ATV accidents; the secondary outcomes were injury site and mechanism of injury, and the association between the impact of injury and the clinical and demographic variable. RESULTS: In total, 165 patients were involved in ATV accidents and met our inclusion criteria. The mean age was 8 ± 4 years, and 79% (131/165) were boys. Over 50% (84/165) of the sample had lower limb injuries. The majority of patients had fracture injuries (37%, 61/165), followed by amputations (30%, 50/165). Of the amputation group, the majority (86%, 43/50) was from 1 to 5 years compared to the no amputation group (P < 0.001). For the amputation group, 67% (33/50) had a limb trapped in the chain of the vehicle as to the mechanism of injury. CONCLUSION: The majority of patients had lower-extremity injuries, specifically fractured (37%) or amputated (30%) with children from age 1-5 years having a significantly higher proportion of hospital admission compared to the rest of the study population. Despite the existing legislation for ATV use in children, they are not enforced. The finding of this study recommends urgent implementation of these regulations for both ATV retailers and users and promotes public awareness about the severity of such injuries.
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Peritoneal dialysis (PD) may lead to infection, which could cause dialysis failure. Estimates of infectious peritonitis rate, identification of causative microbes, and infection outcomes are scarcely reported in Saudi Arabia. We conducted this study to provide epidemiological data as a geographical reference for PD-associated peritonitis. Epidemiological, microbiological, and clinical data were retrospectively collected from pediatric patients' medical records who were on PD between 2009 and 2018. A total of 54 pediatric patients on PD were involved in the study. The median age of the patients was 3.6 years [interquartile range (IQR) 1.7-8.0]; 56% were female children. The median time spent on PD was 39.5 months (IQR 19.75-64.25), with an overall peritonitis rate of 0.52 episodes per patient-year. In terms of infection, 116 PD-associated peritonitis episodes were identified in 37 patients. There were 38 infection episodes (32.3%) due to skin microbiota, 22 (18.8%) of gut microbiota, 12 (10.2%) of environmental microbiota, three (2.6%) of polymicrobial, and 27 (23.2%) of culture negative peritonitis. There were 45 (39%) episodes of noncomplicated peritonitis and 71 (61%) complicated peritonitis episodes. The latter included 14 (19%) relapses, 45 (63%) repeated infections, and 12 (17%) catheter removals. Using multivariate analysis, the history of peritonitis [OD 7.59, 95% confidence interval (CI) 2.87-20.00] and the presence of cardiovascular disease (OD 3.24,95% CI 1.18-8.85) were independent predictors of a complicated peritonitis episode. History of infectious peritonitis and the presence of cardiovascular disease are potential predictors of complicated PD-associated peritonitis and may provide an identifier of high-risk patients.
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Fallo Renal Crónico/terapia , Diálisis Peritoneal/efectos adversos , Peritonitis/epidemiología , Peritonitis/microbiología , Antibacterianos/uso terapéutico , Niño , Preescolar , Femenino , Bacterias Gramnegativas/aislamiento & purificación , Bacterias Grampositivas/aislamiento & purificación , Hospitales Pediátricos , Humanos , Lactante , Masculino , Peritonitis/tratamiento farmacológico , Estudios Retrospectivos , Arabia Saudita/epidemiología , Resultado del TratamientoRESUMEN
The success of COVID-19 vaccination depends on individual's vaccine acceptance. There has been misinformation on the media that doubts its effectiveness, safety, and long-term risk. Such controversy could affect the acceptance toward the uptake of the COVID-19 vaccine. The objective of this study was to assess the factors influencing the acceptance and hesitancy toward the COVID-19 vaccine in Saudi Arabia. A cross-sectional study was conducted. An online survey was conducted with four parameters: Demographics, medical history, knowledge and information sources about COVID-19 and vaccine, and hesitancy/acceptance of vaccinations. Bivariate analysis between several survey items and the acceptance of COVID-19 vaccine was conducted using Chi-square test. Logistic regression was used to assess to what degree each variable affects the acceptance and the hesitancy toward the COVID-19 vaccine. Approximately 64% show a desire to accept the vaccine while 18.3% were extremely hesitant to take the vaccine. Non-demographic factors that were associated with the acceptance toward the COVID-19 vaccine were the source of health information about COVID-19 (OR:1.63; 95% CI:1.07-2.47), perception toward whether the vaccine is effective on other variants of the virus (OR:7.24; 95% CI:4.58-11.45), previous uptake of the influenza vaccine (OR:1.62; 95% CI:1.07-2.47), and potential mandatory of vaccination in order to travel internationally (OR:16.52; 95% CI:10.23-26.68). This study provides an insight into factors - other than the sociodemographic - influencing the acceptance of the COVID-19 vaccine in Saudi Arabia. The government should address the COVID-19-related misinformation and rumors to increase acceptance of COVID-19 vaccination.
Asunto(s)
COVID-19 , Vacunas contra la Influenza , Vacunas contra la COVID-19 , Estudios Transversales , Humanos , Internet , SARS-CoV-2 , Arabia Saudita , VacunaciónRESUMEN
Healthcare workers (HCWs) stand at the frontline for fighting coronavirus disease 2019 (COVID-19) pandemic. This puts them at higher risk of acquiring the infection than other individuals in the community. Defining immunity status among health care workers is therefore of interest since it helps to mitigate the exposure risk. This study was conducted between May 20th and 30th, 2020. Eighty-five hospitals across Kingdom of Saudi Arabia were divided into 2 groups: COVID-19 referral hospitals are those to which RT-PCR-confirmed COVID-19 patients were admitted or referred for management (Case-hospitals). COVID-19 nonaffected hospitals where no COVID-19 patients had been admitted or managed and no HCW outbreak (Control hospitals). Next, seroprevalence of severe acute respiratory syndrome coronavirus 2 among HCWs was evaluated; there were 12,621 HCWs from the 85 hospitals. There were 61 case-hospitals with 9379 (74.3%) observations, and 24 control-hospitals with 3242 (25.7%) observations. The overall positivity rate by the immunoassay was 299 (2.36%) with a significant difference between the case-hospital (2.9%) and the control-group (0.8%) (P value <0.001). There was a wide variation in the positivity rate between regions and/or cities in Saudi Arabia, ranging from 0% to 6.31%. Of the serology positive samples, 100 samples were further tested using the SAS2pp neutralization assay; 92 (92%) samples showed neutralization activity. The seropositivity rate in Kingdom of Saudi Arabia is low and varies across different regions with higher positivity in case-hospitals than control-hospitals. The lack of neutralizing antibodies (NAb) in 8% of the tested samples could mean that assay is a more sensitive assay or that neutralization assay has a lower detection limits; or possibly that some samples had cross-reaction to spike protein of other coronaviruses in the assay, but these were not specific to neutralize severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).