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Background The increase in incidence of multidrug-resistant (MDR) organisms, especially gram-negative bacteria, in healthcare facilities is a serious cause of concern worldwide. This study was done at King Abdulaziz Medical City, Jeddah, a tertiary care hospital. The World Health Organization has published a priority pathogens list of antibiotic-resistant bacteria. The priority pathogens have been categorized into three major priorities (i.e., critical, high, and medium). The critical priority pathogens include common gram-negative bacteria (GNB) such as carbapenem-resistant Acinetobacter baumannii, carbapenem-resistant Pseudomonas aeruginosa, and carbapenem-resistant and third-generation cephalosporin-resistant Enterobacteriaceae such as Klebsiella pneumoniae and Escherichia coli. The current study identified risk factors for the acquisition of these MDR gram-negative critical priority pathogens in King Abdulaziz Medical City, Jeddah, to inform strategies for their containment. Methods A case-control study was carried out from January to April 2015, in which 100 patients with healthcare-associated infections (infections arising 48 hours after admission) caused by MDR GNB were compared with two control groups, i.e., 100 patients with healthcare-associated infections caused by non-MDR GNB (not meeting the criteria of MDR) and 100 patients without infection caused by GNB. MDR bacteria were defined as bacteria that were non-susceptible to at least one antibiotic in three or more classes of antibiotics. Data were analyzed using descriptive statistics (frequency and percentage of categorical variables). Multivariate regression analysis was undertaken to identify significant predictors of MDR GNB. Odds ratios (ORs) with 95% CIs were calculated and the level of significance was determined as p Results A total of 388 organisms were isolated during the study period from 332 patients. 56 (14%) patients were infected with more than one organism. Antibiotic therapy (OR 5.50, 95% CI 2.19–13.84; OR 3.98, 95% CI 1.68–9.44), stay in intensive care unit (OR 11.11, 95% CI 4.58–26.93; OR 8.60, 95% CI 3.28–22.57), and having indwelling medical devices (OR 3.02, 95% CI 1.45–6.33; OR 2.43, 95% CI 1.11–5.33) were the significant risk factors in patients infected with MDR GNB compared with each of the other two control groups, respectively. Conclusion The risk factors identified in our study provide guidance for healthcare workers for the prevention and containment of MDR GNB with special emphasis on effective implementation of an antimicrobial stewardship program and enhancing infection control practices in intensive care units.

The objective of this study was to compare central line-associated bloodstream infection (CLABSI) rates in Gulf Cooperation Council (GCC) states with those of the U.S. National Healthcare Safety Network (NHSN) and International Nosocomial Infection Control Consortium (INICC) using pooled data from 6 hospitals in 3 GCC countries. The overall CLABSI rate was 3.1 per 1,000 central line days. After adjusting for differences in intensive care unit types, the risk of CLABSI in GCC hospitals was 146% higher than NHSN hospitals but 33% lower than INICC hospitals.

Data estimating the rates of ventilator-associated pneumonia (VAP) in critical patients in Gulf Cooperation Council (GCC) countries are either limited in some countries or completely lacking in other countries.

Background Although the risk of hepatitis B virus (HBV) was reported to be higher in military personnel than the general population in Saudi Arabia (SA), there is lack of studies assessing HBV awareness among them. The objective was to evaluate the knowledge, attitude and practice (KAP) of HBV infection among military personnel. Methods An intervention design with pre- and post-education KAP questionnaire was completed among National Guard soldiers working in Jeddah during January 2009. Educational intervention was provided through educational leaflets, group and individual discussions, visual show, and a lecture. A score was created from the correct answers to 58 questions. Results A total of 400 male soldiers with mean age 30.7 ± 6.1 years completed both questionnaires. The majority had school education (96.8%) and in the lower military ranks (66.0%). Only 19.5% of soldiers reported HBV vaccine intake. The low median and inter-quartile range of the pre-intervention score (16, 6–26) markedly increased after education (to 53, 50–55, p Conclusion We are reporting a low level of HBV awareness among Saudi military population. The study confirms the need and effectiveness of focused multifaceted educational campaigns among the military population.

Background The H1N1 influenza pandemic had garnered a large amount of attention. Currently, the most effective preventive measure available is the H1N1 vaccine. We aimed to assess the willingness of our study participants to receive the H1N1 vaccination prior to the annual Hajj season. If any participant declined, we investigated the reasons for vaccine rejection. Findings We conducted a prospective cohort study of National Guard employees during the 1430 (2009) Hajj season. A survey was used as the primary method for data collection. Participants were vaccinated one to two weeks prior to their trip to Mona, and any side effects reported at the time of injection and three weeks post vaccination were recorded. There were 100 male and 26 female participants in the study. In total, 66.7% (n = 84) of the participants were health care workers (HCWs) and 33.3% (n = 42) were non-health care workers (non-HCWs). Less than half of the respondents (46.8%, n = 59) accepted the vaccination. The vaccination acceptance rate was higher among non-HCWs, at a rate of 71.4% (n = 30); HCWs only accepted at a rate of 34.5% (n = 29) (OR 1.103, 95% CI [0.488-2.496]). The most common reason for vaccine refusal was the impression that the disease was not fatal (25.4%, n = 32). Finally, all participants reported pain at the injection site and 18.3% (n = 11) reported swelling. All other side effects were reported in less than 15% of the participants. Conclusions Despite fears of the new H1N1 vaccine, there was a reasonable rate of vaccine acceptance among our study participants. Early health education may increase the rate of acceptance of the H1N1 vaccine. Furthermore, additional research is needed on long-term adverse effects of the H1N1 vaccine.

There is lack of benchmarking data for central line associated bloodstream infection (CLABSI) in Gulf Cooperation Council (GCC) countries. Available data are small isolated reports that do not cover different hospital locations.

femoral sites for extended periods of time. We recognized the need to address more than line placement to prevent BSI. We looked at NACHRI's multicenter PICU project progress in BSI prevention through standardizing line care and maintenance (LCM). When our Medical Center's Infection Prevention and Control (IPC) Department organized a team to customize an intravascular (IV) LCM bundle, key PICU nursing personnel joined the effort. A customized IV LCM bundle based on CDC and INS bloodstream infection (BSI) prevention guidellines was developed by the hospital's Zero BSI team. Mandating education of CL insertion and LCM bundles in the PICU was not enough. When the hospital committed to participating in the national Stop BSI project, the PICU volunteered and a multidisciplinary unit-based team was organized to eliminate CLABSI. Patient safety became part of the unit culture. Unit champions were identified and empowered. Medical and nursing staff were engaged. A daily patient goal sheet was put into practice. Line care audits were started. Days and then months since the unit's last CLABSI were counted. Results: This multidisciplinary project resulted in nearly 97% reduction in CLABSI with a mean rate of 0.2/1,000 CL days from November 2009 to November 2011 while decreasing the number of CL days. Using SHEA's published estimates that each CLABSI has an 18% fatality rate, costs $36,000 to treat, and increases length of stay an average of 13 days, we calculated an expected number of CLABSI. Based on our baseline rate, the PICU's CLABSI prevention program has saved an estimated 3 or 4 lives, $756,000 in patient charges, and 273 days of unnecessary hospitalization. Lesson Learned: We learned that CLABSI prevention requires a standardized continuous multidisciplinary effort. It involves creating a culture of safety. Frequent monitoring and regular reports of bundle audits and infection rates to maintain staff interest and engagement are needed. Active participation and visible involvement of the IPC Department in the process is important. Administrative support is essential. All of these have helped our PICU change what is possible in CLABSI prevention.