Application of ventilator care bundle and its impact on ventilator associated pneumonia incidence rate in the adult intensive care unit

To reduce ventilator associated pneumonia [VAP] incidence rate, lessen the cost of care, and correlate VAP bundles compliance with VAP incidence rate. This study was a prospective longitudinal study conducted on adult intensive care unit [ICU] patients at Hera General Hospital, Makkah, Kingdom of Saudi Arabia from January to December 2010. The following Institute for Healthcare Improvement VAP prevention bundle was applied: head-of-bed elevation; daily "sedation-vacation" along with a readiness-to-wean assessment; peptic ulcer disease [PUD] prophylaxis; and deep venous thrombosis [DVT] prophylaxis. Among a total of 2747 patients, the bundle compliance rate in January 2010 was 30%, and reached to 100% in December 2010, while the overall rate was 78.9%. The individual bundle compliance rates were as follows: head-of-bed elevation - 99.9%; daily sedation vacation - 88.9%; PUD prophylaxis - 94.9%; and DVT prophylaxis - 85.7%. At the beginning, VAP rate was 2.5/1000 ventilator days, and reduced to 0.54 in the next month. The overall VAP incidence rate in 2010 was found to be 1.98 with a reduction of 1.41 by comparing with the same data of year 2009 collected retrospectively. The total reduction cost in one year was $154,930. A significant correlation was found between the VAP rate and its bundle compliance [p=0.001]. Most frequent pathogens found were Pseudomonas aeruginosa [30.8% of all isolates] followed by Acinetobacter baumannii [27.7%], and methicillin-resistant Staphylococcus aureus [15.4%]. Application of VAP prevention bundle reduced the VAP incidence rate and lowered the cost of care

Hand hygiene compliance rate among healthcare professionals

To motivate healthcare professionals, with a focus on improving hand hygiene compliance. An observational, prospective, longitudinal study was conducted on the evaluation of hand hygiene compliance at Hera General Hospital, Makkah, Kingdom of Saudi Arabia from May 2009 to May 2010. Four components to improve hand hygiene compliance were implied; daily audit, monthly staff education; quarterly workshops of hand hygiene, and education material distribution. The compliance rate was calculated by its adherence with number of opportunities. Of total 163 healthcare professionals were surveyed for hand hygiene compliance; 57 [35%] were doctors, 92 [56.4%] nurses, and 14 [8.6%] patient care technicians. The overall compliance rate was 50.3%, and its distribution among staff was as follows; doctors 49.1%, nurses 52.2%, and technicians 42.8%. The highest compliance rate among doctors and nurses was found in surgical units. A low compliance in high intensity patient care area was observed such as in the Emergency Room and out patient department. The patient care technicians showed highly variable results, as their compliance rate was 100% in medical units while 0% in various other clinical areas. The overall hand hygiene compliance rate of healthcare professionals reached 50% after a long education campaign, and was highest among the nurses. Further study is needed to explore the reasons for non-compliance

Multi-drug resistant Ewingella americana

We report a case of pneumonia due to multi-drug resistant Ewingella americana in a young patient admitted in the Intensive Care Unit of Hera General Hospital, Makkah, Saudi Arabia with severe head injury in a road traffic accident. He was an Indonesian pilgrim who had traveled to the Kingdom of Saudi Arabia to perform Hajj in December 2007. Ewingella americana was identified to be the pathogen of pneumonia with clinical signs and symptoms along with positive radiological findings

Efficacy of air sampler sartorious MD8 and settle plate method for quantitative estimation of air microorganisms

The main aim of the study was to identify pathogenic strains floating in the environment of Makkah city during Hajj 1424-H and to compare the efficacy of air filter device Sartorious MD8 to the traditional method called exposing settle plate method for the quantitative estimation of microorganisms. Air samples for identification of bacteria and fungi were taken from three different environments; outdoor, indoor, and microbiology department. Seven outdoor locations were selected; Muna, Arafat, Jamarat, slaughter areas, tunnels, grounds and toilet surrounding. For the in-door environment, the following clinical units of Hera General Hospital were selected; intensive care unit, nursery, emergency room, operation room, medical ward, and surgical ward, microbiology environment three places were selected microbiology departments of Hera General Hospital, Al-Noor Specialist Hospital, and Umm Al-Qura University. Mean bacterial and fungal colony count was calculated in each area by both methods. The four major potential human pathogens Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, and Aspergillus fumigatus were isolated. Mean bacterial and fungal colony count was significantly found higher in air filter method. The air pier [MD8] was found more effective for monitoring the viable bacteria and fungi in hospital environment outdoor environment as compared to the exposing settle plate method