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Background: The objective of this retrospective cohort study was to assess the impact of implementation of different levels of infection prevention and control (IPC) measures during an outbreak of Middle East respiratory syndrome (MERS) in a large tertiary hospital in Saudi Arabia. The setting was an emergency room (ER) in a large tertiary hospital and included primary and secondary MERS patients., Methods: Rapid response teams conducted repeated assessments of IPC and monitored implementation of corrective measures using a detailed structured checklist. We ascertained the epidemiologic link between patients and calculated the secondary attack rate per 10,000 patients visiting the ER (SAR/10,000) in 3 phases of the outbreak., Results: In phase I, 6 primary cases gave rise to 48 secondary cases over 4 generations, including a case that resulted in 9 cases in the first generation of secondary cases and 21 cases over a chain of 4 generations. During the second and third phases, the number of secondary cases sharply dropped to 18 cases and 1 case, respectively, from a comparable number of primary cases. The SAR/10,000 dropped from 75 (95% confidence interval [CI], 55-99) in phase I to 29 (95% CI, 17-46) and 3 (95% CI, 0-17) in phases II and III, respectively., Conclusions: The study demonstrated salient evidence that proper institution of IPC measures during management of an outbreak of MERS could remarkably change the course of the outbreak., (Copyright © 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Extended-spectrum β-lactamase (ESBL)-producing Klebsiella species cause worldwide problems in neonatal intensive care units (NICUs). This study aimed to determine possible risk factors for infection or colonization with ESBL-producing Klebsiella pneumoniae (ESBLKp) during an outbreak in the NICU., Methods: A retrospective cohort study was conducted among neonates admitted to the NICU of a teaching hospital in Riyadh, Saudi Arabia, during an outbreak of ESBLKp from April to July 2008. The incidence density ratio was calculated to determine possible predictors of ESBLKp colonization or infection., Results: During 2,265 person-days of follow-up of 118 neonates, 4 became infected, and 8 were colonized with ESBLKp. Univariate analyzes revealed that, among 14 neonates who were treated with vancomycin, 9 (64.3%) developed infection or colonization with ESBLKp, whereas, among 104 neonates who were not treated with vancomycin, 3 (2.9%) were affected, with an incidence density ratio of 4.22 (95% confidence interval: 1.47-5.15). Parenteral feeding and mechanical ventilation were found to be marginally significant risk factors., Conclusion: Treatment with vancomycin appears to be a risk factor for infection or colonization with ESBLKp in the NICU setting., (Copyright © 2014 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.)

Background: Hand hygiene (HH) is single most effective preventive measure for health care-associated infection, but compliance rates remain low. This study estimated HH compliance among health care workers (HCWs) and examined factors associated with noncompliance., Methods: An observational study design was carried out in 5 intensive care units (ICUs) at the University Hospital in Riyadh, Saudi Arabia. Among 242 HCWs, a total of 3,940 HH opportunities were observed by 6 trained medical interns and students. The World Health Organization's "Five Moments for Hand Hygiene" procedure was used as a basis for the observations., Results: The overall observed noncompliance rate was 58%. The factors associated with noncompliance were HCW job title (physicians, odds ratio [OR], 2.8; 95% confidence interval [CI], 1.8-4.2; allied health professionals, OR, 2.9, 95% CI, 1.9-4.6); working the a.m. shift (OR, 1.5; 95% CI, 1.3-1.8), working in a pediatric ICU (OR, 1.8; 95% CI, 1.5-2.2), and performance of HH before patient contact (OR, 4.5; 95% CI, 2.6-7.8)., Conclusions: Overall HH noncompliance was high in ICUs of this hospital. The demanding ICU work setting was an important factor associated with noncompliance. HH compliance was highest among therapists and technicians because of fewer patient interactions and thus fewer HH noncompliance opportunities per person. Further studies on the relationship between work environment demands and HH compliance rates are needed., (Copyright © 2013 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.)