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Hind M AlOsaimi,1 Mohammed K Alshammari,2 Ghadah K Almijlad,3 Nawaf M Alotaibi,3 Dhafer A Alqahtani,4 Mohammed M Alshamrani,5 Tariq A Shutur,6 Mansior F Alhazmi,6 Mohammed A Hurubi,6 Kutayd S ALShammari,6 Khalid M Alzahrani,7 Hadeel M Aldaghriri,7 Anood A Alshammari,8 Oudah S Alatawi,8 Reema A Alharbi9 1Department of Pharmacy Services Administration, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia; 2Department of Clinical Pharmacy, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia; 3Department of Clinical Pharmacy, Northern Border University, Rafha, Kingdom of Saudi Arabia; 4Department of Pharmacy, Security Forces Hospital, Riyadh, Kingdom of Saudi Arabia; 5Department of Respiratory Care, Northern Armed Area Forced Hospital, Hafar al Batin, Kingdom of Saudi Arabia; 6Department of Supply and Logistics, Northern Armed Area Forced Hospital, Hafar Al Batin, Kingdom of Saudi Arabia; 7Department of Radiology, Northern Armed Area Forced Hospital, Hafar Al Batin, Kingdom of Saudi Arabia; 8Pharmaceutical Services Department, Northern Area Armed Forces Hospital, King Khalid Military, Hafr Al Batin, Kingdom of Saudi Arabia; 9Department of Medicine, University of Tabuk, Tabuk, Saudi ArabiaCorrespondence: Mohammed K Alshammari, Department of Clinical Pharmacy, King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia, Email Mkaalshammari@kfmc.med.saPurpose: Despite the existence of effective medications, pulmonary tuberculosis (PTB) remains a significant global public health concern, The evaluation and feedback of national TB control programs are crucial, requiring diligent monitoring of TB treatment outcomes and analysis of the factors influencing these outcomes. This study aims to provide valuable insights into the challenges faced by TB patients, which can inform better strategies for treatment and management in the future.Patients and Methods: We conducted a study in King Fahad Medical City, Riyadh, Kingdom of Saudi Arabia (KSA), from January 1, 2018 to December 31, 2023. The study was a registry-based retrospective cohort study. Patients’ data were sourced from the National Tuberculosis Registry database of Saudi Arabia. Treatment outcomes were determined as either success or failure, considering clinical evaluation, changes in chest X-rays, and the results of subsequent sputum examinations during follow-up. To evaluate the data, SPSS version 28.0 was used.Results: A total of 427 PTB patients participated in the study. The results show successful treatment outcomes among 88.5% of patients. Among the patients, males exhibited a higher likelihood of treatment failure as compared to females (aOR 1.3; 95%Cl 1.2– 1.5, p < 0.001). Patients with positive sputum smear (aOR 1.3; 95%Cl 1.1– 1.3 p < 0.00) and the presence of cough were associated with an increased risk of treatment failure (aOR1.5; 95%Cl 1.1– 1.4, p < 0.001).Conclusion: This study shows that the percentage of unsuccessful treatment outcomes is high, ie, 11.5%, due to patients’ deaths and loss to follow-up. Enhanced supervision and treatment monitoring for tuberculosis patients at high risk of treatment failure can lead to improved treatment success rates in Saudi Arabia.Keywords: tuberculosis, treatment outcomes, retrospective study, Saudi Arabia

Background: Competency of the staff working in infection prevention and control (IPC) is the cornerstone of successful IPC programs. The objective was to assess competency level and associated factors among IPC staff working in the Middle East and North Africa (MENA) region., Methods: A cross-sectional study was carried out in 2019 among active IPC staff who were members of the Arab Countries Infection Control Network. The questionnaire covered demographic and professional characteristics of IPC staff and characteristics of work facilities and IPC programs. A competency score was created from self-perceived responses to 8 competency domains. The competency score was then transformed into 100-scale and categorized into two groups (≥ median and < median)., Results: A total of 176 participants completed the survey. Participants were mostly female (65.7%), and the mean age was 40.2 ± 8.3 years. The mean competency score was 61.4%. It was slightly variable between domains, being highest with preventing transmission of infection (65%) and lowest with sterilization and disinfection (59%). Higher (≥ median) competency score was associated with having CBIC certification (p < 0.001). It was also associated with facilities having IPC plan (p = 0.005), IPC committee (p = 0.049), regular meetings of IPC committee (p < 0.001), and IPC plan included communications with healthcare workers (p < 0.001). Domain-specific competency scores were significantly associated with receiving same domain-specific training (p < 0.05 for all)., Conclusions: The competency levels of IPC staff in the MENA region is still suboptimal. The current finding calls for more regional and national investment in IPC staff by providing up-to-date customized educational and training opportunities., (© 2024. The Author(s).)

Objective:  Even though COVID-19 is no longer in an acute pandemic phase, sustaining awareness and promoting the uptake of COVID-19 vaccines are crucial for preventing future outbreaks and protecting public health. This study explores the awareness and uptake of COVID-19 vaccines among residents of Bisha, Asir province. It examines sources of information, healthcare providers' influence, and community engagement initiatives. The findings can inform future public health policies and strategies, supporting efforts to control the spread of the pandemic and enhance community resilience., Methods:  The cross-sectional study was administered to the adult population in Bisha. The study involved a total of 220 respondents. Data were collected using a questionnaire and analyzed using SPSS version 27 to obtain essential insights., Results: Most respondents (n = 204, 92.73%) reported receiving information about COVID-19 vaccines from healthcare professionals, other people, and family members. The study also revealed that only 46 (20.9%) individuals had exposure to COVID-19, with 36 (78.26%) reporting infection before vaccination and only 10 (21.74%) reporting infection after vaccination. Regarding COVID-19 vaccine first-dose uptake, less than half (27.73%) of the respondents had received the first dose. Among those who took the first dose, 29 (47.54%) took the second dose, while 32 (52.46%) did not. It also shows a statistically significant difference in COVID-19 vaccine uptake based on the participant's age, gender, education level, comorbidity, smoking status, and place of residence (P < 0.05)., Conclusion: There was a significantly high level of awareness about the vaccine, with significant proportions of respondents indicating their willingness to take preventive measures even after vaccination. However, vaccine uptake remains below optimal levels, with various reasons cited for non-vaccination, including concerns about vaccine availability, efficacy, and side effects. Healthcare professionals should intensify public education efforts and ensure the availability of vaccines in various forms at hospitals to address this issue., Competing Interests: Human subjects: Consent was obtained or waived by all participants in this study. Bisha University Ethics Committee issued approval BU/1814/223 (dated 22/03/2021). Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Alghamdi et al.)

Background: COVID-19 is the largest recorded pandemic in history. It causes several complications such as shock, pneumonia, acute respiratory distress syndrome, and organ failure. The objective was to determine COVID-19 outcomes and risk factors in the intensive care (ICU) setting., Methods: A retrospective review of prospectively collected data was conducted. Adult patients with a positive RT-PCR test for COVID-19 admitted to ICUs of a tertiary care hospital between 2020 and 2022 were included. Patients who had severe complex trauma were excluded. The outcomes examined included ventilation use and duration, length of stay (LOS), and mortality., Results: A total of 964 patients were included. The mean ( ± standard deviation, SD) age was 63.7 ± 16.9 years. The majority of the patients were males (59.0 %) and Saudi (75.7 %). Ventilation use was documented in 443 (57.1 %) patients, with a mean ( ± SD) ventilation duration of 9.7 ± 8.4 days. Death occurred in 361 (37.4 %) patients after a mean ( ± SD) of 33.3 ± 44.5 days from infection. The mean ( ± SD) LOS was 30.6 ± 54.1 days in hospital and 5.2 ± 5.4 days in ICU. Ventilation use was associated with older age, males, longer ICU LOS, mortality, and admission to medical-surgical ICU. Crude mortality use was associated with older age, longer ICU LOS, use of ventilator, shorter ventilation duration, and admission to medical-surgical or respiratory ICUs., Conclusions: COVID-19 patients admitted to adult ICUs are at high risk of death and mechanical ventilation. The crude risks of both outcomes are higher in older age and longer ICU LOS and are very variable by ICU type., Competing Interests: Declaration of Competing Interest This manuscript is an original work and is not under consideration for publication by other journals. Some of this study’s findings have been presented at a conference KSA ID week on 13 December 2022., (Copyright © 2024 King Abdulaziz Medical City. Published by Elsevier Ltd.. All rights reserved.)

This retrospective study compared central line-associated bloodstream infection (CLABSI) rates per 1 000 central line days, and overall mortality before and during the COVID-19 pandemic in adult, paediatric, and neonatal ICU patients at King Abdul-Aziz Medical City-Riyadh who had a central line and were diagnosed with CLABSI according to the National Healthcare Safety Network standard definition. The study spanned between January 2018 and December 2019 (pre-pandemic), and January 2020 and December 2021 (pandemic). SARS-CoV-2 was confirmed by positive RT-PCR testing. The study included 156 CLABSI events and 46 406 central line days; 52 and 22 447 (respectively) in pre-pandemic, and 104 and 23 959 (respectively) during the pandemic. CLABSI rates increased by 2.02 per 1 000 central line days during the pandemic period (from 2.32 to 4.34, p  < 0.001). Likewise, overall mortality rates increased by 0.86 per 1 000 patient days (from 0.93 to 1.79, p  = 0.003). Both CLABSI rates (6.18 vs. 3.7, p  = 0.006) and overall mortality (2.72 vs. 1.47, p  = 0.014) were higher among COVID-19 patients compared to non-COVID-19 patients. The pandemic was associated with a substantial increase in CLABSI-associated morbidity and mortality.

Competing Interests: We declare no competing interests. AZ acknowledges support from the Pan-African Network for Rapid Response, Research and Preparedness for Emerging and Re-Emerging Infections (PANDORA-ID-NET) funded by the EU-EDCTP2—EU Horizon 2020 Framework Program, has received a UK NIHR Senior Investigator Award, and is a Mahathir Science Award and EU-EDCTP Pascoal Mocumbi Prize Laureate.

Background: A widely-accepted standardized preventive bundle targeting multidrug-resistant organisms (MDROs) is lacking. The objective was to describe the components, implementation, compliance, and impact of a novel MDROs bundle in intensive care units (ICUs)., Methods: Cohort study of surveillance activities on the components of MDROs bundle (July 2019 to June 2022) and the incidence of MDROs (April 2016 to June 2022). The implementation of MDROs bundle were preceded by ICPs-led education of the staff working in target ICUs about the importance and components of the MDROs bundle. These included the overall use of antimicrobials, appropriate environmental cleaning, appropriate contact precautions, and hand hygiene compliance., Results: During implementation, the overall use of antimicrobials was 57.8 days of therapy per 100 patient-days (44,492/76,933). It was higher in adult compared with pediatric/neonatal ICUs (p < 0.001). Appropriate environmental cleaning was 74.8% (12,409/16,582), appropriate contact precautions was 83.8% (10,467/12,497), and hand hygiene compliance was 86.9% (27,023/31,096). The three components were significantly higher in pediatric/neonatal compared with adult ICUs (p = 0.027, p < 0.001, p = 0.006, respectively). The MDROs rates per 10,000 patient-days were 71.8 before (April 2016 to June 2019) and 62.0 during (July 2019 to June 2022) the bundle implementation (858/119,565 versus 891/143,649 p = 0.002). The reduction in MDROs rates were replicated in adult (p = 0.001) but not pediatric/neonatal ICUs (p = 0.530)., Conclusions: The finding of this study indicate that the implementation of the current bundle was associated with a modest decrease in MDROs rates in adult ICUs. The provided detailed definitions and methodology will facilitate its use by other healthcare facilities., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2024 The Authors.)

Background: Hospital outbreaks caused by Burkholderia spp. have been linked to contamination of several medical solutions and products and are frequently associated with delayed detection and high mortality., Aim: To describe the management of two consecutive Burkholderia contaminans outbreaks caused by contaminated mouthwash of different brands during the COVID-19 pandemic., Methods: This was a retrospective cohort study of all patients involved in two outbreaks caused by B. contaminans detected in 2021 and 2022. The investigation was initiated after a cluster of positive respiratory specimens, followed by retrospective and prospective case-finding., Findings: A total of 69 patients were affected, 47 in 2021 and 22 in 2022. The majority of affected patients had positive respiratory specimens (85.5%); 55.1% of cases had COVID-19, and 72.5% had multidrug-resistant organisms. Almost all (97.1%) patients required ventilation and 42.0% died. Seventeen percent of cases in the first outbreak were deemed to have been acquired by patient-to-patient transmission, whereas all of the cases in the second outbreak were infected directly from using mouthwash. The experience gained from the first outbreak and the formation of a multidisciplinary Infection Control Rapid Response Team resulted in more rapid recognition and control of the second outbreak. Multivariate analysis showed that older age, intensive care unit admission, and COVID-19 infection were independent predictors of mortality., Conclusion: Burkholderia outbreaks at the time of COVID-19 were associated with high mortality. Rapid detection and response by a dedicated experienced team (as in the second outbreak) can reduce mortality and prevent superimposed cross-transmission between patients., (Copyright © 2023 The Healthcare Infection Society. Published by Elsevier Ltd. All rights reserved.)

Background: The general human immune responses similarity against different coronaviruses may reflect some degree of cross-immunity, whereby exposure to one coronavirus may confer partial immunity to another. The aim was to determine whether previous MERS-CoV infection was associated with a lower risk of subsequent COVID-19 disease and its related outcomes., Methods: We conducted a retrospective cohort study among all patients screened for MERS-CoV at a tertiary care hospital in Saudi Arabia between 2012 and early 2020. Both MERS-CoV positive and negative patients were followed up from early 2020 to September 2021 for developing COVID-19 infection confirmed by RT-PCR testing., Results: A total of 397 participants followed for an average 15 months during COVID-19 pandemic (4.9 years from MERS-CoV infection). Of the 397 participants, 93 (23.4%) were positive for MERS-CoV at baseline; 61 (65.6%) of the positive cases were symptomatic. Out of 397, 48 (12.1%) participants developed COVID-19 by the end of the follow-up period. Cox regression analysis adjusted for age, gender, and major comorbidity showed a marginally significant lower risk of COVID-19 disease (hazard ratio = 0.533, p = 0.085) and hospital admission (hazard ratio = 0.411, p = 0.061) in patients with positive MERS-CoV. Additionally, the risk of COVID-19 disease was further reduced and became significant in patients with symptomatic MERS-CoV infection (hazard ratio = 0.324, p = 0.034) and hospital admission (hazard ratio = 0.317, p = 0.042)., Conclusions: The current findings may indicate a partial cross-immunity, where patients with symptomatic MERS-CoV have a lower risk of future COVID-19 infection and related hospitalization. The present results may need further examination nationally using immunity markers., (© 2023. The Author(s).)

Background: Portable computerized devices represent a potential source of healthcare infections. The objective was to assess the knowledge, attitudes, and practices (KAP) of healthcare workers (HCWs) toward infection control practices used with Close Loop Medication Administration (CLMA) devices. Additionally, to quantify the impact of education and training on the bacterial burden on CLMA devices., Methods: The study design consisted of two steps: a cross-sectional study was conducted among HCWs working in a tertiary care center in Riyadh, Saudi Arabia. A 32-item questionnaire was used to assess KAP information. The second step was environmental samples collected from the surfaces of CLMA devices before and after implementing a multifaceted intervention., Result: A total of 325 HCWs were included in the study. The mean age was 32.6±7.4 years. The majority were females (92%) and nurses (91.3%). The overall KAP score was 74.8%, 74.2% adequate knowledge, 79.3% positive attitude, and 71.3% appropriate practices. KAP score was better (≥ median KAP score) among HCWs working in laboratory and organ transplant units ( P <0.001). It was also better among those with a longer duration of work experience ( P <0.001) and those who received related training ( P <0.001). Approximately 75% of HCWs expressed their need for more information about CLMA. Post-interventional samples had much lower bacterial burden, with the positive rate reduced from 51.4% before intervention to 16.8% after intervention ( P <0.001)., Conclusions: Awareness and behavior of HCWs about appropriate infection control practices related to portable devices is still inadequate. A multifaceted intervention including education and training significantly reduces the bioburden on portable devices., (© 2023 The Authors.)

Background: Surveillance of healthcare-associated infections (HAIs) is a cornerstone for effective infection prevention and control (IPC) programs. The objective was to evaluate the coverage and methods of HAI surveillance in Middle Eastern and North African (MENA) countries., Methods: A cross-sectional study targeted IPC staff working in MENA countries using the Infection Control Network electronic database of the Arab countries. The study focused on self-reported surveillance-related characteristics of IPC staff, facilities, and the IPC program., Results: A total of 269 IPC staff were included. They were mainly females (68%), nurses (63%), and working in GCC countries (83%). Approximately 69% of covered facilities had surveillance activities. Hand hygiene, multidrug-resistant organisms, central line-associated bloodstream infections, and catheter-associated urinary tract infections were the most common surveillance activities (>90%). The surveillance workload consumed 27% of the average weekly working time. The scores of performing multiple surveillance, with appropriate methods and tools, were 83%, 67%, and 61% (respectively). Appropriate surveillance methods and/or tools were linked to GCC region, CBIC qualifications, surveillance training, specific setting (acute care and long term), staff-to-bed ratio, presence and active function of IPC committee, presence of IPC annual plan, communications with health care workers, and leadership support., Conclusions: While most health care facilities in the MENA region perform multiple surveillance, surveillance methods and tools are still suboptimal and their optimization should be a priority., (Copyright © 2023 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Background Multidrug-resistant Gram-negative bacteria (MDR-GNB) present a significant and escalating hazard to healthcare globally. Context-specific interventions have been implemented for the prevention and control of MDR-GNB in several healthcare facilities. The objective of this study was to implement and evaluate the effectiveness of evidence-based interventions in the incidence and dissemination of MDR-GNB. Methods This was a pre-and post-intervention study conducted in three phases at King Abdulaziz Medical City Jeddah, Saudi Arabia. During Phase-1, the data on each of the four MDR-GNB ( Acinetobacter baumannii, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Escherichia coli ) were collected prospectively. Genomic fingerprinting was performed on isolates using enterobacterial repetitive intergenic consensus-polymerase chain reaction (ERIC-PCR) to determine clonality and establish a link between different strains within and between the hospital wards/units. In the second phase, targeted interventions were implemented in the adult intensive care unit (ICU) based on previously determined risk factors and included the education of healthcare workers on hand hygiene, disinfection of patients' surrounding, daily chlorhexidine baths, and disinfection rooms on discharge with hydrogen peroxide fogging after MDR-GNB patients were discharged. An antibiotic restriction protocol was simultaneously implemented as part of the hospital antibiotic stewardship program. In the third phase, the effectiveness of the interventions was evaluated by comparing the incidence rate and clonality (using ERIC-PCR genetic fingerprints) of MDR-GNB before and after the intervention. Results A significant reduction of MDR-GNB was observed in Phase-2 and Phase-3 compared with Phase-1. The mean incidence rate of MDR-GNB per 1000 patient days in Phase-1 (pre-intervention) was 11.08/1000, followed by 6.07 and 3.54/1000 in Phase-2 and Phase-3, respectively. A statistically significant reduction was observed in the incidence rate of MDR-GNB in the adult ICU (P=0.007), whereas no statistically significant decrease (P=0.419) was observed in areas other than the adult ICU. Two A. baumannii strains appear to be circulating within the ICU environment with reduced frequency in Phase-2 and Phase-3 compared to Phase-1. Conclusion  There was a significant reduction in the incidence of MDR-GNB in the adult ICU due to the successful implementation of both infection control and stewardship interventions, albeit challenging to ascertain the relative contribution of each., Competing Interests: Professor Essack is the chairperson of the Global Respiratory Infection Partnership (GRIP), sponsored by an unrestricted educational grant from Reckitt and Benckiser (Pty) Ltd. UK. The other author(s) declared no potential conflicts of interest concerning this article's research, authorship, and publication, (Copyright © 2023, Althaqafi et al.)

Objective: To examine the distribution and the trend of airborne particles and bio-aerosol concentration in pediatric intensive care units (PICUs) in two tertiary care hospitals with different ventilation setting., Methods: Hospitals A but not B is provided with a central HEPA filter. PICUs in both hospitals were categorized into protective environment (PE) with room HEPA filter, semi-protective environment (SPE) with portable air-purifier, and non-protective environment (NPE) with neither system. Fine particles (≤ 2.5 µm) and coarse particles (≤ 10.0 µm) were obtained using optical particle counter (Lighthouse Handheld 3016) and total bacterial (TBC) and fungal (TFC) counts were obtained using Andersen air sampler., Results: Hospital B had significantly higher levels of fine and coarse particles (in all room), TBC (in PE), but not TFC compared with matched rooms in hospital A. In hospital B, the levels of fine particles, coarse particles, and TBC were lowest in SPE (p < 0.001, p = 0.004, and p = 0.006, respectively) while TFC was lowest in NPE (p = 0.014). Airborne particles, TBC, and TFC had variable trends with some of the indoor peaks follow outdoor peaks. Gram-positive bacteria (69 %) were the predominant bacteria in hospital A while bacterial flora (70 %) were the predominant bacteria in hospital B (p < 0.001 for each)., Conclusions: The levels of airborne contaminants and microbial counts in PICUs are significantly affected by the ventilation system and to less extent by outdoor levels. The results indicated that advanced filtration system and central HEPA filters play a significant role in the reduction of indoor fine particulates and TBC., Competing Interests: Conflict of interest All authors have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Background: The higher risk of COVID-19 in health care workers (HCWs) is well-known. However, the risk within HCWs is not fully understood. The objective was to compare the COVID-19 risk in intensive care unit (ICU) vs non-ICU locations., Methods: A prospective surveillance study was conducted among HCWs at a large tertiary care facility in Riyadh between March 1st to November 30th, 2020. HCWs included both clinical (provide direct patient care) and nonclinical positions (do not provide direct patient care)., Results: A total 1,594 HCWs with COVID-19 were included; 103 (6.5%) working in ICU and 1,491 (93.5%) working in non-ICU locations. Compared with non-ICU locations, ICU had more nurses (54.4% vs 22.1%, P < .001) and less support staff (2.9% vs 53.1%, P < .001). COVID-19 infection was similar in ICU and non-ICU locations (9.0% vs 9.8%, P = .374). However, it was significantly higher in ICU nurses (12.3% vs 6.5%, P < .001). Support staff had higher risk than other HCWs, irrespective of ICU working status (15.1% vs 7.2%, P < 0.001). The crude relative risk of COVID-19 in ICU vs non-ICU locations was 0.92, 95% confidence interval ( was 0.76-1.11 (P = .374). However, relative risk adjusted for professional category was significantly increased to 1.23, 95% confidence interval 1.01-1.50 (P = .036)., Conclusions: ICU had a significantly higher risk of COVID-19 infection only after adjusting for the distribution and risk of different professional categories. The latter is probably determined by both exposure level and protection practices. The finding underscores the importance of strict implementation of preventive measures among all HCWs, including those performing nonclinical services., (Copyright © 2022 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.)

Background: Since the occurrence of coronavirus disease in 2019 (COVID-19), the global community has witnessed its exponential spread with devastating outcomes within the general population and specifically within hemodialysis patients., Objectives: Compare the state of immunity to SARS-CoV-2 among hemodialysis patients and staff., Design: Cross-sectional study with a prospective follow-up period., Setting: Hemodialysis centers in Madinah region., Patients and Methods: We prospectively tested for SARS-CoV-2 antibodies in dialysis patients using dialysis centers staff as controls. The participants were tested on four occasions when feasible for the presence of anti-SARS-CoV-2 antibodies. We also analyzed factors that might be associated with seropositivity., Main Outcome Measures: SARS-CoV-2 positivity using immunoglobulin G (IgG) levels SAMPLE SIZE: 830 participants, 677 patients and 153 dialysis centers staff as controls., Results: Of the total participants, 325 (257 patients and 68 staff) were positive for SARS-CoV-2 IgG antibodies, for a prevalence of 38.0% and 44.4% among patients and staff, respectively ( P =.1379). Participants with a history of COVID-19 or related symptoms were more likely to have positive IgG ( P <.0001). Surprisingly, positivity was also center-dependent. In a multivariable logistic regression, a history of infection and related symptoms contributed significantly to developing immunity., Conclusion: The high prevalence of SARS-CoV-2 antibody among hemodialysis patients and previously asymptomatic staff suggested past asymptomatic infection. Some centers showed more immunity effects than others., Limitations: Unable to collect four samples for each participant; limited to one urban center., Conflict of Interest: None.

Introduction: Infection prevention and control (IPC) programs in the Middle Eastern and North African (MENA) countries are evolving. The objective was to characterize IPC personnel and programs in MENA countries, with special emphasis on the differences between Gulf Cooperation Council (GCC) and non-GCC countries., Methodology: A cross-sectional online survey was conducted in 2019 among IPC members of the Arab Countries Infection Control Network (AcicN). The survey focused on three domains; demographic and professional characteristics, organizational structure, and IPC program characteristics., Results: A total of 269 participants aged 39.9 ± 8.4 years were included in the study. Majority of the participants were females (67.7%), nurses (63.7%), and of Middle-Eastern origin (57.3%). 32.2% of the participants were certified by the Certification Board of Infection Control (CBIC). Only 22.7% of participants were satisfied with their current compensation. Surveillance was the most time-consuming task (26.6%), followed by isolation (12.4%), and investigation of outbreaks (12.1%). Majority of the facilities had at least one IPC personnel per 100 beds (60.9%), supported IPC program (63.9%), a formal IPC committee (93.7%), and an IPC plan (91.4%). Compared with non-GCC countries, GCC countries had significantly more frequent CBIC certification (p = 0.003), training in cleaning/sterilization (p = 0.010), supported IPC program (p = 0.010), formal IPC committee (p = 0.001), IPC plan (p = 0.001), and higher number of IPC personnel per 100 beds (p = 0.047)., Conclusions: MENA countries had generally satisfactory IPC programs and to a lesser extent staffing, with considerable variability between countries with different resources., Competing Interests: No Conflict of Interest is declared, (Copyright (c) 2022 Elias Tannous, Aiman El-Saed, Kholoud Ameer, Abeer Khalaf, Shafi Mohammad, Basel Molaeb, Majid M Alshamrani.)

Healthcare workers have been categorized among the priority groups for COVID-19 vaccination. However, post-vaccination infections have been identified. This study was conducted to investigate SARS-CoV-2 infection among healthcare workers (HCWs) who received the COVID-19 vaccine. A case series in a multicenter healthcare system in Saudi Arabia was created from HCWs who had (PCR-RT) confirmed SARS-CoV-2 infection after at least one dose of Pfizer-BioNTech vaccination. A total of 20 healthcare workers (HCWs) have been included. The majority (70.0%) were males and the average age was 39.4 ± 10.1 years. They included physicians (55.0%), nurses (25.0%) and other HCWs (20.0%). Eighteen (90%) HCWs had infection after the first dose; 47.1% within the first week, 41.2% within the second week, and 11.8% within the third week. Only two HCWs (10.0%) had infection one week after the second dose. The majority (63.2%) had mild (52.6%) or moderate (10.3%) disease with no severe disease or hospitalization. The majority of post-vaccination COVID-19 infections among HCWs occurred before the full protection of the vaccine is gained. Suspicion of COVID-19 infection should be considered even with a history of COVID-19 vaccination. Recently vaccinated HCWs should be advised to fully comply with all recommended precautions to prevent COVID-19 transmission., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: COVID-19 pandemic caused enormous implications on the frontline staff. The objective was to share our nursing experience in responding to COVID-19 pandemic at a large hospital and its impact on nursing safety and healthcare services., Methods: Six nursing strategic pillars were implemented. Pillar 1: establishing corona command centre. Pillar 2: limiting exposure by virtual care model, strict infection control measures, altered patient flow, active surveillance, and contact tracing. Pillar 3: maintaining sufficient supplies of personal protective equipment. Pillar 4: creating surge capacity by establishing dedicated COVID-19 units and increasing critical care beds. Pillar 5: training and redeployment of nurses and implementing alternate staffing models. Pillar 6: monitoring staff wellbeing, establishing mental health support hotline and clinic, providing hotel self-quarantine, and financial incentives., Results: Out of 5483 nurses, 543 (10%) were trained for redeployment, mainly at acute and intensive care units. After serving 11,623 infected patient including 1646 hospitalizations during the first 9 months of the pandemic, only 385 (7.0%) nurses were infected with COVID-19. Out of them, only 10 (2.6%) required hospitalization, one (0.3%) required ICU admission, and none died. Although the number of patients hospitalized at our hospital during the current pandemic was 17 folds higher than the 2015 outbreak of middle East respiratory syndrome coronavirus, the hospital administration did not have to close the hospital as they did in 2015., Conclusions: Proactive nursing leadership and implementation of multiple nursing pillars enabled the facility to maintain the safety of nursing workforce while serving large influx of COVID-19 patients., (Copyright © 2021 The Author(s). Published by Elsevier Ltd.. All rights reserved.)

Objectives: To estimate COVID-19 infection and outcomes among healthcare workers (HCWs) compared with non-HCWs., Methods: A prospective surveillance study was conducted among HCWs and non-HCWs eligible for treatment at a large tertiary care facility in Riyadh between March 1st to November 30th, 2020., Results: A total 13,219 cases with confirmed COVID-19 have been detected during the study; 1596 (12.1%) HCW patients (HCWPs) and 11623 (87.9%) non-HCWPs. Infection per 100 population was almost ten-fold higher in HCWs compared with non-HCWs (9.78 versus 1.01, p<0.001). The risk of infection in support staff (15.1%) was almost double the risk in other professional groups (p<0.001). Hospitalization (14.1% versus 1.8%, p<0.001), ICU admission (3.0% versus 0.5%, p<0.001), and case fatality (0.13% versus 2.77%, p<0.001) were significantly lower in HCWPs compared with non-HCWPs. The mortality per 100,000 population was significantly lower in HCWs compared with non-HCWs (12.3 and 28.1, p<0.001)., Conclusion: HCWs are at ten-fold higher risk of COVID-19 infection but have much better outcomes compared with non-HCWs. More strict infection control measures are still required to protect HCWs, including those who are not involved in direct patient care., Competing Interests: Declaration of Competing Interests The authors declare no conflicts of interest., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Community-acquired pneumonia (CAP) is a significant cause of morbidity and mortality, especially for the elderly and people who suffer from chronic conditions. This study was conducted to assess the clinical and microbiological characteristics and disease outcomes associated with the occurrence of CAP., Methods: This retrospective chart review was conducted at King Abdulaziz Medical City, Jeddah, Saudi Arabia. Cases with documented clinical diagnosis of CAP during the period from 2016 to 2019 were included. Data were collected on demographic, clinical, and microbiological characteristics, used antimicrobials and patients' outcomes, including length of hospital stay, intensive care unit admission, and mortality. Multivariate regression analysis was performed to identify risk factors for increased length of hospital stay., Results: A total of two hundred and eighteen CAP episodes were identified. Patients had a median age of 64.5 years, and 54.1% were males. Microbiological diagnosis was established in 33 patients (15.1%). Admission to ICU and diagnosis of a neurological disease were significantly associated with longer hospital stay (>7 days). An average of 2.7 antimicrobials were used per patient, and the most common antibiotics used were Piperacillin/Tazobactam (46.3%), Doxycycline (44%), then Ceftriaxone (42.7%). Four patients (1.8%) died during hospital stay., Conclusions: This retrospective analysis of CAP cases identified a lack of microbiological diagnosis and increased burden associated with disease severity and the need for hospitalization. The ability to identify CAP at an earlier stage will be a cornerstone to mitigate its impact on the healthcare system and ICU units., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Objective: To describe local experience in managing an outbreak of Candida auris in a tertiary-care setting., Methods: In response to emerging Candida auris, an outbreak investigation was conducted at our hospital between March 2018 and June 2019. Once a patient was confirmed to have Candida auris, screening of exposed patients and healthcare workers (HCWs) was conducted. Postexposure screening included those who had had direct contact with or shared the same unit or ward with a laboratory-confirmed case. In response to the increasing number of cases, new infection control measures were implemented., Results: In total, 23 primary patients were detected over 15 months. Postexposure screening identified 11 more cases, and all were patients. Furthermore, ~28.6% of patients probably caught infection in another hospital or in the community. Infection control measures were strictly implemented including hand hygiene, personal protective equipment, patient hygiene, environmental cleaning, cohorting of patients and HCWs, and avoiding the sharing of equipment. The wave reached a peak in April 2019, followed by a sharp decrease in May 2019 and complete clearance in June 2019. The case patients were equally distributed between intensive care units (51.4%) and wards (48.6%). More infections (62.9%) occurred than colonizations (37.1%). Urinary tract infection (42.9%) and candidemia (17.1%) were the main infections. In total, 7 patients (20.0%) died during hospitalization; among them, 6 (17.1%) died within 30 days of diagnosis., Conclusions: Active screening of exposed patients followed by strict infection control measures, including environmental cleaning, was successful in ending the outbreak. Preventing future outbreaks is challenging due to outside sources of infection and environmental resistance.

Objectives: There is local and regional deficiency in the data examining the contribution of resistant pathogens to device-associated healthcare-associated infections (DA-HAIs). The objective was to examine such data in a multi-hospital system in Saudi Arabia in comparison with the US National Health Surveillance Network (NHSN)., Methods: Surveillance of DA-HAIs was prospectively conducted between 2008 and 2016 in four hospitals of Ministry of National Guard Health Affairs. Consecutive NHSN reports were used for comparisons. Definitions and methodology of DA-HAIs and bacterial resistance were based on NHSN., Results: A total 1260 pathogens causing 1141 DA-HAI events were included. Gram negative pathogens (GNPs) were responsible for 62.5% of DA-HAIs, with a significantly higher Klebsiella, Pseudomonas, Acinetobacter, and Enterobacter than NHSN hospitals. Approximately 28.3% of GNPs and 23.5% of gram positive pathogens (GPPs) had some type of resistance. Nearly 34.3% of Klebsiella were resistant to third/fourth generation cephalosporins, 4.8% of Enterobacteriaceae were carbapenem-resistant (CRE), 24.4% of Staphylococcus aureus were methicillin-resistant (MRSA), and 21.9% of Enterococci were vancomycin-resistant (VRE). Multidrug resistance (MDR) was 65.0% in Acinetobacter, 26.4% in Escherichia coli, 23.0% in Klebsiella, and 14.9% in Pseudomonas. Resistant GNPs including cephalosporin-resistant Klebsiella, MDR Klebsiella, and MDR Escherichia coli were significantly more frequent while resistant GPPs including MRSA and VRE were significantly less frequent than NHSN hospitals., Conclusion: The current findings showed heavier and more resistant contribution of GNPs to DA-HAIs in Saudi hospitals compared with American hospitals. The higher resistance rates in Klebsiella and Escherichia coli are alarming and call for effective antimicrobial stewardship programs., (Copyright © 2020. Published by Elsevier Ltd.)

Background: The life expectancy of people living with HIV is markedly increasing with the introduction of effective antiretroviral medications. However, these patients face an increased risk of developing multi-morbidities-especially with advanced age. This study was conducted to assess the prevalence of and risk factors associated with the occurrence of chronic comorbidities among patients diagnosed with HIV infection., Methods: A retrospective chart review was conducted on the medical records of patients with HIV diagnoses from 2000 to 2018. Data were collected on age, sex, date of diagnosis, associated co-morbidities, antiretroviral medications (ART) and status at time of data collection (alive or deceased). Only adult patients 18 years or above were studied., Results: A total of 130 confirmed HIV cases were included. Patient ages ranged from 23 to 86 years old (mean±SD 50.1±12.6). Almost half of the patients (48.5%) had at least one associated comorbidity. The most common chronic comorbidity was diabetes mellitus (15.4%), followed by dyslipidemia (10.8%), hypertension (10.8%) and lymphoma (10.0%). Comorbidity proportions increased with advanced patient age (p=0.047). Three or more comorbidities were reported in 40.7% of patients aged 60 years old or above. Using logistic regression analysis, only patients aged 50 years old or above were more likely to have at least one comorbidity (OR=7.59, 95%CI=2.25, 25.61)., Conclusions: The burden of chronic comorbidities among people diagnosed with HIV is high, especially among older age individuals, with an increasing number of comorbidities per patient. Proper counseling for HIV patients is highly recommended-not only for prevention of other infectious diseases (e.g., vaccination) but also for lifestyle modification and self-management for those with chronic conditions., (Copyright © 2020 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Background: Despite being largely preventable, surgical site infections (SSIs) are still one of the most frequent healthcare-associated infections. The presence of resistant pathogens can further augment their clinical and economic impacts. The objective was to estimate the distribution and resistance in SSI pathogens in Saudi Arabia and to compare them to the US National Healthcare Safety Network (NHSN) hospitals., Methods: Targeted SSI surveillance was prospectively conducted on several surgical procedures done between 2007 and 2016 in four hospitals of Ministry of National Guard Health Affairs. Definitions and methodology of SSI and bacterial resistance were based on NHSN., Results: A total 492 pathogens causing 403 SSI events were included. The most frequent pathogens were Staphylococcus aureus (22.8%), Pseudomonas aeruginosa (20.1%), Klebsiella spp. (12.2%), and Escherichia coli (12.2%), with marked variability between surgeries. Approximately 30.3% of Staphylococcus aureus was methicillin-resistant (MRSA), 13.0% of Enterococcus spp. was vancomycin-resistant (VRE), and 5.5% of Enterobacteriaceae were carbapenem resistant (CRE). The highest multidrug-resistant (MDR) GNPs were Acinetobacter spp. (58.3%), Klebsiella spp. (20.4%) and Escherichia coli (16.3%). MRSA was significantly less frequent while cephalosporin-resistant Klebsiella spp., MDR Klebsiella spp., and MDR Escherichia coli were significantly more frequent in our hospitals compared with NHSN hospitals., Conclusion: GNPs in a tertiary care setting in Saudi Arabia are responsible for more than 60% of SSI with more resistant patterns than Western countries. This information may be critical to secure resources and ensure support for caregivers and healthcare leaders in implementing antimicrobial stewardship programs and evidence-based SSI preventive practices.

Background: Studying temporal changes in resistant pathogens causing healthcare-associated infections (HAIs) is crucial in improving local antimicrobial and infection control practices. The objective was to describe ten-year trends of resistance in pathogens causing HAIs in a tertiary care setting in Saudi Arabia and to compare such trends with those of US National Health Surveillance Network (NHSN)., Methods: Pooled analysis of surveillance data that were prospectively collected between 2007 and 2016 in four hospitals of Ministry of National Guard Health Affairs. Definitions and methodology of HAIs and antimicrobial resistance were based on NHSN. Consecutive NHSN reports were used for comparisons., Results: A total 1544 pathogens causing 1531 HAI events were included. Gram negative pathogens (GNP) were responsible for 63% of HAIs, with a significant increasing trend in Klebsiella spp. and a decreasing trend in Acinetobacter. Methicillin-resistant Staphylococcus aureus (27.0%) was consistently less frequent than NHSN. Vancomycin-resistant Enterococci (VRE, 20.3%) were more than doubled during the study, closing the gap with NHSN. Carbapenem resistance was highest with Acinetobacter (68.3%) and Pseudomonas (36.8%). Increasing trends of carbapenem resistance were highest in Pseudomonas and Enterobacteriaceae, closing initial gaps with NHSN. With the exception of Klebsiella and Enterobacter, multidrug-resistant (MDR) GNPs were generally decreasing, mainly due to the decreasing resistance towards cephalosporins, fluoroquinolones, and aminoglycosides., Conclusion: The findings showed increasing trends of carbapenem resistance and VRE, which may reflect heavy use of carbapenems and vancomycin. These findings may highlight the need for effective antimicrobial stewardship programs, including monitoring and feedback on antimicrobial use and resistance.

Background: Bloodstream infections (BSI) are a major complication of hemodialysis. The risk of infection among hemodialysis patients is usually associated with the dialysis procedure itself, specifically the means of vascular access., Objectives: Estimate the rate of BSI and assess factors possibly associated with BSI., Design: Analytical retrospective medical record review., Setting: Hemodialysis unit in a tertiary care center., Patients and Methods: Adult patients (18-60 years old) who had hemodialysis as first renal replacement therapy in the 20-month period from January 2014 to August 2016 were included in this study. Demographic and clinical characteristics were used in a multivariate logistic regression to assess factors that might be associated with BSI., Main Outcome Measures: The rate of BSI and associated factors among chronic hemodialysis outpatients., Sample Size and Characteristics: 160 outpatients on hemodialysis, median (IQR) age 47.7 (37.0-56.0) years, males (60.6%)., Results: The rate of BSI was 0.4 per 100 patient-months. Multivariate logistic regression revealed that patients who had central venous catheters had the highest risk for BSI (odds ratio: 10.088; 95% CI= 2.595-39.215; P=.001) compared with arteriovenous fistulas. Gram-negative bacteria were isolated in 54.6% of cases, with coagulase-negative Staphylococcus the most frequent isolate (18.2%), followed by Klebsiella pneumoniae and Enterobacteriaceae (15.2%, each)., Conclusions: The type of vascular access type is the main risk factor associated with BSI in hemodialysis patients. The arteriovenous fistula, which has a lower infection rate compared to the catheter, is the best available option for hemodialysis patients., Limitations: Retrospective, single center and relatively small sample size., Conflict of Interest: None.

A point prevalence survey was conducted on May 11, 2017, among inpatients at 6 hospitals in Saudi Arabia. The overall point prevalence was 6.8% (114 of 1,666). The most common types of infections were pneumonia (27.2%), urinary tract infections (20.2%), and bloodstream infections (10.5%). Approximately 19.2% of healthcare-associated infections were device associated.

The Gulf Cooperation Council Center for Infection Control (GCC-IC) has moved forward over the past several years on the antimicrobial resistance (AMR) agenda. Many of the GCC countries have now developed a national plan to combat AMR and have engaged the leadership of the involved sectors in the discussion on how to mitigate this threat. During the first meeting for the GCC-IC center on AMR, which took place early 2015, the roadmap for combating AMR was developed [1] and since then much more has been done. We present here the discussion that took place during the second GCC-IC center meeting on AMR where not only have the countries presented their progress, but we conducted 2 round table discussions inviting international and regional experts in the field to share their thoughts, progress and knowledge on this topic [2]. Within is the 2nd round table discussion at the 2017 GCC AMR meeting which took place in Riyadh, Saudi Arabia, April 2017. Where the 1st round table discussion during this meeting addressed the role of leadership in managing AMR [2]., (Copyright © 2018. Published by Elsevier Ltd.)

The threat of Antimicrobial Resistance (AMR) has attracted the highest level of attention after the United Nation (UN) General Assembly's High Level meeting on AMR in 2016. During that meeting a temporary committee, the inter agency coordination group (IACG) [1] was formulated, under the chairmanship of the Director General of the World Health Organization (DG-WHO) and the UN Deputy Secretary General. The IACG group was tasked to link, guide and advise on political steps needed to address and mitigate the emergence of AMR globally [2]. Efforts to combat AMR, however, have previously been developed prior to this initiative by several decades. Yet, the emergence of resistance continues to be on the rise. The Gulf Cooperation Council Center for Infection Control (GCC-IC) was been established in 2005 and has made major efforts to address all aspects related to human infection control in the member countries. Many of which have been reached. In 2015, the board was able to draft through its multidisciplinary meeting the first roadmap for the counties on this issue [3]. Two years later a follow-up meeting took place in Riyadh on April 2017. Regional and international experts joined in to share and contribute to the understanding of AMR and to advise on further steps needed for this initiative. We dedicated 3 papers on this meeting. The first paper is to provide an update on progress form the GCC countries and further steps that need to be taken, (in press). The second paper is part one out of two round table discussions. The first round table discussion paper, which is the current paper, addresses AMR and the "One Health" concept with a focus on leadership. The second round table discussion paper addresses AMR and the "One Health" concept with a focus on human health [4]., (Copyright © 2018. Published by Elsevier Ltd.)

Objectives: To determine the impact of applying the best available clinical evidence on the preventive measures to reduce the rate of catheter-associated urinary tract infections (CAUTI) in adult intensive care units (ICU).     Methods:  Data were collected from adult ICUs (28 beds) from 2008 to 2016. The proper use of silicon catheter, aseptic insertion technique, emptying bag three-fourth via close circuit, the use of appropriate size catheter, securing the draining tube on the thigh to keep catheter bag below patient's bladder level and removal of the catheter as early as possible were ensured in all patients.   Results: Rate of UTI and urinary catheter utilization ratios were reviewed during the study period. There was a mean of 6,175 catheter days/year for ICU. Despite the overall rise in the urinary catheterization ratio over these years; we observed a significant reduction in the UTI rate per 1000 Urinary catheter days; from 2.3 in 2010 to 0.3 in 2011 and it was sustained through 2016.  Conclusion: The monthly rates of CAUTI significantly declined after the enforcement of agreed strategies and interventions to prevent CAUTI rates in adult ICU.

A total 130 cases of Middle East respiratory syndrome coronavirus were identified during a large hospital outbreak in Saudi Arabia; 87 patients and 43 healthcare workers. The majority (80%) of transmission was healthcare-acquired (HAI) infection, with 4 generations of HAI transmission. The emergency department was the main location of exposure., (© The Author 2017. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.)

BACKGROUND Since the first isolation of Middle East respiratory syndrome coronavirus (MERS-CoV) in Saudi Arabia in 2012, sporadic cases, clusters, and sometimes large outbreaks have been reported. OBJECTIVE To describe the recent (2015) MERS-CoV outbreak at a large tertiary care hospital in Riyadh, Saudi Arabia. METHODS We conducted an epidemiologic outbreak investigation, including case finding and contact tracing and screening. MERS-CoV cases were categorized as suspected, probable, and confirmed. A confirmed case was defined as positive reverse transcription polymerase chain reaction test for MERS-CoV. RESULTS Of the 130 suspected cases, 81 (62%) were confirmed and 49 (38%) were probable. These included 87 patients (67%) and 43 healthcare workers (33%). Older age (mean [SD], 64.4 [18.3] vs 40.1 [11.3] years, P<.001), symptoms (97% vs 58%, P<.001), and comorbidity (99% vs 42%, P<.001) were more common in patients than healthcare workers. Almost all patients (97%) were hospitalized whereas most healthcare workers (72%) were home isolated. Among 96 hospitalized cases, 63 (66%) required intensive care unit management and 60 (63%) required mechanical ventilation. Among all 130 cases, 51 (39%) died; all were patients (51 [59%]) with no deaths among healthcare workers. More than half (54%) of infections were believed to be caught at the emergency department. Strict infection control measures, including isolation and closure of the emergency department, were implemented to interrupt the chain of transmission and end the outbreak. CONCLUSION MERS-CoV remains a major healthcare threat. Early recognition of cases and rapid implementation of infection control measures are necessary. Infect Control Hosp Epidemiol 2016;1-9.

Since the first diagnosis of Middle East respiratory syndrome (MERS) caused by the MERS coronavirus (MERS-CoV) in the Kingdom of Saudi Arabia in 2012, sporadic cases and clusters have occurred throughout the country (1). During June-August, 2015, a large MERS outbreak occurred at King Abulaziz Medical City, a 1,200-bed tertiary-care hospital that includes a 150-bed emergency department that registers 250,000 visits per year.