Novel preventive bundle for multidrug-resistant organisms in intensive care setting; tertiary care experience.

Background: A widely-accepted standardized preventive bundle targeting multidrug-resistant organisms (MDROs) is lacking. The objective was to describe the components, implementation, compliance, and impact of a novel MDROs bundle in intensive care units (ICUs). Methods: Cohort study of surveillance activities on the components of MDROs bundle (July 2019 to June 2022) and the incidence of MDROs (April 2016 to June 2022). The implementation of MDROs bundle were preceded by ICPs-led education of the staff working in target ICUs about the importance and components of the MDROs bundle. These included the overall use of antimicrobials, appropriate environmental cleaning, appropriate contact precautions, and hand hygiene compliance. Results: During implementation, the overall use of antimicrobials was 57.8 days of therapy per 100 patient-days (44,492/76,933). It was higher in adult compared with pediatric/neonatal ICUs (p < 0.001). Appropriate environmental cleaning was 74.8% (12,409/16,582), appropriate contact precautions was 83.8% (10,467/12,497), and hand hygiene compliance was 86.9% (27,023/31,096). The three components were significantly higher in pediatric/neonatal compared with adult ICUs (p = 0.027, p < 0.001, p = 0.006, respectively). The MDROs rates per 10,000 patient-days were 71.8 before (April 2016 to June 2019) and 62.0 during (July 2019 to June 2022) the bundle implementation (858/119,565 versus 891/143,649 p = 0.002). The reduction in MDROs rates were replicated in adult (p = 0.001) but not pediatric/neonatal ICUs (p = 0.530). Conclusions: The finding of this study indicate that the implementation of the current bundle was associated with a modest decrease in MDROs rates in adult ICUs. The provided detailed definitions and methodology will facilitate its use by other healthcare facilities.

Awareness of health care workers with appropriate infection control practices related to multi-patient use of Close Loop Medication Administration device.

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.

Symptomatic MERS-CoV infection reduces the risk of future COVID-19 disease; a retrospective cohort study.

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.

Improving COVID-19 vaccine uptake: lessons from an academic institution in Saudi Arabia.

Background: Rejection, hesitancy and low uptake of the COVID-19 vaccine are major public health challenges in Saudi Arabia. Aims: To address COVID-19 vaccine hesitancy and rejection at the King Saud Bin Abdulaziz University for Health Sciences (KSAU-HS) using evidence-based strategies. Methods: A questionnaire was administered electronically to participants at KSAU-HS to understand the reasons for vaccine hesitancy or rejection and develop an evidence-informed vaccination plan. Initial results from March 2021 showed that only 60% of respondents had taken at least 1 COVID-19 vaccine dose. Based on the results of the survey, KSAU-HS designed a 6-month vaccination campaign to raise awareness about the vaccine and its importance and increase acceptability rates. Mass media, social media, and direct messaging as reminders were used to address the barriers identified and to help the university community overcome fears and misconceptions about the COVID-19 vaccine. Results: The evidence-based interventions helped achieve a significantly high vaccination rate in the university community, with 99.7% of individuals vaccinated by October 2021; one of the highest vaccination rates among public universities in Saudi Arabia. Conclusion: Evidence-based interventions targeted at specific populations can help address prevailing concerns about the COVID-19 vaccine and other similar public health issues.

Evidence-Based Interventions to Reduce the Incidence of Common Multidrug-Resistant Gram-Negative Bacteria in an Adult Intensive Care Unit.

Background Multidrug-resistant Gram-negative bacteria (MDR-GNB) present a significant and escalating hazard to healthcare globally. Context-specific interventions have been implemented for the prevention and control of MDR-GNB in several healthcare facilities. The objective of this study was to implement and evaluate the effectiveness of evidence-based interventions in the incidence and dissemination of MDR-GNB. Methods This was a pre-and post-intervention study conducted in three phases at King Abdulaziz Medical City Jeddah, Saudi Arabia. During Phase-1, the data on each of the four MDR-GNB (Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli) were collected prospectively. Genomic fingerprinting was performed on isolates using enterobacterial repetitive intergenic consensus-polymerase chain reaction (ERIC-PCR) to determine clonality and establish a link between different strains within and between the hospital wards/units. In the second phase, targeted interventions were implemented in the adult intensive care unit (ICU) based on previously determined risk factors and included the education of healthcare workers on hand hygiene, disinfection of patients' surrounding, daily chlorhexidine baths, and disinfection rooms on discharge with hydrogen peroxide fogging after MDR-GNB patients were discharged. An antibiotic restriction protocol was simultaneously implemented as part of the hospital antibiotic stewardship program. In the third phase, the effectiveness of the interventions was evaluated by comparing the incidence rate and clonality (using ERIC-PCR genetic fingerprints) of MDR-GNB before and after the intervention. Results A significant reduction of MDR-GNB was observed in Phase-2 and Phase-3 compared with Phase-1. The mean incidence rate of MDR-GNB per 1000 patient days in Phase-1 (pre-intervention) was 11.08/1000, followed by 6.07 and 3.54/1000 in Phase-2 and Phase-3, respectively. A statistically significant reduction was observed in the incidence rate of MDR-GNB in the adult ICU (P=0.007), whereas no statistically significant decrease (P=0.419) was observed in areas other than the adult ICU. Two A. baumannii strains appear to be circulating within the ICU environment with reduced frequency in Phase-2 and Phase-3 compared to Phase-1. Conclusion  There was a significant reduction in the incidence of MDR-GNB in the adult ICU due to the successful implementation of both infection control and stewardship interventions, albeit challenging to ascertain the relative contribution of each.

Coverage and methods of surveillance of healthcare-associated infections in Middle Eastern and North African countries.

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.

Distribution and the trend of airborne particles and bio-aerosol concentration in pediatric intensive care units with different ventilation setting at two hospitals in Riyadh, Saudi Arabia.

OBJECTIVE: To examine the distribution and the trend of airborne particles and bio-aerosol concentration in pediatric intensive care units (PICUs) in two tertiary care hospitals with different ventilation setting. METHODS: Hospitals A but not B is provided with a central HEPA filter. PICUs in both hospitals were categorized into protective environment (PE) with room HEPA filter, semi-protective environment (SPE) with portable air-purifier, and non-protective environment (NPE) with neither system. Fine particles (≤ 2.5 µm) and coarse particles (≤ 10.0 µm) were obtained using optical particle counter (Lighthouse Handheld 3016) and total bacterial (TBC) and fungal (TFC) counts were obtained using Andersen air sampler. RESULTS: Hospital B had significantly higher levels of fine and coarse particles (in all room), TBC (in PE), but not TFC compared with matched rooms in hospital A. In hospital B, the levels of fine particles, coarse particles, and TBC were lowest in SPE (p < 0.001, p = 0.004, and p = 0.006, respectively) while TFC was lowest in NPE (p = 0.014). Airborne particles, TBC, and TFC had variable trends with some of the indoor peaks follow outdoor peaks. Gram-positive bacteria (69 %) were the predominant bacteria in hospital A while bacterial flora (70 %) were the predominant bacteria in hospital B (p < 0.001 for each). CONCLUSIONS: The levels of airborne contaminants and microbial counts in PICUs are significantly affected by the ventilation system and to less extent by outdoor levels. The results indicated that advanced filtration system and central HEPA filters play a significant role in the reduction of indoor fine particulates and TBC.

Epidemiological and molecular description of nosocomial outbreak of COVID-19 Alpha (B.1.1.7) variant in Saudi Arabia.

BACKGROUND: Nosocomial outbreaks frequently occurred during the Coronavirus disease 2019 (COVID-19) pandemic; however, sharing experiences on outbreak containment is vital to reduce the related burden in different locations. OBJECTIVES: This article aims at sharing a practical experience on COVID-19 outbreak containment, including contact tracing, screening of target population, testing including molecular analysis, and preventive modalities. It also provides an epidemiological and molecular analysis of the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS­CoV­2) infection outbreak in a tertiary care hospital in Saudi Arabia. METHODS: The outbreak occurred in a non-COVID medical ward at a tertiary care hospital in Jeddah, Saudi Arabia, from 22nd March and 15th April 2021. The multidisciplinary outbreak response team performed clinical and epidemiological investigations. Whole-Genome Sequencing (WGS) was implemented on selected isolates for further molecular characterization. RESULTS: A total of eight nurses (20 % of the assigned ward nurses) and six patients (16.2 % of the ward admitted patients at the time of the outbreak) tested positive for the SARS-CoV-2 virus based on PCR testing. The outbreak investigation identified strong evidence of an epidemiologic link between the affected cases. WGS revealed a set of spike mutations and deletions specific to the Alpha variant (B.1.1.7 lineage). All the nurses had mild symptoms, and the fatality among the patients was 50 % (three out of the six patients). CONCLUSIONS: The current nosocomial COVID-19 outbreak, caused by the Alpha variant, revealed multiple breaches in the adherence to the hospital infection control recommended measures. Containment strategies were successful in controlling the outbreak and limiting infection spread. Molecular analysis and genome sequencing are essential tools besides epidemiological investigation to inform appropriate actions, especially with emerging pathogens.

Infection prevention and control staffing and programs in Middle Eastern Countries.

INTRODUCTION: Infection prevention and control (IPC) programs in the Middle Eastern and North African (MENA) countries are evolving. The objective was to characterize IPC personnel and programs in MENA countries, with special emphasis on the differences between Gulf Cooperation Council (GCC) and non-GCC countries. METHODOLOGY: A cross-sectional online survey was conducted in 2019 among IPC members of the Arab Countries Infection Control Network (AcicN). The survey focused on three domains; demographic and professional characteristics, organizational structure, and IPC program characteristics. RESULTS: A total of 269 participants aged 39.9 ± 8.4 years were included in the study. Majority of the participants were females (67.7%), nurses (63.7%), and of Middle-Eastern origin (57.3%). 32.2% of the participants were certified by the Certification Board of Infection Control (CBIC). Only 22.7% of participants were satisfied with their current compensation. Surveillance was the most time-consuming task (26.6%), followed by isolation (12.4%), and investigation of outbreaks (12.1%). Majority of the facilities had at least one IPC personnel per 100 beds (60.9%), supported IPC program (63.9%), a formal IPC committee (93.7%), and an IPC plan (91.4%). Compared with non-GCC countries, GCC countries had significantly more frequent CBIC certification (p = 0.003), training in cleaning/sterilization (p = 0.010), supported IPC program (p = 0.010), formal IPC committee (p = 0.001), IPC plan (p = 0.001), and higher number of IPC personnel per 100 beds (p = 0.047). CONCLUSIONS: MENA countries had generally satisfactory IPC programs and to a lesser extent staffing, with considerable variability between countries with different resources.

Antimicrobial therapy, resistance, and appropriateness in healthcare-associated and community-associated infections; a point prevalence survey.

BACKGROUND: Data examining differences in antimicrobial therapy and its appropriateness between healthcare-associated infections (HAIs) and community-associated infections (CAIs) are limited. The objective was to compare antimicrobial therapy, resistance, and appropriateness between CAIs and HAIs. METHODS: One-day point prevalence survey targeting admitted patients with active infections was conducted in six tertiary care hospitals. Antimicrobial appropriateness was decided based on hospital antimicrobial guidelines, clinical assessment, culture results, and other relevant investigations. RESULTS: Out of 1666 patient records reviewed, 240 (14.4%) infection events were identified. Prevalence of infections treated with antimicrobials were 6.5% for HAIs and 7.1% for CAIs. The most commonly prescribed antimicrobials were carbapenems (19.6%), cephalosporins (14.8%), and vancomycin (13.2%), with some differences between HAIs and CAIs. The overall contribution of MDR pathogens to both HAIs and CAIs was similar (34.0% versus 34.3%, p = 0.969). ESBL was significantly associated with CAIs while other gram-negative MDR pathogens significantly associated with HAIs. Overall appropriateness of antimicrobial therapy was similar in HAI and CAI events (64.2% versus 64.7%, p = 0.934). However, it was highest in aminoglycosides (78.6%) and lowest in vancomycin (40.8%). It was lowest in bloodstream infections than other infections (48.5% versus 61% to 78%, p = 0.044). CONCLUSION: Although the overall burden of MDR pathogens and appropriateness of antimicrobial therapy were similar in HAI and CAI events, there were some differences related to the type of MDR, type of antimicrobials, and type of infection. The current finding can guide training and educational activities of local antimicrobial stewardship initiatives aiming to improve antimicrobial therapy in hospital setting.

Efficacy of favipiravir in adults with mild COVID-19: a randomized, double-blind, multicentre, placebo-controlled clinical trial.

OBJECTIVE: To evaluate whether favipiravir reduces the time to viral clearance as documented by negative RT-PCR results for severe acute respiratory syndrome coronavirus 2 in mild cases of coronavirus disease 2019 (COVID-19) compared to placebo. METHODS: In this randomized, double-blinded, multicentre, and placebo-controlled trial, adults with PCR-confirmed mild COVID-19 were recruited in an outpatient setting at seven medical facilities across Saudi Arabia. Participants were randomized in a 1:1 ratio to receive either favipiravir 1800 mg by mouth twice daily on day 1 followed by 800 mg twice daily (n = 112) or a matching placebo (n = 119) for a total of 5 to 7 days. The primary outcome was the effect of favipiravir on reducing the time to viral clearance (by PCR test) within 15 days of starting the treatment compared to the placebo group. The trial included the following secondary outcomes: symptom resolution, hospitalization, intensive care unit admissions, adverse events, and 28-day mortality. RESULTS: Two hundred thirty-one patients were randomized and began the study (median age, 37 years; interquartile range (IQR): 32-44 years; 155 [67%] male), and 112 (48.5%) were assigned to the treatment group and 119 (51.5%) into the placebo group. The data and safety monitoring board recommended stopping enrolment because of futility at the interim analysis. The median time to viral clearance was 10 days (IQR: 6-12 days) in the favipiravir group and 8 days (IQR: 6-12 days) in the placebo group, with a hazard ratio of 0.87 for the favipiravir group (95% CI 0.571-1.326; p = 0.51). The median time to clinical recovery was 7 days (IQR: 4-11 days) in the favipiravir group and 7 days (IQR: 5-10 days) in the placebo group. There was no difference between the two groups in the secondary outcome of hospital admission. There were no drug-related severe adverse events. CONCLUSION: In this clinical trial, favipiravir therapy in mild COVID-19 patients did not reduce the time to viral clearance within 15 days of starting the treatment.

Risk of COVID-19 in healthcare workers working in intensive care setting.

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.

Post-vaccination SARS-CoV-2 infection among healthcare workers in tertiary care hospitals in Saudi Arabia: A case series.

Healthcare workers have been categorized among the priority groups for COVID-19 vaccination. However, post-vaccination infections have been identified. This study was conducted to investigate SARS-CoV-2 infection among healthcare workers (HCWs) who received the COVID-19 vaccine. A case series in a multicenter healthcare system in Saudi Arabia was created from HCWs who had (PCR-RT) confirmed SARS-CoV-2 infection after at least one dose of Pfizer-BioNTech vaccination. A total of 20 healthcare workers (HCWs) have been included. The majority (70.0%) were males and the average age was 39.4 ± 10.1 years. They included physicians (55.0%), nurses (25.0%) and other HCWs (20.0%). Eighteen (90%) HCWs had infection after the first dose; 47.1% within the first week, 41.2% within the second week, and 11.8% within the third week. Only two HCWs (10.0%) had infection one week after the second dose. The majority (63.2%) had mild (52.6%) or moderate (10.3%) disease with no severe disease or hospitalization. The majority of post-vaccination COVID-19 infections among HCWs occurred before the full protection of the vaccine is gained. Suspicion of COVID-19 infection should be considered even with a history of COVID-19 vaccination. Recently vaccinated HCWs should be advised to fully comply with all recommended precautions to prevent COVID-19 transmission.

Impact of the COVID-19 pandemic on the surveillance, prevention and control of antimicrobial resistance: a global survey.

OBJECTIVES: The COVID-19 pandemic has had a substantial impact on health systems. The WHO Antimicrobial Resistance (AMR) Surveillance and Quality Assessment Collaborating Centres Network conducted a survey to assess the effects of COVID-19 on AMR surveillance, prevention and control. METHODS: From October to December 2020, WHO Global Antimicrobial Resistance and Use Surveillance System (GLASS) national focal points completed a questionnaire, including Likert scales and open-ended questions. Data were descriptively analysed, income/regional differences were assessed and free-text questions were thematically analysed. RESULTS: Seventy-three countries across income levels participated. During the COVID-19 pandemic, 67% reported limited ability to work with AMR partnerships; decreases in funding were frequently reported by low- and middle-income countries (LMICs; P < 0.01). Reduced availability of nursing, medical and public health staff for AMR was reported by 71%, 69% and 64%, respectively, whereas 67% reported stable cleaning staff availability. The majority (58%) reported reduced reagents/consumables, particularly LMICs (P < 0.01). Decreased numbers of cultures, elective procedures, chronically ill admissions and outpatients and increased ICU admissions reported could bias AMR data. Reported overall infection prevention and control (IPC) improvement could decrease AMR rates, whereas increases in selected inappropriate IPC practices and antimicrobial prescribing could increase rates. Most did not yet have complete data on changing AMR rates due to COVID-19. CONCLUSIONS: This was the first survey to explore the global impact of COVID-19 on AMR among GLASS countries. Responses highlight important actions to help ensure that AMR remains a global health priority, including engaging with GLASS to facilitate reliable AMR surveillance data, seizing the opportunity to develop more sustainable IPC programmes, promoting integrated antibiotic stewardship guidance, leveraging increased laboratory capabilities and other system-strengthening efforts.

Nursing strategic pillars to enhance nursing preparedness and response to COVID-19 pandemic at a tertiary care hospital in Saudi Arabia.

BACKGROUND: COVID-19 pandemic caused enormous implications on the frontline staff. The objective was to share our nursing experience in responding to COVID-19 pandemic at a large hospital and its impact on nursing safety and healthcare services. METHODS: Six nursing strategic pillars were implemented. Pillar 1: establishing corona command centre. Pillar 2: limiting exposure by virtual care model, strict infection control measures, altered patient flow, active surveillance, and contact tracing. Pillar 3: maintaining sufficient supplies of personal protective equipment. Pillar 4: creating surge capacity by establishing dedicated COVID-19 units and increasing critical care beds. Pillar 5: training and redeployment of nurses and implementing alternate staffing models. Pillar 6: monitoring staff wellbeing, establishing mental health support hotline and clinic, providing hotel self-quarantine, and financial incentives. RESULTS: Out of 5483 nurses, 543 (10%) were trained for redeployment, mainly at acute and intensive care units. After serving 11,623 infected patient including 1646 hospitalizations during the first 9 months of the pandemic, only 385 (7.0%) nurses were infected with COVID-19. Out of them, only 10 (2.6%) required hospitalization, one (0.3%) required ICU admission, and none died. Although the number of patients hospitalized at our hospital during the current pandemic was 17 folds higher than the 2015 outbreak of middle East respiratory syndrome coronavirus, the hospital administration did not have to close the hospital as they did in 2015. CONCLUSIONS: Proactive nursing leadership and implementation of multiple nursing pillars enabled the facility to maintain the safety of nursing workforce while serving large influx of COVID-19 patients.

Favipiravir and Hydroxychloroquine Combination Therapy in Patients with Moderate to Severe COVID-19 (FACCT Trial): An Open-Label, Multicenter, Randomized, Controlled Trial.

INTRODUCTION: Antiviral drugs have shown limited effectiveness in treating patients with coronavirus disease 2019 (COVID-19). We aimed to assess the effects of a favipiravir and hydroxychloroquine combination on treating moderate-to-severe COVID-19 patients. METHODS: An investigator-initiated, multicenter, open-label, randomized trial at nine hospitals. Eligible patients were adults with moderate-to-severe COVID-19 defined as oxygen saturation (SaO2) of ≤ 94% while breathing ambient air or significant clinical symptoms with chest x-ray changes requiring hospital admission. Randomization was in a 1:1 ratio to receive standard care (control group) or standard care plus favipiravir and hydroxychloroquine. The primary outcome was time to clinical improvement of two points (from the status at randomization) on a seven-category ordinal scale or live discharge from the hospital within 14 days. Analyses were done in an intention-to-treat population. RESULTS: From May 2020 to Jan 2021, 254 patients were enrolled; 129 were assigned to standard of care and 125 to the treatment. The mean age was 52 (± 13) years, and 103 (41%) were women. At randomization, six patients were on invasive mechanical ventilation, 229 (90.15%) were requiring supplemental oxygen only (with or without non-invasive ventilation), and 19 (7.48%) were receiving neither. The time to clinical improvement was not significantly different between the groups: median of 9 days in the treatment group and 7 days in the control group (HR: 0.845; 95% CI 0.617-1.157; p-value = 0.29). The 28-day mortality was not significantly different between the groups (7.63% treatment) vs. (10.32% control); p-value = 0.45. The most prevalent adverse events were headache, elevation in ALT, and the prolonged QTc interval in the treatment group. CONCLUSION: The combination of favipiravir and hydroxychloroquine did not result in a statistically significant clinical benefit in patients with moderate-to-severe COVID-19. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov (NCT04392973).

Risk of COVID-19 morbidity and mortality among healthcare workers working in a Large Tertiary Care Hospital.

OBJECTIVES: To estimate COVID-19 infection and outcomes among healthcare workers (HCWs) compared with non-HCWs. METHODS: A prospective surveillance study was conducted among HCWs and non-HCWs eligible for treatment at a large tertiary care facility in Riyadh between March 1st to November 30th, 2020. RESULTS: A total 13,219 cases with confirmed COVID-19 have been detected during the study; 1596 (12.1%) HCW patients (HCWPs) and 11623 (87.9%) non-HCWPs. Infection per 100 population was almost ten-fold higher in HCWs compared with non-HCWs (9.78 versus 1.01, p<0.001). The risk of infection in support staff (15.1%) was almost double the risk in other professional groups (p<0.001). Hospitalization (14.1% versus 1.8%, p<0.001), ICU admission (3.0% versus 0.5%, p<0.001), and case fatality (0.13% versus 2.77%, p<0.001) were significantly lower in HCWPs compared with non-HCWPs. The mortality per 100,000 population was significantly lower in HCWs compared with non-HCWs (12.3 and 28.1, p<0.001). CONCLUSION: HCWs are at ten-fold higher risk of COVID-19 infection but have much better outcomes compared with non-HCWs. More strict infection control measures are still required to protect HCWs, including those who are not involved in direct patient care.

Clinical characteristics and outcomes of community-acquired pneumonia in western Saudi Arabia: A four-year retrospective analysis of medical records.

BACKGROUND: Community-acquired pneumonia (CAP) is a significant cause of morbidity and mortality, especially for the elderly and people who suffer from chronic conditions. This study was conducted to assess the clinical and microbiological characteristics and disease outcomes associated with the occurrence of CAP. METHODS: This retrospective chart review was conducted at King Abdulaziz Medical City, Jeddah, Saudi Arabia. Cases with documented clinical diagnosis of CAP during the period from 2016 to 2019 were included. Data were collected on demographic, clinical, and microbiological characteristics, used antimicrobials and patients' outcomes, including length of hospital stay, intensive care unit admission, and mortality. Multivariate regression analysis was performed to identify risk factors for increased length of hospital stay. RESULTS: A total of two hundred and eighteen CAP episodes were identified. Patients had a median age of 64.5 years, and 54.1% were males. Microbiological diagnosis was established in 33 patients (15.1%). Admission to ICU and diagnosis of a neurological disease were significantly associated with longer hospital stay (>7 days). An average of 2.7 antimicrobials were used per patient, and the most common antibiotics used were Piperacillin/Tazobactam (46.3%), Doxycycline (44%), then Ceftriaxone (42.7%). Four patients (1.8%) died during hospital stay. CONCLUSIONS: This retrospective analysis of CAP cases identified a lack of microbiological diagnosis and increased burden associated with disease severity and the need for hospitalization. The ability to identify CAP at an earlier stage will be a cornerstone to mitigate its impact on the healthcare system and ICU units.