Examining the Clinical Prognosis of Critically Ill Patients with COVID-19 Admitted to Intensive Care Units: A Nationwide Saudi Study.

Backgroundand Objectives: COVID-19 is a novel infectious disease caused by a single-stranded RNA coronavirus called severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We aimed to conduct a nationwide multicenter study to determine the characteristics and the clinical prognostic outcome of critically ill COVID-19 patients admitted to intensive care units (ICUs). Materials and Methods: This is a nationwide cohort retrospective study conducted in twenty Saudi hospitals. Results: An analysis of 1470 critically ill COVID-19 patients demonstrated that the majority of patients were male with a mean age of 55.9 ± 15.1 years. Most of our patients presented with a shortness of breath (SOB) (81.3%), followed by a fever (73.7%) and a cough (65.1%). Diabetes and hypertension were the most common comorbidities in the study (52.4% and 46.0%, respectively). Multiple complications were observed substantially more among non-survivors. The length and frequency of mechanical ventilation use were significantly greater (83%) in the non-survivors compared with the survivors (31%). The mean Sequential Organ Failure Assessment (SOFA) score was 6 ± 5. The overall mortality rate of the cohort associated with patients that had diabetes, hypertension and ischemic heart disease was 41.8%. Conclusion: Age; a pre-existing medical history of hypertension, diabetes and ischemic heart disease; smoking cigarettes; a BMI ≥ 29; a long mechanical ventilation and ICU stay; the need of ventilatory support; a high SOFA score; fungal co-infections and extracorporeal membrane oxygenation (ECMO) use were key clinical characteristics that predicted a high mortality in our population.

Examining and investigating the impact of demographic characteristics and chronic diseases on mortality of COVID-19: Retrospective study.

BACKGROUND: Epidemiological features characterization of COVID-19 is highly important for developing and implementing effective control measures. In Saudi Arabia mortality rate varies between 0.6% to 1.26%. The purpose of the study was to investigate whether demographic characteristics (age and gender) and non-communicable diseases (Hypertension and Diabetes mellitus) have a significant association with mortality in COVID-19 patients. METHODS: Prior to data collection, an expedite approval was obtained from Institutional Review Board (IRB Log No: RC. RC20.09.10) in Al Habib Research Center at Dr. Sulaiman Al-Habib Medical Group, Riyadh, Saudi Arabia. This is a retrospective design where we used descriptive and inferential analysis to analyse the data. Binary logistic regression was done to study the association between comorbidities and mortality of COVID-19. RESULTS: 43 (86%) of the male patients were non-survivors while 7 (14%) of the female patients were survivors. The odds of non-survivors among hypertensive patients are 3.56 times higher than those who are not having a history of Hypertension (HTN). The odds of non-survivors among diabetic patients are 5.17 times higher than those who are not having a history of Diabetes mellitus (DM). The odds of non-survivors are 2.77 times higher among those who have a history of HTN and DM as compared to those who did not have a history of HTN and DM. CONCLUSIONS: Those patients that had a history of Hypertension and Diabetes had a higher probability of non-survival in contrast to those who did not have a history of Diabetes and hypertension. Further studies are required to study the association of comorbidities with COVID-19 and mortality.

Level of anxiety among healthcare providers during COVID-19 pandemic in Saudi Arabia: cross-sectional study.

BACKGROUND: The burden of the spread of the COVID-19 pandemic has impacted widely on the healthcare providers physically and mentally. Many healthcare providers are exposed to psychological stressors due to their high risk of contracting the virus. AIMS: This study aimed to measure the level of anxiety among healthcare providers during the COVID-19 pandemic in Saudi Arabia. In addition, this study aimed to measure the level of anxiety based on demographic characteristics. METHOD: A cross-sectional survey was employed to recruit a convenience sample of healthcare providers. A pencil and paper self-administered questionnaires were used to collect data from demographic and generalized anxiety disorder GAD-7 data. However, this study received written informed consent from participants of the study. In addition, the study was approved by the Institutional Review Board at Dr. Sulaiman Al Habib Medical Group (IRB Log No. RC20.06.88-03). RESULTS: A total of 650 participants were recruited, results of GAD-7 showed that 43.5%, 28.9% and 27.5% of healthcare providers in Saudi Arabia experienced mild, moderate and severe anxiety, respectively, during the COVID-19 pandemic. Results indicated that age, health specialty, nationality, and sleeping disorders before COVID-19 were associated with anxiety levels. CONCLUSION: The generalized anxiety among healthcare providers in Saudi Arabia was mild. Older healthcare providers were found to have a higher level of anxiety compared to other participating healthcare providers. Several factors may contribute to a higher level of anxiety including age, socioeconomic status, marital status, having chronic conditions, and sleeping disorder before the COVID-19 pandemic. To further understand the level of anxiety among healthcare providers during the COVID-19 pandemic in Saudi Arabia, longitudinal and mixed-method research is needed.

The Effective Strategies to Avoid Medication Errors and Improving Reporting Systems.

BACKGROUND: Population-based studies from several countries have constantly shown excessively high rates of medication errors and avoidable deaths. An efficient medication error reporting system is the backbone of reliable practice and a measure of progress towards achieving safety. Improvement efforts and system changes of medication error reporting systems should be targeted towards reductions in the likelihood of injury to future patients. However, the aim of this review is to provide a summary of medication errors reporting culture, incidence reporting systems, creating effective reporting methods, analysis of medication error reports, and recommendations to improve medication errors reporting systems. METHODS: Electronic databases (PubMed, Ovid, EBSCOhost, EMBASE, and ProQuest) were examined from 1 January 1998 to 30 June 2020. 180 articles were found and 60 papers were ultimately included in the review. Data were mined by two reviewers and verified by two other reviewers. The search yielded 684 articles, which were then reduced to 60 after the deletion of duplicates via vetting of titles, abstracts, and full-text papers. RESULTS: Studies were principally from the United States of America and the United Kingdom. Limited studies were from Canada, Australia, New Zealand, Korea, Japan, Greece, France, Saudi Arabia, and Egypt. Detection, measurement, and analysis of medication errors require an active rather than a passive approach. Efforts are needed to encourage medication error reporting, including involving staff in opportunities for improvement and the determination of root cause(s). The National Coordinating Council for Medication Error Reporting and Prevention taxonomy is a classification system to describe and analyze the details around individual medication error events. CONCLUSION: A successful medication error reporting program should be safe for the reporter, result in constructive and useful recommendations and effective changes while being inclusive of everyone and supported with required resources. Health organizations need to adopt an effectual reporting environment for the medication use process in order to advance into a sounder practice.

Clinical Predictors of COVID-19 Mortality Among Patients in Intensive Care Units: A Retrospective Study.

OBJECTIVE: The ongoing pandemic of the coronavirus disease 2019 (COVID-19), which originated from Wuhan, China, has been identified to be caused by the novel beta coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 has been spreading rapidly worldwide within just a few months. Our aims were to analyze clinical and laboratory abnormalities in ICU patients with COVID-19, in order to define which predictors can distinguish between those who are at higher risk of developing fatal versus non-fatal forms of the disease. METHODS: A descriptive cross-sectional survey was used; demographics, comorbidities, symptoms, laboratory parameters at ICU admission, and clinical outcomes for the adult patients admitted to ICU were collected from five hospitals in Saudi Arabia. RESULTS: A total of 86 patients with COVID-19 admitted in ICU, 50 patients died, 23 recovered, and 13 were still admitted, with a mortality rate of 58.1%. Septic shock (OR (95% CI): 58.1 (5.97-7812.8), p < 0.001) and acute kidney injury (AKI) (OR (95% CI): 7.279 (1.191-65.43), p = 0.032) had a significant impact on mortality. Cox proportional-hazards regression analysis revealed that septic shock (HR (95% CI): 9.502 (2.958-30.524), p < 0.001) and neutrophil count (HR (95% CI): 1.053 (1.023-1.085), p < 0.001) were significant predictors for mortality. CONCLUSION: Septic shock, AKI, and high neutrophil count were found to be predictive of death in these patients. Further studies are needed to aid efficient recognition and management of severe COVID-19 patients in our population. .

The impact of COVID-19 pandemic on the level of depression among health care workers: cross-sectional study.

BACKGROUND: The outbreak of the novel Corona Virus Infectious Disease 2019 (COVID-19) has spread rapidly to many countries leading to thousands of deaths globally. The burden of this pandemic has affected the physical and mental health of the frontline health care workers (HCWs) who are exposed to high risk of infection and psychological stressors. AIMS: The aim is to measure the level of depression among healthcare workers in Saudi Arabia during COVID-19 pandemic to establish interventional strategies. METHOD: A descriptive cross-sectional study was used to conduct the current study. The data of this study was recruited between 15 June and 15 July 2020 from healthcare providers who work in both public and private healthcare sectors in Riyadh and Eastern province in Saudi Arabia utilizing a self-administered questionnaire. The study was approved by the Institutional Review Board at Dr. Sulaiman Al Habib Medical Group (IRB Log No. RC20.06.88-2). Data were collected by using The Zung Self-Rating Depression Scale SDS. A total of 900 healthcare providers working in the healthcare setting during COVID-19 pandemic were invited to participate in the study. A total of 650 healthcare providers participated in the study by completing and submitting the survey. RESULTS: Almost 30% suffered from depression which can be divided into three categories; mild depression (26.2%), moderate/major (2.5%) and severe/extreme (0.8%). The finding shows that the level of depression among respondents at the age range of 31-40 years old was significantly higher than the level of depression among respondents with the age above 50 years old. Non-Saudi healthcare workers experienced more depression than Saudi workers. It also shows how nurses suffered from depression compared to their physician colleagues. Those who did not suffer from sleeping disorder perceived more depression as compared to those who are having sleeping disorder. CONCLUSION: It is recommended that health care facilities should implement strategies to reduce the prevalence of mental health problems among healthcare providers and eventually it will improve their performance in provision of safe and high-quality care for patients.

The retention effect of staff education programme: Sustaining a decrease in hospital-acquired pressure ulcers via culture of care integration.

Hospital-acquired pressure ulcers (HAPUs) negatively affect patients during hospitalisation, putting patients at risk for further complications. HAPUs are one of the hospital quality key performance indicators (KPIs) that necessitate quality initiatives and/or programmes to minimise its occurrence and consequences. When quality initiatives are put into place and proven effective, the next important focus is sustainability of the effects. The original Saudi Arabian study based on data collected from 50 441 patients, showed that implementation of the pressure ulcer prevention programme (PUPP) was successful showing a statistically significant reduction of HAPUs from 0.20% in 2014 to 0.06% in 2018 (P value <.001). The aim of this follow-up check of the original study was to assess if the PUPP's effectiveness success was retained. Also, to try and determine why the implemented quality improvement programme to prevent HAPUs was so successfully retained. Designed and conducted as a systemic review, it tracked the outcomes of pressure ulcer rates during and post PUPP implementation that mostly focused on evidence-based staff education, concentrating on years 2016 to 2018. Statistically significant reductions were captured by data that have been presented through Pearson Chi squares. HAPU decline was notable between year 2017 and 2018. This was followed by a further reduction in year 2018. The results determine retention effect sustainability of the initial positive results achieved. By doing so, the study was further able to establish that the PUPP had been integrated into the hospital system's care culture as evidenced by the reduction of HAPUs despite a large inpatient growth. Consideration of what contributing factors led to this successful integration of new knowledge into the care culture are also examined. KPIs can be used as indicators to help reinforce staff education. Culture of care (support of values and interventions taught during the PUPP) offer hope that these may be duplicated in future improvement projects. The supportive nature of a given culture of care may in fact be just as important as the practical education provided to staff members.

Narrative Review of Infection Control Knowledge and Attitude among Healthcare Workers.

BACKGROUND: Infection is one of the major threats to Healthcare Workers (HCW) worldwide. It exposes HCW to more than 20 kinds of blood-borne pathogen infections, especially the most severe cases, namely Hepatitis B Virus (HBV), Hepatitis C Virus (HCV), and Human Immunodeficiency Virus (HIV). The impact of infection about HCWs' health, clinical burden, national economic burden, and humanistic burden suggests the importance of further investigation and discussion on this topic. AIMS: This paper aimed to discuss literature on infection control knowledge and attitudes among HCWs and potential factors contributing to infection control. METHOD: For this narrative review Proquest, Medline, and Up To Date have been utilized to search articles about infection control knowledge and attitudes among healthcare workers and potential factors contributing to infection control. The search was narrowed to article between 2000 and 2018. A total of 400 materials were initially identified to be potentially relevant for the review. A total of 28 articles were included, and they were found to match the inclusion criteria. RESULTS: Results from the reviewed studies showed that there was a high-level knowledge in terms of precautionary measures and compliance with needle safety precautions while staff attitude achieved above average. Weak positive correlation was found between staff attitude and precautionary measures, while moderate positive correlation was found between precautionary measures and compliance with needle safety precautions. Only precautionary measures were found to significantly influence compliance with needle safety precautions, in which higher precautionary measures, resulted in higher compliance with needle safety precautions.

Hospital-acquired pressure ulcer incident rates among hospitals that implement an education program for staff, patients, and family caregivers inclusive of an after discharge follow-up program in Saudi Arabia.

A tertiary public hospital in Saudi Arabia set out in 2015 to establish a team focused on reducing hospital-acquired pressure ulcers (HAPUs). The pressure ulcer prevention program (PUPP) had a multifaceted approach and data were collected for a period of 5 years. The results showed a definite reduction in the incidences of HAPUs. Many such programs show similar positive results and echo many of the same considerations of risk, prevention strategies, and the need for early intervention. However, none of the other studies either replicate the hospital's PUPP nor the extent of the positive and lasting effect of the program. Eager to determine the contributing factor(s) in order that the project success could be continued and possibly replicated in other quality improvement projects, it was decided that an examination and comparison of other similar programs and their results would be necessary in order to uncover the answer. It was determined that the in-person in-home discharge follow-up portion of the program most likely had the largest effect on the outcomes. Outcomes that were supported by the pre-work completed during the hospital portion of the PUPP towards reducing HAPUs and readmissions.

The effectiveness of pressure ulcer prevention programme: A comparative study.

Hospital-acquired pressure ulcers (HAPUs) affect patients during hospitalisation, putting patients at risk for further complications. HAPU is one of the hospital quality indicators that require quality initiatives or programmes to minimise its occurrence and consequences. The aim of this study was to assess the effectiveness of a developed quality improvement programme in preventing HAPUs. This is a retrospective comparative study, which tracked the outcomes of pressure ulcer prevention programme (PUPP) for 5 years from 2014 to 2018. Data from 50 441 patients were collected from different units in a tertiary hospital in the eastern region of Saudi Arabia. The programme focused on building a wound care team; providing education to hospital staff, patients, and their families; and continuous data monitoring, in addition to follow-up visits after discharge. Implementation of the programme was successful showing a statistically significant reduction of HAPUs from 0.20% in 2014 to 0.06% in 2018 (P value <.001). The PUPP was effective in reducing the percentage of pressure ulcer cases. The programme can be extended and implemented in other hospitals.

Health Care Workers Safety: Screening And Immunization: A Review

The paper puts forth the need for health care workers safety whilst undertaking their job on a daily basis. Presently there are number of factors that are directly linked to the safety of health care workers. However, Occupational Health is very important and useful for health workers that are exposed to their job hazards. Every year, many lives are lost because of the spread of infections in hospitals. Every hospital’s occupational health departments should ensure that all new staff are vaccinated to protect them against microorganisms carried by other patients, and with vaccinated against preventable diseases. This will help to prevent the health workers from occupational exposure to patients’ blood or any other bodily substances, including injury from sharp objects, and also guarantees that the new employees does not infect the patients with infectious diseases. Furthermore, all the new staff should be screened for blood borne pathogenic diseases.

Health Care Workers Safety: Screening And Immunization: A Review

@#The paper puts forth the need for health care workers safety whilst undertaking their job on a daily basis. Presently there are number of factors that are directly linked to the safety of health care workers. However, Occupational Health is very important and useful for health workers that are exposed to their job hazards. Every year, many lives are lost because of the spread of infections in hospitals. Every hospital’s occupational health departments should ensure that all new staff are vaccinated to protect them against microorganisms carried by other patients, and with vaccinated against preventable diseases. This will help to prevent the health workers from occupational exposure to patients’ blood or any other bodily substances, including injury from sharp objects, and also guarantees that the new employees does not infect the patients with infectious diseases. Furthermore, all the new staff should be screened for blood borne pathogenic diseases.