Surveillance of preventive measures for ventilator associated pneumonia (VAP) and its rate in Makkah Region hospitals, Saudi Arabia.

BACKGROUND/AIM: The present study aimed to assess the VAP rate and to identify VAP prevention activities in public sector hospitals situated in the Makkah Region, Saudi Arabia (SA). MATERIALS AND METHODS: In this cross-sectional study, the VAP data from 13 public sector hospitals were collected from January to December 2013 and analyzed using SPSS 16. RESULTS: The overall VAP rate in Makkah Region hospitals was 6.89 cases per 1000 ventilator-days. There was a significant difference in VAP rate among the hospitals of the Makkah Region (P < 0.001). There was no significant difference in the VAP rate among hospitals, which were using only one, two, or all three VAP preventive approaches (P = 0.26) accredited by the Joint Commission International (JCI) and Central Board for Accreditation of Health Care Institution (CBAHI) (P = 0.12), and using the form in intensive care units (ICUs) (P = 0.85). There was a significant difference in the VAP rate among hospitals having different bed capacities (P < 0.001), data regularly collected (P = 0.03), and had a team to supervise the VAP project (P = 0.04). CONCLUSION: The VAP rate in Makkah Region hospitals is 6.89 cases per 1000 ventilator-days.

Analysis of patient falls among hospitalised patients in Makkah region.

OBJECTIVE: To assess the frequency and its correlation of patient fall with preventing or precipitating factors among inpatients. METHODS: The observational study was conducted in Makkah Region, Saudi Arabia from October 15 2012 to November 4, 2013. Data was collected using a questionnaire from 16 hospitals in four districts of Makkah province. The material was sampled through systematic randomisation from inpatient files and data was collected for those who had fallen inside the hospital. The questionnaire, validated through a pilot study run under the Directorate of Quality and Patient Safety in Makkah, was used to see whether the hospitals had adopted and applied international standards for assessment of adult and paediatric patients for falls as well as effectiveness of these applications. RESULTS: Of 4,799 beds, occupancy rates ranged from 1680(35%) to 4,799(100%). Out of 291 falls in all, 144(49.48%) were in Jeddah. Besides, 116(40%) of the falls occurred in the last quarter of the Islamic calendar. Statistically significant difference was found in fall episodes in different months (p=0.007). Statistical analysis indicated that the factors that significantly raised the number of patient falls were increase in hospital beds and their occupancy rate (Spearman's correlation: 0.621 and 0.579 respectively). CONCLUSIONS: The frequency of falls varied from hospital to hospital and factors like higher number of bed capacity and occupancy rate increased the falls.

Cancellation of operations in Saudi Arabian hospitals: Frequency, reasons and suggestions for improvements.

OBJECTIVE: To identify the frequency and reasons of operations cancellation in 25 Makkah region hospitals in Saudi Arabia. METHODS: Retrospective evaluation of the rate of surgery cancellation in 25 hospitals of Makkah region was performed in this study. The data of scheduled surgeries from 15 different surgical specialties was collected from January to December 2013. Frequency and reasons of cancellation of elective surgical cases in different specialty were studied with a view to recommend suggestions for improvement. Data was analyzed on SPSS -16. RESULTS: There are 120 operating rooms (OR) in 25 Makkah region hospitals and during the year 2013, a total of 16,211 surgery cases were listed, and 1,238 (7.6%) cases were canceled. Contribution to total cancellation was highest in orthopedic 33.8% followed by general surgery 27.5%, obstetrics 7.7% and ENT 5.2%. According to category, 42.81% rate of cancellation was patient related, 20.03% facility related, 9.45% due to improper work-up, 1.45% associated with anesthesia, 7.19% related to surgeons, and 18.90% other/and not recorded reasons. CONCLUSIONS: Present study found 7.6% cancelation rate in Makkah region hospitals and three most common causes for cancellations were patients related, facility related and improper work-up.

Pattern of patients and diseases during mass transit: The day of Arafat experience.

BACKGROUND AND OBJECTIVE: Every year 2-3 million Muslims gather for a few days around the Holy city of Makkah in Saudi Arabia to perform Hajj. Managing enormous health issues associated with such a mass gathering requires a very vibrant health delivery plan. Related research is part of the strategy. This study was done to assess the pattern of patients and illnesses encountered at one health facility at Arafat on the 2nd day of Hajj, when all the pilgrims move from Mina and stay in Arafat for a few hours. The objective of the study was to provide input so that recommendations can be given for future improvement of health care during this mass transit. METHODS: All patients reporting sick to the Nimra Hospital on the Day of Arafat were included and documented on a detailed Performa and analyzed. RESULTS: We received 211 patients, essentially all of those were in need of acute medical intervention. Acute severe asthma and injuries were the major problems encountered. There were two deaths both related to heat stroke. Patients received were predominantly Arabic speaking. CONCLUSIONS: Only those needing acute intervention seek medical advice during transit. Well equipped and staffed health facilities are, however, needed to cater these and for any mass casualties. Pre Hajj training and mandatory Flu vaccination can help.

Diseases pattern among patients attending Holy Mosque (Haram) Medical Centers during Hajj 1434 (2013).

OBJECTIVE: To evaluate the diseases pattern among pilgrims attending the 2 Holy Mosque (Haram) Health Care Centers during the Hajj season 2013 (Hijra 1434).  METHODS: In this cross-sectional study, data was collected from 2 medical centers located in the Holy Mosque in Makkah city, Saudi Arabia, from the first of Dhul-Hijjah to sixteenth Dhul-Hijjah 1434. The present study was completed in 16 days (6th October to 21st October 2013). RESULTS: Over 16 days, 1008 patients attended the medical centers during Hajj 1434, (2013), out of which 554 (55%) were males and 454 (45%) were females. Most of the patients were Egyptians (n=242, 24%), followed by Saudis (n=116, 11.5%), Pakistani (n=114, 11.3%), Turkish (n=50, 5%), and other nationalities (n=404). According to age distribution, mostly were in the 51-60 years age group (n=237, 23.5%), followed by other age groups. Out of 1008 patients, 842 (83.5%) patients were treated and subsequently discharged, while 166 patients (16.5%) were referred to the tertiary centers. According to the diseases pattern, most of the patients were suffering from respiratory problems (n=177, 17.6%) followed by skin diseases (n=158, 15.7%), gastrointestinal tract (GIT) diseases (n=133, 13.2%), and others. CONCLUSION: Most of the patients were suffering from respiratory problems followed by skin and GIT diseases, and less than 25% of patients were referred to tertiary care centers.

Physicians' perception about electronic medical record system in Makkah Region, Saudi Arabia.

OBJECTIVES: The study was done to determine the physicians' perception about electronic medical record system (EMRS) in the context of its productivity in order to improve its functionality and advantages. MATERIALS AND METHODS: This cross-sectional survey was performed from July to August 2009 with structured questionnaire of 15 closed-ended questions with five points Likert scaling starting from strongly disagree to strongly agree as 1-5, reflecting the perception of physicians about EMRS. The physicians of the Makkah region working in six different hospitals were selected. "Positive" response means if percent of responses were rated 4 or 5 (agree/strongly agree), "neutral" if rated 3, and negative if rated 1 or 2 (strongly disagree/disagree). Descriptive data analysis techniques were used. RESULTS: We selected 317 completed questionnaires. Majority of subjects were from King Fahd Hospital, Jeddah (83, 26.3%), residents (147, 46.4%), male (200,63.1%), expatriates (207, 65%), and age group 36-45 years (133, 42%) were dominant. The stem regarding importance of computers for practicing medicine and EMRS to improve quality of practice was appreciated by majority, that is, 77.7 and 71.2%, respectively. However, "It does not disrupt the workflow" (35.1%) and "EMRS is comfortable while entering the data instead of writing" (34.8%) were appreciated negatively. Consultants (53.9%), male (53.4%), expatriates (56.7%), physicians of King Abdul Aziz Hospital, Ta'if (56.9%), and age group of 46-55 years (53.8%) appreciated EMRS positively. Overall perception of EMRS was found positive by 52.8%. CONCLUSION: Majority appreciated the EMRS, but specific concerns about its usage easiness and workflow disturbance were opposed by them also.

Hajj: infectious disease surveillance and control.

Religious festivals attract a large number of pilgrims from worldwide and are a potential risk for the transmission of infectious diseases between pilgrims, and to the indigenous population. The gathering of a large number of pilgrims could compromise the health system of the host country. The threat to global health security posed by infectious diseases with epidemic potential shows the importance of advanced planning of public health surveillance and response at these religious events. Saudi Arabia has extensive experience of providing health care at mass gatherings acquired through decades of managing millions of pilgrims at the Hajj. In this report, we describe the extensive public health planning, surveillance systems used to monitor public health risks, and health services provided and accessed during Hajj 2012 and Hajj 2013 that together attracted more than 5 million pilgrims from 184 countries. We also describe the recent establishment of the Global Center for Mass Gathering Medicine, a Saudi Government partnership with the WHO Collaborating Centre for Mass Gatherings Medicine, Gulf Co-operation Council states, UK universities, and public health institutions globally.

Audit of an urban paediatric emergency department visits.

BACKGROUND: This study aimed to highlight the health seeking behavior of children in an Emergency Department (ED). MATERIALS AND METHODS: Retrospective files review of ED was done for the month of July, 2008. Data about the children ≤12 years of age was gathered. RESULTS: In one month period a total 21000 patients visited our ED, out of them 6120 (29%) were children. Males, Saudis and children of (1-6 years) were more frequent, i.e., 3540 (57.8%), 5760 (94.1%) and 3180 (52%), respectively. Majority of patients visited in shift "2", i.e., 15:30 hours to 23:30 hours. Among the patients "diseases of respiratory system" were found more frequent 4170 (68.1%) and main diagnosis was "acute upper respiratory tract infection" 3300 (53.9%). Non-urgent cases were 2020 (33%) while 244 (4%) were admitted. CONCLUSION: Young children as well as non-urgent cases were predominant. Evening shift was the busiest one.

Prevalence of Intestinal Parasites among Patients of Al-Noor Specialist Hospital, Makkah, Saudi Arabia.

OBJECTIVES: To determine the prevalence of intestinal parasites among patients of a tertiary care hospital. METHODS: A total of 12,054 samples received from the outpatient as well as inpatient departments from January 1, 2004 to December 31, 2009 in Al-Noor Specialist Hospital, Makkah, Saudi Arabia. Stool examinations were performed by direct method and concentrated Techniques for all patients. RESULTS: Overall, the prevalence of intestinal parasites was 6.2% (740 cases). Majority of patients were infected by Entamoeba histolytica (4.7%) followed by Giardia lamblia (1.3%), while Ankylostoma duodenal (0.02%) exhibited the minimum prevalence. Parasitic infections were more frequent in non-Saudis than Saudis patients (7.1% vs. 5.8%; p<0.05). There was no significant difference between males and females regarding parasitic infections, with a female:male ratio of 1:1.08. There was a higher prevalence in patients under five years of age (9.1%), followed by patients aged 5-14 years (7.5%). CONCLUSION: The notable finding from this study is the high prevalence of E. histolytica. Overall, parasitic infections were more prevalent in patients under five years of age and in non-Saudi nationals.

Predictors of asthma severity during the pilgrimage to Mecca (Hajj).

INTRODUCTION: The annual pilgrimage to Mecca (Hajj) is one of the largest gatherings in the world and thus its participants are exposed to various communicable and noncommunicable diseases. This provides an opportunity to study travel epidemiology. OBJECTIVES: The aim of the study was to estimate the predictors of asthma severity during the Hajj. PATIENTS AND METHODS: The study cohort was recruited from patients who presented to the emergency department (ED) of the King Abdul Aziz Hospital, Mecca, Saudi Arabia, between December 3 and 18, 2008 (5-20 Dhul-Hijjah 1429 H). We included newly diagnosed and previously documented cases presenting with asthma symptoms. Sociodemographic and clinical data were collected and the risk factors were assessed. The severity of asthma exacerbation was measured according to the National Heart, Lung, and Blood Institute guidelines. Data were analyzed using the SPSS software. RESULTS: The study involved 58 subjects, including 38 women (65.5%). There were 27 subjects (46.6%) with mild asthma attack, 18 (31%) with moderate asthma attack, and no cases with life-threatening asthma. Insignificantly increased risk of severe asthma attack was observed in the following groups: women, people aged 46-60 years, pilgrims (hajis) who did not belong to a hajj group, non-hajis, illiterates, and nonsmokers - the odds ratio (OR) (95% confidence interval [CI]) was 3.7 (0.7-18.5), 1.7 (0.5-6.3), 2.4 (0.7-8.5), 5.1 (0.6-44.1), 2.3 (0.7-9.1), and 2.0 (0.4-10.4), respectively. Forty-six subjects (79.3%) had a history of allergy to components of smoke, detergents, dust, animal dander, and perfumes, while only 5 patients (8.6%) had drug allergy. High risk of severe asthma was observed in subjects with a history of drug allergy, as well as in obese subjects and those who often presented to the ED - OR (95% CI) was 6.5 (0.9-43.9), 18.0 (4.0-80.7), and 3.1 (0.8-11.5), respectively. CONCLUSIONS: Higher risk of severe asthma attack was observed in women, people aged 46-60 years, hajis who did not belong to a hajj group, non-hajis, illiterates, nonsmokers, obese patients, and those who often presented to the ED within the previous 12 months due to asthma exacerbation.

Clinical profile of haemodialysis patients with diabetic nephropathy leading to end stage renal disease.

BACKGROUND: The incidence of patients with end-stage renal failure and type 2 diabetes mellitus as a comorbid condition has increased progressively in the past decades. Causes of renal disease might vary from one population to another. The aim of this study was to know the characteristics of the diabetic patients on regular dialysis at Al-noor Specialist Hospital, Makkah, Saudi Arabia. METHODOLOGY: The data had been collected retrospectively in the month of Shawal 1425 corresponding to 13-11-2004----12-12-2004 from the diabetic patients directly that were on dialysis due to end stage renal disease (ESRD) and from their files. RESULTS: The mean age of Diabetics was (55.2 years) showing male predominance 31 (60.8%). All were Saudies. The mean duration of Diabetes mellitus & dialysis were (16.8 years) and (22 months), respectively. The mean age of start of Diabetes mellitus & dialysis was (37.4 years) & (53.5 years). The mean duration of onset of diabetes to dialysis was (16.1 years). Out of the total, 29 (56.9%) were non-smoker. Patients with family H/O diabetes with other associated illnesses were 23 (45%) followed by 15 (29.4%) had family H/O only diabetes. Type II diabetics were 40 (78.4%). Regarding metabolic profile, patients with high blood glucose level were 10 (19.6%) while 3 (5.9%), 50 (98%) & 18 (35.3%) patients had high cholesterol, low density lipoprotein & triglyceride levels, respectively. CONCLUSION: Maximum patients were in sixth decade of life. Up to three fourth patients had family H/O diabetes. Most of the subjects had only diabetic nephropathy Maximum patients had high low density lipoprotein level. Dialysis was main treatment to control diabetes.

Reasons for delay in inpatient admission at an emergency department.

OBJECTIVE: This study highlighted the reasons which contributed to longer stay of patients in Emergency Department (ED) who were advised admission. METHODOLOGY: This study was conducted from August 4 to 11, 2004G as a retrospective review of the ED cards of patients admitted to inpatients wards of Al-Noor Specialist Hospital, Makkah, Saudi Arabia. The demographic data, doctors & nurses notes with their timings were reviewed. The maximum consumed time by a reason was considered as the main reason of delay for that subject. The delayed patients were divided into Group A and B, delayed before and after admission was advised, respectively. Prolonged length of stay (Delay) in ED was defined as stay longer than 2 hours after patient's arrival in ED until they were received to wards. RESULTS: Out of total 4876 visits during study period, 355 (7.3%) patients were admitted, and 238 (67%) were delayed. Age group 13-30 years was common in delayed 78 (32.8%) and not delayed 56 (47.9%) subjects. The mean length of stay of delayed subjects was 256 minutes. Group A 146 (61.4%) had more subjects than group B 92 (38.6%) (p < 0.001). Fifty eight (39.7%) patients stayed between 2-3hours in Group A vs. B 23 (25%) (OR 2, 95% CI 1.1-3.5). Common reason of delay in Group A was multiple consultations with further investigations 70 (48%) (p < 0.001) while file making process was common 40 (43.5%) in group B (p < 0.001). CONCLUSIONS: Out of admitted patients 67% were delayed mainly due to late advised admission with major reason of delay were multiple consultations.

Pattern of psychiatry morbidity during Hajj period at Al-Noor Specialist Hospital.

OBJECTIVE: To study the pattern and extent of psychiatric morbidity in the Hajj period (pilgrimage to Mecca by a Muslim). METHOD: Study was conducted by psychiatry department and Health Research Centre, Al-Noor Specialist Hospital. We recorded demographic and clinical characteristics of all patients presenting during first two weeks of Zulhajjah, 1425H (11th to 24th of January 2005). Detailed clinical interviews were conducted by qualified psychiatrists and findings were recorded in semi-structured form. Diagnoses were made following the guidelines in clinical version of chapter V (Mental and Behavioral Disorders) of International Classification of Diseases (ICD-10). In difficult cases diagnosis was assigned by consensus between three psychiatrists. RESULTS: During study period 92 patients presented. Males were dominant (54%). Mean age was 43 +/- 17. Highest proportion (52%) belonged to young adults followed by middle-aged (20%). Majority (48%) belonged to Saudi Arabia. Self-referrals were 66% and 52% presented as first episodes. Behavior, mood, and sleep were affected more commonly (65%, 63%, and 59% respectively). Physical symptoms were reported by 28% of patients. Highest number (34%) belonged to "Neurotic, stress-related and somatoform disorders" followed by "Mood disorders" (22%). Medical disorder was reported by 33% of patients. Medications were advised to 79% and psychiatric admission to 6.5% of patients. CONCLUSIONS: In our study, important findings are outlined and discussed. Replication of study with increased sample size and planning of psychiatric services according to established need of population served particularly during hajj period is needed.

Evaluation of the available anti-HCV antibody detection tests and RT-PCR assay in the diagnosis of hepatitis C virus infection.

The aim of the present work is to evaluate the commercially available antibody tests in the diagnosis of hepatitis C virus (HCV) infection by comparing their results with the RT-PCR test. The study included 316 serum samples from three groups: blood donors, patients on maintenance hemodialysis (HD) and patients infected with the human immunodeficiency virus (HIV). Samples were subjected to HCV-antibody detection by ELISA and RIBA tests and HCV-RNA detection by RT-PCR assay. The percentage of infectivity for blood donors was 18.9% by ELISA, 20.8% by RIBA and 23.6% by RT-PCR test. For patients on HD and those positive for HIV, the test positivity was respectively 59.3% and 5.3% by ELISA, 64% and 10.5% by RIBA and, 66.3% and 21% by PCR test. The percentage of false negativity of HCV-Ab by ELISA and RIBA when compared with RT-PCR test was 3.5 and 8.1% for samples blood donors, 17.1 and 25.7% for HD patients and 5.6 and 16.7% for HIV-infected samples, respectively. The false positivity of HCV-Ab by ELISA and RIBA, when compared with RT-PCR, was 5%, 3.9% and zero for blood donors, HD patients and HIV-HCV co-infected cases, respectively. While comparing ELISA with RT-PCR, the false positivity was 10%, 5.9% and zero respectively for blood donors, HD patients and HIV-HCV co-infected cases. Thus, it is very important to screen blood donors, HD patients and HIV-infected patients by using the RT-PCR for HCV-RNA to avoid false negative results.

Prevalence of gastroesophageal reflux disease in patients with laryngeal and voice disorders.

OBJECTIVE: To determine the prevalence of gastroesophageal reflux disease (GERD) for the management of patients with laryngeal and voice disorders. METHODS: This study consisted of 30 patients from Ear, Nose and Throat (ENT) and Phoniatric outpatient clinics at Al-Noor Specialist Hospital in Holy Makkah, Saudi Arabia complaining of laryngeal symptoms mainly dysphonia, during one year period from May 2005 to May 2006. All patients were subjected to: voice evaluation, which include searching for etiological factors, auditory perceptual assessment (APA), laryngeal examination and upper gastrointestinal tract (GIT) endoscopy. RESULTS: The onset of complaint of voice changes was gradual (93%), the duration was more than 6 months (90%) and the course was intermittent in 43% of patients. Phonasthenia symptoms were common. The change of voice was mainly due to high vocal demand (63.3%), tense temperament (93.3%) and spicy foods (60%). The grade of dysphonia was slight in 50% of patients, the characters of voice were mainly strained and leaky (76.7%) and the pitch was mainly decreasing (56.7%). Hyperfunctional dysphonia was present in 26.7% of patients, phonasthenia in 16.7%, vocal fold (VF) polyp in 13.3% and contact granuloma in 6.7%. Presence of GERD with hiatus hernia in 63.3% of patients, GERD with acute gastritis and duodenitis in 10% and incompetent lower esophagus in 6.67%. CONCLUSION: Laryngeal and voice disorders was mostly due to GERD in 80% of patients, which was mainly GERD with hiatus hernia.

Initial experience with Swedish adjustable gastric band at Al-noor hospital.

BACKGROUND: The aim of this 4-year study is to give an initial account of the weight loss and complications after applying the Swedish adjustable gastric band (SAGB) at Al-Noor Specialist Hospital-Makkah. MATERIALS AND METHODS: 97 morbidly obese patients underwent SAGB. RESULTS: 94 patients benefited by losing weight. 1 patient had a minor complication (wound infection) and 1 did not return for follow-up. 2 early patients died of pulmonary embolism. The 64 females (68%) and 30 males had mean BMI 50.8 kg/m2 before SAGB and 35.0 at 2 years after SAGB. CONCLUSION: Gastric banding generally was a valuable procedure for morbidly obese patients. It was easy to perform, with low operative risk and few longterm complications.