Needlestick and sharps injuries among secondary and tertiary healthcare workers, Saudi Arabia.

AIM: The study aimed to assess the incidence of needlestick and sharps injuries among healthcare workers (HCWs) in the Jazan region of Saudi Arabia, as well as to determine whether there exists an association between hospital level and needlestick and sharps injuries rate. DESIGN: A cross-sectional survey was conducted among 609 randomly selected HCWs from nine general hospitals. METHODS: A self-administered questionnaire, which covered the structure and process of injection safety, was used for data collection. RESULTS: The overall needlestick and sharps injuries incidence rate was 24%. The needlestick and sharps injuries rates were 30% and 14% in secondary and tertiary hospitals, respectively. HCWs working in tertiary hospitals were 61% less likely to have needlestick and sharps injuries than those employed in secondary hospitals. This was mainly the impact of better and continuous training. High safety level maintenance and health education provision are vital in such settings.

Dengue meningoencephalitis in a child presenting with focal seizures.

We report a 9-year-old female child who presented with fever and focal seizures. The Cerebrospinal Fluid (CSF) analysis was compatible with viral meningoencephalitis and Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) on same sample was positive for dengue virus RNA, serotype 2. The dengue IgM in blood sample was positive on the 8th day of the illness. This case demonstrates the emerging neurological manifestations of dengue infection and the first confirmed pediatric meningoencephalitis reported from Saudi Arabia. In areas where it does exist, dengue should be included in the differential diagnosis of cases of viral meningitis or meningoencephalitis.

First confirmed case of local human rabies in Saudi Arabia.

Rabies is a common zoonotic viral infection worldwide. Numerous animals can transmit the virus to humans, but dogs are the main ones. Despite the high incidence of animal bites overall in Saudi Arabia, of which most are dog bites, no single case of confirmed local human rabies has been reported. This article reports the case of a 12-year-old boy who lived with his family in a village in Jazan region in the southeast area of Saudi Arabia. He presented with signs suggestive of rabies. Saliva testing by rabies PCR was positive, confirming this as the first case of local human rabies in Saudi Arabia. The management plan followed the Milwaukee protocol, but the patient unfortunately died after 13 days of admission.

Impact of the International Nosocomial Infection Control Consortium (INICC)'s multidimensional approach on rates of ventilator-associated pneumonia in intensive care units in 22 hospitals of 14 cities of the Kingdom of Saudi Arabia.

BACKGROUND: To analyze the impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Approach (IMA) and use of INICC Surveillance Online System (ISOS) on ventilator-associated pneumonia (VAP) rates in Saudi Arabia from September 2013 to February 2017. METHODS: A multicenter, prospective, before-after surveillance study on 14,961 patients in 37 intensive care units (ICUs) of 22 hospitals. During baseline, we performed outcome surveillance of VAP applying the definitions of the CDC/NHSN. During intervention, we implemented the IMA and the ISOS, which included: (1) a bundle of infection prevention practice interventions, (2) education, (3) outcome surveillance, (4) process surveillance, (5) feedback on VAP rates and consequences and (6) performance feedback of process surveillance. Bivariate and multivariate regression analyses were performed using generalized linear mixed models to estimate the effect of intervention. RESULTS: The baseline rate of 7.84 VAPs per 1000 mechanical-ventilator (MV)-days-with 20,927 MV-days and 164 VAPs-, was reduced to 4.74 VAPs per 1000 MV-days-with 118,929 MV-days and 771 VAPs-, accounting for a 39% rate reduction (IDR 0.61; 95% CI 0.5-0.7; P 0.001). CONCLUSIONS: Implementing the IMA was associated with significant reductions in VAP rates in ICUs of Saudi Arabia.

Epidemiological and clinical aspects of neonatal tetanus from a tertiary care hospital.

BACKGROUND AND OBJECTIVES: To study the epidemiology, clinical presentation and outcome of all patients diagnosed with neonatal tetanus and to provide a recommendation for maternal and neonatal tetanus elimination. DESIGN AND SETTING: Retrospective study of all cases of neonatal tetanus admitted from 1991 to 2013.Neonatal intensive care unit, King Fahad Central Hospital, Jazan, Saudi Arabia. RESULTS: Thirty patients were diagnosed with neonatal tetanus over 22 years. Eighteen (60%) of the patients were born to Saudi mothers, and 12 (40%) were born to non-Saudi mothers. Twenty-seven (90%) deliveries occurred at home. Most of the mothers lived in the mountainous zone of the region. Two (10%) of the mothers had only a single dose of the tetanus toxoid; the status of the remaining pregnant women was unknown or unimmunized before or during conception. In 18 of the 30 patients (60%), the umbilical cord was severed using household knife, razor blade or plain scissors. Most of the patients presented with muscle spasms (96.7%), refusal to eat and abnormal posture. All of the patients were intubated and receiving mechanical ventilation. Six (20%) of the patients died. CONCLUSION: It is essential to begin campaigns or integrate complete maternal tetanus toxoid immunization at primary health centers (PHC) during antenatal care. Immunization needs to be arranged so pregnant women can be educated regarding the importance of ANC and the risks of unhygienic home delivery, and immunization should be addressed with adequate information. Pregnant women and those of childbearing age in mountainous areas should be the first targets for these activities.

Surveillance for influenza admissions among children hospitalized in Canadian immunization monitoring program active centers, 2003-2004.

OBJECTIVES: Influenza is a common childhood infection that may result in hospitalization. Our objectives were to (1) determine characteristics of children hospitalized for influenza and disease manifestations and (2) obtain baseline data before implementation of new recommendations for routine immunization of young children and their caretakers against influenza. METHODS: All of the children hospitalized with laboratory-confirmed influenza at 9 Canadian tertiary care hospitals during the 2003-2004 influenza season were identified from virology laboratory reports, and their charts were reviewed. RESULTS: There were 505 children admitted because of influenza. Fifty-seven percent were < 2 years old. Previously healthy children accounted for 58% of all of the cases. Pulmonary and neurologic disorders were the most common underlying chronic conditions. Fever and cough were the most frequent manifestations. Seizures occurred in 9% of cases. Serious complications included myocarditis (2), encephalopathy (6), and meningitis (1). There were 3 influenza-related deaths. Mean duration of hospitalization was 5.3 days. Twelve percent of children required ICU admission, and 6% required mechanical ventilation. Antibiotic therapy was administered in 77% of cases, and 7% received anti-influenza drugs. Information on influenza vaccination was available for 84 of 154 children identified as vaccine candidates. Twenty two had received vaccine, but only 7 children had been fully immunized > 14 days before the onset of illness. CONCLUSIONS: Healthy young children and children with chronic conditions are at risk for serious illness with influenza. Ongoing surveillance is needed to evaluate the impact of changing immunization recommendations on the burden of influenza illness in children.

Vertical transmission of fatal Rift Valley fever in a newborn.

Rift Valley Fever (RVF) is a viral disease transmitted to humans by mosquito bite and contact with animals or their infected tissues. Other modes of transmission include aerosol inhalation and possibly ingestion of raw milk from infected animals. We present a 5-day-old neonate with fatal RVF. Onset of the infant's illness on the 2nd day of life combined with positive RVF-IgM and serological evidence of maternal disease supports vertical transmission.