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

Causes and outcome of medication errors in hospitalized patients

To develop better understanding of Medication Errors [MEs] in the health care sector, and to improve the error prevention services in the hospital. We conducted a retrospective study at the Hera General Hospital, Makkah, Saudi Arabia. The medical records were reviewed for adult hospitalized patients from June 1, 2000 to June 30, 2002. Patients demographic data, types, and causes of MEs, were recorded. The contributing factors, frequency and patient's outcome were also analyzed. A total of 2627 patient files were analyzed, 3963 errors were studied as follows: 1559 files contain one error, 800 files with 2 errors, and 268 with >3 errors. The most common type of error found was wrong strength [concentration] in 914 patients [34.79%], 807 patients [30.7%] had wrong route of administration, and 788 [30%] had wrong dosage form. On the other hand, the most common cause identified for MEs, was human factor, which accounted in 1223 patients [46.49%]. Miscommunication was the most common second cause in 920 patients [35.02%], and the third common cause was name confusion [484, [18.43%]]. Medication Errors were classified from a regulatory prospective into actual in 735 patient files [28%], potential in 1866 [71%] and serious in 26 [0.98%]. The study showed that wrong strength was the most common ME found and human factors were the most common cause contributing MEs. Therefore, focusing on these factors will definitely minimize MEs in hospitalized patients