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Journal articles on the topic 'Intensive care units Saudi Arabia'

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Author: Grafiati

Published: 10 December 2022

Last updated: 28 January 2023

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1

Alabdullah, Amany, Lisa Whiting, Brian Littlechild, and Ben Liu. "Workplace stress in paediatric intensive care units in Saudi Arabia: A mixed-methods study." Journal of Nursing Education and Practice 13, no. 2 (November 1, 2022): 44. http://dx.doi.org/10.5430/jnep.v13n2p44.

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Workplace stress, as experienced by nurses working in intensive care units, can affect health, quality and delivery of nursing care and healthcare costs. However, no studies have purely focused on Paediatric Intensive Care Units (PICU) and specifically considered workplace stress within a Saudi Arabian context. This study addressed this omission. This study explored workplace stress amongst nurses working in PICUs in Saudi Arabia. A mixed-method research was conducted in two phases. In Phase One, (n = 172) nurses from six PICUs completed a questionnaire; in Phase Two, face-to-face semi-structured interviews were conducted with 24 of the original 172 participants. The quantitative data revealed that workplace stress was associated with workload (2.29 ± 0.81), followed by death and dying (2.07 ± 0.77) alongside patients and their families (2.02 ± 0.79). Most nurses suffered from medium levels of workplace stress; this was associated with tangible personal characteristics, including nationality and academic nursing qualifications. Six key themes emerged from the qualitative results: Sources of workplace stress, consequences of workplace stress, individual characteristics that help to manage workplace stress, work characteristics that help to manage workplace stress, motivation to work in PICUs in Saudi Arabia and suggestions for workplace stress management. The Dynamic Model of Workplace Stress was developed, highlighting the interactions between the sources and consequences of workplace stress. Despite reporting a medium level of workplace stress, the nurses perceived their workplace to be a highly rewarding environment.

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Osman, S., Y. M. Al Talhi, M. H. Ahmed, A. Abutaleb, M. Humoodi, M. Bakhsh, R. Babakr, and H. A. Aburjeila. "Comfort care practice in pediatric intensive care units; practitioner-oriented survey from Saudi Arabia." Ethics, Medicine and Public Health 22 (June 2022): 100771. http://dx.doi.org/10.1016/j.jemep.2022.100771.

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3

Kambal, Abdelmageed Mohammed, Subash C. Arora, Abdulaziz Al Zeer, and Hanan Habib Babay. "Flavobacterium Meningosepticumin Intensive Care Units of a Teaching Hospital in Riyadh, Saudi Arabia." Annals of Saudi Medicine 17, no. 2 (March 1997): 240–46. http://dx.doi.org/10.5144/0256-4947.1997.240.

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4

Alshargi, Omar Yahya, Abubakar Ibrahim Jatau, and Abubakar Sha’aban. "Drug-Related Problems in Emergency Department Visits and Intensive Care Units at Healthcare Facilities in Saudi Arabia: A Review of the Literature." Malaysian Journal of Pharmaceutical Sciences 19, no. 2 (November 23, 2021): 153–69. http://dx.doi.org/10.21315/mjps2021.19.2.10.

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The burden of drug-related problems (DRPs) is becoming an issue of healthcare concern. It has been responsible for many intensive care unit (ICU) admissions and emergency department (ED) visits in Saudi Arabia. We aim to summarise available data on ED visits and ICU admissions linked to DRPs in Saudi Arabia and provide recommendations for preventive measures. A systematic search of the literature was conducted using PubMed and Google Scholar databases to identify eligible studies. The review included research on ED visits and ICU admissions linked to DRPs performed in Saudi Arabia from the database’s inception to January 2020. Study selection, data extraction and assessment were performed based on the Preferred Reporting Items for Systematic Review and MetaAnalysis (PRISMA) guidelines. The initial search of literature generated 267 articles. After the study selection, 15 articles met our eligibility criteria and were included in the review. The commonly implicated DRPs were adverse drug reactions, medication non-adherence, drug overdose and drug interactions. Central nervous system drugs and cardiovascular drugs were the most frequently involved drugs. Most of these visits resulted in moderate harm. The prevalence of DRPs associated with ED visits and ICU admissions is high in Saudi Arabia. Sixteen out of a hundred ED visits and ICU admissions are related to DRPs. Therefore, the Saudi government should implement interventions to improve the awareness of rational drug use in the general public.

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Azim, Nahla Shazli Abdel, Maha Abdullah Al-Harbi, Mayasar Ibrahim Al-Zaban, Marwa Youssef Nofal, and Ali Mohammed Somily. "Prevalence and Antibiotic Susceptibility among Gram Negative Bacteria Isolated from Intensive Care Units at a Tertiary Care Hospital in Riyadh, Saudi Arabia." Journal of Pure and Applied Microbiology 13, no. 1 (March 31, 2019): 201–8. http://dx.doi.org/10.22207/jpam.13.1.21.

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6

Alshehri, Hanan Hamdan, Axel Wolf, Joakim Öhlén, and Sepideh Olausson. "Healthcare Professionals’ Perspective on Palliative Care in Intensive Care Settings: An Interpretive Descriptive Study." Global Qualitative Nursing Research 9 (January 2022): 233339362211380. http://dx.doi.org/10.1177/23333936221138077.

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There is a growing need to integrate palliative care into intensive care units and to develop appropriate knowledge translation strategies. However, multiple challenges persist in attempts to achieve this objective. In this study, we aimed to explore intensive care professionals’ perspectives on providing palliative and end-of-life care within an intensive care context. We used an interpretive description approach and interviewed 36 intensive care professionals at four hospitals in Saudi Arabia. Our findings reflect a discourse about end-of-life care driven by a do-not-resuscitate classification and challenges associated with family involvement in care goals. We provide key insights of importance for the development of strategies for the integration and knowledge translation of palliative care into intensive care contexts. [Formula: see text]

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7

Al Malki, Adel, Ruth Endacott, and Kelli Innes. "Health professional perspectives of patient safety issues in intensive care units in Saudi Arabia." Journal of Nursing Management 26, no. 2 (September 27, 2017): 209–18. http://dx.doi.org/10.1111/jonm.12536.

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8

Ballut, Omar Mahmoud, Thamer Ahmed Alghamdi, Fares Gormallah A. Alghamdi, Thamer Abdullah Tami Alghamdi, and Thamer Saad Saeed Alzahrani. "The extent of family satisfaction to relatives’ care in the intensive care units in Saudi Arabia." Medical Science 26, no. 125 (July 23, 2022): 1–8. http://dx.doi.org/10.54905/disssi/v26i125/ms298e2394.

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9

Aljumah, Hind, and Maram Banakhar. "Exploring the Factors Influencing Saudi Nurses' Intentions to Leave Critical Care Units in Government Hospitals at Qassim Region." Academic Journal of Research and Scientific Publishing 3, no. 29 (September 5, 2021): 70–86. http://dx.doi.org/10.52132/ajrsp.e.2021.295.

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The health system is based on major pillars that it cannot continue without, the most important of which are doctors and qualified nursing staff. The departure of nursing staff is one of the dilemmas that threaten the health system. Another place, especially leaving work in intensive care. The current scoping review aims to identify relevant evidence related to the factors influencing nurses' intentions to leave critical care units at governmental hospitals at Saudi Arabia. In this study, the researcher explored that some factors were not covered, so the most of the knowledge gap regarding the factors that contribute to nurses’ intentions to leave their current occupations in critical care units at governmental hospitals in Saudi Arabia, are motivation and communication among staff members. As well as, conflict among staff members, Nurse Manager Ability, leadership and support of nurses, and nurse-physician relationships are some of the important factors that contribute to nurses’ intentions to leave their current occupations that needs to be studied.

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10

Mansour, S. A., O. Eldaly, A. Jiman Fatani, M. L. Mohamed, and E. M. Ibrahim. "Epidemiological characterization of P. aeruginosa isolates of intensive care units in Egypt and Saudi Arabia." Eastern Mediterranean Health Journal 19, no. 01 (January 1, 2013): 71–80. http://dx.doi.org/10.26719/2013.19.1.71.

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11

Kazzaz, Yasser M., Musaed Alharbi, Kim C. Nöel, Caroline Quach, Douglas F. Willson, Elaine Gilfoyle, James D. McNally, et al. "Evaluation of antibiotic treatment decisions in pediatric intensive care units in Saudi Arabia: A national survey." Journal of Infection and Public Health 14, no. 9 (September 2021): 1254–62. http://dx.doi.org/10.1016/j.jiph.2021.08.021.

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12

Memish, Z., A. El-Saed, and E. Tannous. "P148 Improved hand hygiene compliance after education of health care workers in adult intensive care units in Saudi Arabia." International Journal of Antimicrobial Agents 34 (July 2009): S73—S74. http://dx.doi.org/10.1016/s0924-8579(09)70367-x.

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13

M. Hassanein, Khaled, Marwa Salah Mostafa, Raafat El- Sanhoty, and K. M. Hassan. "Multi-Drug Resistance in Health Care-Associated Bacteremia in Intensive Care Units at King Fahad Specialized Hospital, Buraidah, Saudi Arabia." Journal of Microbiology Research 2, no. 6 (December 1, 2012): 152–56. http://dx.doi.org/10.5923/j.microbiology.20120206.01.

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14

Soliman, Ibrahim, Waleed Tharwat Aletreby, Fahad Faqihi, Nasir Nasim Mahmood, Omar E. Ramadan, Ahmad Fouad Mady, Babar Kahlon, Abdulrahman Alharthy, Peter Brindley, and Dimitrios Karakitsos. "Improved Outcomes following the Establishment of a Neurocritical Care Unit in Saudi Arabia." Critical Care Research and Practice 2018 (July 18, 2018): 1–6. http://dx.doi.org/10.1155/2018/2764907.

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Background. Dedicated neurocritical care units have dramatically improved the management and outcome following brain injury worldwide. Aim. This is the first study in the Middle East to evaluate the clinical impact of a neurocritical care unit (NCCU) launched within the diverse clinical setting of a polyvalent intensive care unit (ICU). Design and Methods. A retrospective before and after cohort study comparing the outcomes of neurologically injured patients. Group one met criteria for NCCU admission but were admitted to the general ICU as the NCCU was not yet operational (group 1). Group two were subsequently admitted thereafter to the NCCU once it had opened (group 2). The primary outcome was all-cause ICU and hospital mortality. Secondary outcomes were ICU length of stay (LOS), predictors of ICU and hospital discharge, ICU discharge Glasgow Coma Scale (GCS), frequency of tracheostomies, ICP monitoring, and operative interventions. Results. Admission to NCCU was a significant predictor of increased hospital discharge with an odds ratio of 2.3 (95% CI: 1.3–4.1; p=0.005). Group 2 (n = 208 patients) compared to Group 1 (n = 364 patients) had a significantly lower ICU LOS (15 versus 21.4 days). Group 2 also had lower ICU and hospital mortality rates (5.3% versus 10.2% and 9.1% versus 19.5%, respectively; all p<0.05). Group 2 patients had higher discharge GCS and underwent fewer tracheostomies but more interventional procedures (all p<0.05). Conclusion. Admission to NCCU, within a polyvalent Middle Eastern ICU, was associated with significantly decreased mortality and increased hospital discharge.

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15

Aloraini, Muhannad. "The effectiveness of a tele-intensive care unit implementation at a secondary hospital in Eastern Saudi Arabia." International Journal Of Community Medicine And Public Health 4, no. 11 (October 25, 2017): 3956. http://dx.doi.org/10.18203/2394-6040.ijcmph20174684.

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Background: Tele-intensive care units (tele-ICUs) are promising medical solutions for improving critical care quality, enhancing access to health care, and increasing the productivity of intensivists. King Faisal Specialist Hospital and Research Center (KFSHRC) initiated a tele-ICU implementation in Saudi Arabia during 2009/2010, with the aim of creating 28 tele-ICU-connected hospitals throughout the region by 2014. However, the effect of tele-ICUs on patient outcomes remains unclear. This study assessed the effectiveness of a tele-ICU intervention program on patient outcomes. Methods: A retrospective pre-post study was performed in an adult medical-surgical ICU at a secondary hospital in Eastern Saudi Arabia. Tele-intensivists were located at the KFSHRC. The sample comprised adult patients (≥12 years, as per hospital policy) admitted to the ICU. Patients were allocated into pre-intervention (January 1 to April 29, 2012) and post-intervention (May 1 to August 31, 2012) groups; each group had 178 patients. The tele-ICU was implemented on April 30, 2012. Results: According to a Mann–Whitney U-test, the groups did not differ on length of stay (LOS) (U=16097.50, p=0.78). Medians and interquartile ranges in length of stay for both groups were 2 days. Regarding mortality, 10 (5.6%) pre-intervention patients died, while 12 (6.7%) post-intervention patients died. This difference was not significant (p=0.51). Conclusions: The tele-ICU program did not appear to impact patient outcomes in terms of mortality or LOS.

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16

Obaid, Najla A. "Preventive Measures and Management of Catheter-Associated Urinary Tract Infection in Adult Intensive Care Units in Saudi Arabia." Journal of Epidemiology and Global Health 11, no. 2 (2021): 164. http://dx.doi.org/10.2991/jegh.k.210418.001.

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17

ALKHATHAMI, M., M. AL HADDAD, and M. ALENAZI. "PERCEIVED RESPONSIBILITY FOR MECHANICAL VENTILATION AND WEANING DECISIONS IN INTENSIVE CARE UNITS IN THE KINGDOM OF SAUDI ARABIA." Chest 161, no. 6 (June 2022): A497. http://dx.doi.org/10.1016/j.chest.2022.04.031.

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18

Mahfouz, Ahmed A., Ibrahim A. Al-Zaydani, Ali O. Abdelaziz, Mohammad N. El-Gamal, and Abdullah M. Assiri. "Changes in hand hygiene compliance after a multimodal intervention among health-care workers from intensive care units in Southwestern Saudi Arabia." Journal of Epidemiology and Global Health 4, no. 4 (2014): 315. http://dx.doi.org/10.1016/j.jegh.2014.05.002.

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19

Sobayo, Eunice I., Ziad Memish, Adnan Mofti, Suleiman Al-Mohaya, and Nathaniel Rotowa. "Device-day Infection Rates — A Surveillance Component System for Intensive Care Units at Security Forces Hospital, Riyadh, Saudi Arabia." Annals of Saudi Medicine 15, no. 6 (November 1995): 602–5. http://dx.doi.org/10.5144/0256-4947.1995.602.

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20

Lorina, Badger-Emeka, Abdulhadi Al-Sultan Abdulrahman, Sami Alrashed Abdullatif, Sami Alhaddad Mohammed, and Khalifah Al-Barjas Afnan. "Antimicrobial susceptibility pattern of Gram negative bacteria isolated from intensive care units in Al-Ahsa, Kingdom of Saudi Arabia." African Journal of Microbiology Research 12, no. 31 (August 21, 2018): 747–53. http://dx.doi.org/10.5897/ajmr2018.8925.

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21

Madani, Tariq A., Nabeela A. Al-Abdullah, Ali A. Al-Sanousi, Tawfik M. Ghabrah, Shadia Z. Afandi, and Huda A. Bajunid. "Methicillin-Resistant Staphylococcus aureus in Two Tertiary-Care Centers in Jeddah, Saudi Arabia." Infection Control & Hospital Epidemiology 22, no. 4 (April 2001): 211–16. http://dx.doi.org/10.1086/501891.

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AbstractObjective:To review clinical experience with methicillin-resistant Staphylococcus aureus (MRSA) in tertiary-care hospitals in Jeddah, Saudi Arabia.Design:Retrospective review for the year 1998.Setting:Two tertiary-care hospitals.Methods:Results of MRSA-positive cultures of clinical specimens obtained as part of investigations for suspected infections were retrieved from the microbiology laboratories' records. Charts of patients were reviewed, with standardized data collection.Results:Of 673 S aureus isolates identified, 222 (33%, or 6.8 isolates/1,000 admissions) were MRSA Overall MRSA prevalence was 2% in 1988. Nosocomial acquisition occurred in 84.2% of cases. All age groups were affected, and 52% of patients had at least one comorbidity. MRSA prevalence was highest in the intensive care units (26.6% of all isolates), the medical wards (24.8%), and the surgical wards (19.8%). Seventy-three percent of isolates caused infection; the rest represented colonization. Surgical wounds (35.2%), the chest (29%), and central venous catheters (13%) were the most common sites of infection. Bacteremia occurred in 15.4% of patients. Local signs (84%) and fever (75.9%) were the most common clinical manifestations. Respiratory distress and septic shock occurred in 30.2% and 13.6% of cases, respectively. Of 162 patients with MRSA infection and 60 patients with MRSA colonization, 95.7% and 70% received antibiotics in the preceding 6 weeks, respectively (P<.0001). The total mortality of patients with MRSA infection was 53.7%: 36.4% as a result of MRSA infection and 17.3% as a result of other causes.Conclusions:The prevalence of MRSA is high and rapidly increasing in the two hospitals, as it is worldwide. Control measures to prevent die spread of MRSA in hospitals should continue, with reinforcement of hygienic precautions and development of policies to restrict the use of antibiotics.

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22

Kharaba, Ayman, Haifa Algethamy, Mohamed Hussein, Fahad M. Al-Hameed, Adnan Alghamdi, Ammar Hamdan, Jehan Fatani, et al. "Incidence, outcomes, and predictors of Acinetobacter infection in Saudi Arabian critical care units." Journal of Critical Care 66 (December 2021): 109–16. http://dx.doi.org/10.1016/j.jcrc.2021.08.010.

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23

Baddour, Manal M., Manal M. Abuelkheir, Amal J. Fatani, Marie F. Bohol, and Mohammad N. Al-Ahdal. "Molecular epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) isolates from major hospitals in Riyadh, Saudi Arabia." Canadian Journal of Microbiology 53, no. 8 (August 2007): 931–36. http://dx.doi.org/10.1139/w07-063.

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The few studies that have reported the incidence of methicillin-resistant Staphylococcus aureus (MRSA) in Saudi Arabia have indicated that a diverse number of circulating MRSA strains have been detected in several major hospitals. Thus, this study was designed to track the presence of MRSA strains in major hospitals in Riyadh, Saudi Arabia, and perform comparative chromosomal DNA analysis of MRSA strains for epidemiological investigation using pulsed-field gel electrophoresis (PFGE). Correlation of the PFGE types generated with microbiological and clinical data of the isolates was attempted. Screening for decreased susceptibility to vancomycin among the isolates was also done. A dendogram was generated using PFGE macrorestriction fragments and 6 types were identified (M1–M6) with M1 being predominant and widespread. A clear link between PFGE types and some clinical and microbiological data available for the strains was found. For example, M1 was statistically associated with male patients, whereas the unique types were associated with female patients, M2 was associated with isolates from wounds and age group <5 years, and M4 was associated with isolates from patients admitted to intensive care units. M5 was highly correlated with low sensitivity to linezolid. No vancomycin-resistant isolates were detected.

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24

Temsah, Mohamad-Hani, Noura Abouammoh, Ayman Al-Eyadhy, Yazed AlRuthia, Marwah Hassounah, Fahad Alsohime, Ali Alhaboob, et al. "Predictors and Direct Cost Estimation of Long Stays in Pediatric Intensive Care Units in Saudi Arabia: A Mixed Methods Study." Risk Management and Healthcare Policy Volume 14 (June 2021): 2625–36. http://dx.doi.org/10.2147/rmhp.s311100.

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25

Almahmoud, Rasha S., Maha A. Alfarhan, Walaa M. Alanazi, Farah K. Alhamidy, Hanan H. Balkhy, Majid Alshamrani, Aiman El-Saed, Betule A. Sairafi, and Salim A. Bahron. "Assessment knowledge and practices of central line insertion and maintenance in adult intensive care units at a tertiary care hospital in Saudi Arabia." Journal of Infection and Public Health 13, no. 11 (November 2020): 1694–98. http://dx.doi.org/10.1016/j.jiph.2020.07.009.

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26

Bandy, Altaf, and Bilal Tantry. "ESBL Activity, MDR, and Carbapenem Resistance among Predominant Enterobacterales Isolated in 2019." Antibiotics 10, no. 6 (June 19, 2021): 744. http://dx.doi.org/10.3390/antibiotics10060744.

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Antimicrobial-resistance in Enterobacterales is a serious concern in Saudi Arabia. The present study retrospectively analyzed the antibiograms of Enterobacterales identified from 1 January 2019 to 31 December 2019 from a referral hospital in the Aljouf region of Saudi Arabia. The revised document of the Centers for Disease Control (CDC) CR-2015 and Magiorakos et al.’s document were used to define carbapenem resistance and classify resistant bacteria, respectively. The association of carbapenem resistance, MDR, and ESBL with various sociodemographic characteristics was assessed by the chi-square test and odds ratios. In total, 617 Enterobacterales were identified. The predominant (n = 533 (86.4%)) isolates consisted of 232 (37.6%), 200 (32.4%), and 101 (16.4%) Escherichia coli, Klebsiella pneumoniae, and Proteus mirabilis, respectively. In general, 432 (81.0%) and 128 (24.0%) isolates were of MDR and ESBL, respectively. The MDR strains were recovered in higher frequency from intensive care units (OR = 3.24 (1.78–5.91); p < 0.01). E. coli and K. pneumoniae resistance rates to imipenem (2.55 (1.21–5.37); p < 0.01) and meropenem (2.18 (1.01–4.67); p < 0.04), respectively, were significantly higher in winter. The data emphasize that MDR isolates among Enterobacterales are highly prevalent. The studied Enterobacterales exhibited seasonal variation in antimicrobial resistance rates towards carbapenems and ESBL activity.

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27

Ageel, Mohammed, and Abdullah Shbeer. "Exploring Occupational Stress Among Intensive Care Units Nurses in Saudi Arabia Using the Health and Safety Executive Management Standards Indicator Tool." Nursing: Research and Reviews Volume 12 (December 2022): 247–58. http://dx.doi.org/10.2147/nrr.s386670.

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28

Ibrahim, Mutasim. "High antimicrobial resistant rates among Gram-negative pathogens in intensive care units. A retrospective study at a tertiary care hospital in Southwest Saudi Arabia." Saudi Medical Journal 39, no. 10 (October 3, 2018): 1035–43. http://dx.doi.org/10.15537/smj.2018.10.22944.

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29

AbdelRazik, Mohamed, IbrahimAbdulrahman Alquwaiz, AbdulazizAbdulrahman Khojah, AbdullahYahya Alshahrani, OsamahZeid Aldakkan, NaifKhalid Alhumaydani, and FaisalTurki Alqahtani. "Clinical and epidemiological characteristics of road traffic accidents patients received at 2 intensive care units in Saudi Arabia—A cross-sectional study." Journal of Family Medicine and Primary Care 10, no. 10 (2021): 3863. http://dx.doi.org/10.4103/jfmpc.jfmpc_879_21.

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30

Al-Gethamy, Manal M., Hani S. Faidah, Hamed Ademola Adetunji, Abdul Haseeb, Sami S. Ashgar, Tayeb K. Mohanned, Al-Haj Mohammed, Muhammad Khurram, and Mohamed A. Hassali. "Risk factors associated with multi-drug-resistant Acinetobacter baumannii nosocomial infections at a tertiary care hospital in Makkah, Saudi Arabia - a matched case–control study." Journal of International Medical Research 45, no. 3 (May 8, 2017): 1181–89. http://dx.doi.org/10.1177/0300060517706284.

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Objective To determine risk factors for multi-drug-resistant Acinetobacter baumannii (MDR-AB) nosocomial infections in intensive care units in a tertiary care hospital, Makkah, Saudi Arabia. Methods We performed a hospital-based, matched case–control study in patients who were admitted to Al Noor Specialist Hospital between 1 January 2012 and 31 August 2012. The study included cases of A. baumannii nosocomial infection and controls without infection. Controls were matched to cases by age and ward of admission. Results The most frequent site of infection was the respiratory tract (77.3%). Susceptibility to antimicrobial MDR-AB was 92.0% for ceftazidime and ciprofloxacin, while it was 83.3% for imipenem, 83.0% for trimethoprim, 79.0% for amikacin, and 72.7% for gentamicin. Multiple logistic regression of risk factors showed that immunosuppression (OR = 2.9; 95% CI 1.5–5.6; p = 0.002), clinical outcome (OR = 0.4; 95% CI 0.3–0.9; p = 0.01), invasive procedures (OR = 7.9; 95% CI 1.8–34.2; p = 0.002), a central venous catheter (OR = 2.9; 95% CI 1.5–5.6; p = 0.000), and an endotracheal tube (OR = 3.4; 95% CI 1.6–7.3; p = 0.001) were associated with MDR-AB. Conclusions Acinetobacter nosocomial infections are associated with admission to the ICU (Intensive care unit) and exposure to invasive procedures.

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S. Alayed, Abdulrahman, Helena Lööf, and Unn-Britt Johansson. "Saudi Arabian ICU safety culture and nurses’ attitudes." International Journal of Health Care Quality Assurance 27, no. 7 (August 5, 2014): 581–93. http://dx.doi.org/10.1108/ijhcqa-04-2013-0042.

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Purpose – The purpose of this paper is to examine nurses’ attitudes towards safety culture in six Saudi Arabian intensive care units (ICUs). Design/methodology/approach – The study is descriptive with a cross-sectional design. The Safety Attitude Questionnaire (SAQ)-ICU version was distributed and 216 completed questionnaires were returned. Findings – The findings provide a basis for further research on Saudi Arabian ICU safety culture. This study showed that the SAQ-ICU can be used to measure safety climate to identify areas for improvement according to nurse attitudes and perceptions. Findings indicate that ICU safety culture is an important issue that hospital managers should prioritise. Practical implications – The SAQ-ICU questionnaire, used to measure safety climate in Saudi Arabian ICUs, identifies service strengths and improvement areas according to attitudes and perceptions. Originality/value – To the knowledge, this is the first study to use SAQ to examine nurses’ safety culture attitudes in Saudi Arabian ICUs. The present findings provide a baseline and further details about Saudi Arabian ICU safety. Study participants represented nine nationalities, indicating the nursing workforce's diversity, which is expected to continue in the future. Such a nursing cultural heterogeneity calls for further studies to examine and evaluate attitudes and values to improve ICU safety culture.

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32

Arabi, YaseenM, RaymondM Khan, Maha Aljuaid, Hanan Aqeel, MohammedM Aboudeif, Shaimaa Elatwey, Rajeh Shehab, et al. "Introducing the Comprehensive Unit-based Safety Program for mechanically ventilated patients in Saudi Arabian Intensive Care Units." Annals of Thoracic Medicine 12, no. 1 (2017): 11. http://dx.doi.org/10.4103/1817-1737.197765.

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Temsah, M. H., Y. Alruthia, A. Aleyadhy, N. Abouammoh, F. Alsohime, M. Almazyad, K. Alhasan, and A. Jamal. "P0317 / #1844: PREDICTORS AND DIRECT COST ESTIMATION OF EXTENDED LENGTH OF STAY IN PEDIATRIC INTENSIVE CARE UNITS IN SAUDI ARABIA: A MIXED METHODS STUDY." Pediatric Critical Care Medicine 22, Supplement 1 3S (March 2021): 172. http://dx.doi.org/10.1097/01.pcc.0000739608.00603.23.

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34

Balkhy, H., M. Alshamrani, H. Baffoe-Bonnie, A. El-Saed, A. Mohammed, O. Slim, and Y. Arabi. "Direct Physician Engagement as a Stewardship Modality to Curtail the Overuse of Antimicrobials in the Intensive Care Units at a Tertiary Care Hospital in Saudi Arabia." Journal of Infection and Public Health 12, no. 1 (January 2019): 150. http://dx.doi.org/10.1016/j.jiph.2018.10.016.

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35

Abd El Hafez, Maha, Noha G. Khalaf, Mohamed El Ahmady, Ahmed Abd El Aziz, and Abd El Gawad Hashim. "An outbreak of methicillin resistant Staphylococcus epidermidis among neonates in a hospital in Saudi Arabia." Journal of Infection in Developing Countries 5, no. 10 (September 15, 2011): 692–99. http://dx.doi.org/10.3855/jidc.1293.

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Introduction: Staphylococcus epidermidis is a pathogen associated with nosocomial infection in neonatal intensive care units (NICU). This study investigates an outbreak of methicillin resistant S. epidermidis in an NICU in a hospital in Saudi Arabia. Methodology: A total of 41 isolates identified as Gram-positive cocci were obtained from blood culture, umbilical wound swabs and endotracheal aspirate specimens of neonates, of which 29 were identified as S. epidermidis. Bacterial identification at the species level and determination of antibiotic resistance were performed by MicroScan (Dade Behring, USA). Genotyping was completed using randomly amplified polymorphic DNA (RAPD) and the mecA gene was detected by PCR. Results: All 29 S. epidermidis isolates were found to be resistant to oxacillin and were positive for the mecA gene. The isolates showed several multidrug-resistance patterns; the resistance rates to gentamicin, erythromycin, clindamycin, and trimethoprim/sulfamethoxazole were 89.7%, 86.2%, 75.9% and 72.4%, respectively. All isolates were susceptible to vancomycin, teicoplanin, rifampin, synercid, and ciprofloxacin. Several genotypic and phenotypic patterns were detected among the S. epidermidis isolates: antibiogram typing showed seven different patterns, one of which was shared by 65% of the isolates, whereas the most prevalent RAPD genotype was shared by only five S. epidermidis isolates, and did not correlate with antibiotic resistance phenotype. Conclusion: The diverse clonal origin of tested isolates indicates the presence of multiple S. epidermidis strains among neonates in the NICU setting

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Oraby, Tamer, Michael G. Tyshenko, Hanan H. Balkhy, Yasar Tasnif, Adriana Quiroz-Gaspar, Zeinab Mohamed, Ayesha Araya, et al. "Analysis of the Healthcare MERS-CoV Outbreak in King Abdulaziz Medical Center, Riyadh, Saudi Arabia, June–August 2015 Using a SEIR Ward Transmission Model." International Journal of Environmental Research and Public Health 17, no. 8 (April 23, 2020): 2936. http://dx.doi.org/10.3390/ijerph17082936.

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Middle East respiratory syndrome coronavirus (MERS-CoV) is an emerging zoonotic coronavirus that has a tendency to cause significant healthcare outbreaks among patients with serious comorbidities. We analyzed hospital data from the MERS-CoV outbreak in King Abdulaziz Medical Center, Riyadh, Saudi Arabia, June–August 2015 using the susceptible-exposed-infectious-recovered (SEIR) ward transmission model. The SEIR compartmental model considers several areas within the hospital where transmission occurred. We use a system of ordinary differential equations that incorporates the following units: emergency department (ED), out-patient clinic, intensive care unit, and hospital wards, where each area has its own carrying capacity and distinguishes the transmission by three individuals in the hospital: patients, health care workers (HCW), or mobile health care workers. The emergency department, as parameterized has a large influence over the epidemic size for both patients and health care workers. Trend of the basic reproduction number (R0), which reached a maximum of 1.39 at the peak of the epidemic and declined to 0.92 towards the end, shows that until added hospital controls are introduced, the outbreak would continue with sustained transmission between wards. Transmission rates where highest in the ED, and mobile HCWs were responsible for large part of the outbreak.

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Hanif, Abdul-Hasseb, Rozan Radwan, Rehab Adnan Baghdadi, and Hani Saleh Faidah. "1294. A survey on Vancomycin and Beta Lactams usage in critical care settings in Makkah, Kingdom of Saudi Arabia." Open Forum Infectious Diseases 7, Supplement_1 (October 1, 2020): S662. http://dx.doi.org/10.1093/ofid/ofaa439.1477.

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Abstract Background Drug pharmacokinetics/pharmacodynamics (pk/PD) play a vital role in the dose optimization of antimicrobials to maintain targeted effective plasma concentration. Pharmacokinetics parameters e.g., Volume of distribution, clearance, half-life are highly variable in Critically ill patients, therefore require a patient-specific approach to maximize antimicrobials’ clinical effectiveness. The percentage of the dosing interval to ensure free plasma concentration more then MIC is an evidence-based approach to achieve pharmacodynamic targets among critically ill patients. Therefore, using Extended and continuous infusions of Vancomycin and Beta lactams will optimize therapy by promising more time for free plasma concentration above MIC in treatment. Methods A self-administered survey was distributed during morning meeting to intensivists to record their attitude and practice towards Vancomycin and Beta lactams usage in intensive care units. The regional institutional review board approved the study of the ministry of health, Makkah, Saudi Arabia. Results The response rate was 95 %, as the survey was distributed electronically before the dose optimization workshop conducted at each hospital. The majority (72.5 %) of the intensivists were using only extended infusion for Meropenem in practice. Interestingly, none of the hospitals was familiar with the pk/PD target for vancomycin dosing. Further, most of the intensivists (65 %) were unfamiliar with continuous/extended infusion strategy for Vancomycin in their practice. The majority of them were using traditional trough level target by utilizing standard dosing. Conclusion This survey concludes the requirement of a dose optimization policy for beta-lactam and vancomycin in critical settings by utilizing extended/continuous infusion. Disclosures All Authors: No reported disclosures

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Al-Tawfiq, Jaffar A., Antony Amalraj, and Ziad A. Memish. "Reduction and surveillance of device-associated infections in adult intensive care units at a Saudi Arabian hospital, 2004–2011." International Journal of Infectious Diseases 17, no. 12 (December 2013): e1207-e1211. http://dx.doi.org/10.1016/j.ijid.2013.06.015.

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Madani, Tariq A. "Epidemiology and Clinical Features of Methicillin-ResistantStaphylococcus aureusin the University Hospital, Jeddah, Saudi Arabia." Canadian Journal of Infectious Diseases 13, no. 4 (2002): 245–50. http://dx.doi.org/10.1155/2002/235213.

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OBJECTIVE: To describe the prevalence, demography and clinical characteristics of patients who were colonized or infected with methicillin-resistantStaphylococcus aureus(MRSA) in 1998 at King Abdulaziz University Hospital, Jeddah, Saudi Arabia.PATIENTS AND METHODS: Results of MRSA-positive cultures of clinical specimens obtained as part of investigations for suspected infections were retrieved from the King Abdulaziz University Hospital Infection Control Department's records. Charts of patients were reviewed.RESULTS: Of 292S aureusisolates identified, 111 (38%) were MRSA, or 6.0 MRSA isolates/1000 admissions, which represented a marked increase over MRSA prevalence in 1988 (less than 2%). Nosocomial acquisition occurred in 74.8% of isolates. All age groups were affected, but 45.9% of patients were in the 'extremes of age' group (younger than one or older than 60 years of age). The prevalence was highest in the medical ward (27%), followed by the paediatrics combined medical and surgical ward (20.7%), the outpatient department (18%), the adult surgical ward (17.1%) and the intensive care units (17.1%). Two-thirds (66.7%) of cases represented infection and the remainder represented colonization. Surgical wounds (31.1%), the chest (27%) and endovascular catheters (20.3%) were the most common sites of infection. Bacteremia occurred in 27% of patients. Local signs (68.9%) and fever (60.8%) were the most common clinical manifestations. Respiratory distress and septic shock occurred in 28.4% and 6.8% of cases, respectively. Of 74 patients with MRSA infection and 37 patients with MRSA colonization, 91.9% and 56.8% received antibiotics in the preceding six weeks, respectively (P<0.0001). The total mortality of patients with MRSA infection was 60.8%; 37.8% of deaths were the result of MRSA infection and 23% were the result of other diseases.CONCLUSIONS: The prevalence of MRSA is high and rapidly increasing at King Abdulaziz University Hospital, as it is worldwide. Control measures to prevent the spread of MRSA in hospitals should continue with reinforcement of hygienic precautions and development of policies to restrict the use of antibiotics.

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Alenezi, Atallah, Noha El-Tahtawi, and Entesar Mahmoud Makhlouf. "Cross Sectional Study on a Spectrum of Bacterial Pathogens under Actions of Infection Control in Different Clinical Specimens of ICU Patients of Sajer General Hospital in Saudi Arabia, and Their Antibiotic Sensitivity Pattern." Journal of Evolution of Medical and Dental Sciences 10, no. 44 (November 30, 2021): 3762–68. http://dx.doi.org/10.14260/jemds/2021/761.

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BACKGROUND The intensive care unit (ICU) is a special department of the hospital and health care setting that provides intensive nursing care and care to patients with the most severe and life-threatening illnesses and injuries that require accurate, continuous monitoring and support from specialist, medication, and equipment in order to maintain normal bodily functions. Nosocomial infections are one of the leading causes of mortality in hospitalised patients especially the critically ill patients in the intensive care unit. The purpose of the present study was isolation, identification, and detection of the antibiotic sensitivity pattern of pathogenic bacteria isolated from different clinical specimens of ICU patients under the effect of infection control in Sajer General Hospital in Saudi Arabia. METHODS In this cross-sectional study conducted from January 2020 to April 2020, 200 clinical samples, 40 blood, 45 urine, 50 tracheal aspirate, 30 post-surgical Caesarean section wound swabs, 20 central venous catheters and 15 pus swabs were collected from patients hospitalised in ICUs of Sajer General Hospital. Antibiotic sensitivity testing was performed with the diffusion-disk method for several antibiotics. RESULTS The rate of nosocomial infection among ICU patients due to Gram-negative bacteria is significantly higher than that recorded by Gram-positive bacteria (78.75 %, 21.25 %, respectively). The majority of frequent bacteria isolated from all clinical specimens were Klebsielleae pneumoniae 20 (25 %) followed by Pseudomonas aeruginosa 18 (22.5 %), Acinetobacter baumannii 15 (18.75 %), Escherichia coli 10 (12.50 %), Staphylococcus aureus 9 (11.25 %), Streptococcus pyogenes 6 (7.50 %) and enterococcus spp. 2 (2.50 %). K. pneumoniae, P. aeruginosa and E. coli achieved high sensitivity to imipenem and meropenem (100 %). A. baumannii showed high sensitivity to meropenem (100 %) and imipenem (93.33 %). Staph. aureus, Streptococcus pyogenes and enterococcus species showed high sensitivity to vancomycin (100 %). CONCLUSIONS The nosocomial infection is a major cause of mortality and morbidity in hospitals. The role of nursing care in the prevention of nosocomial infection has proven vital due to the emergence and spreading of different pathogenic bacteria. Close interactions between health care providers can save many more lives. KEY WORDS Intensive Care Units, Antibiotics Sensitivity Pattern, Nursing Infection Control

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Abdulrahman, Basheer, Ahmed F. Mady, Noor Monther Ali, Abdulrahman Alharthy, Waleed Tharwat, Shahzad Ahmad, Rehab Eltreafi, et al. "Efficacy Assessment of High Dose Colistin against Carbapenem-Resistant Gram-Negative Bacteria (CR-GNB) in Critically Ill Patients: A Retrospective Non-Inferiority Trial." Pakistan Journal of Medical and Health Sciences 15, no. 10 (October 30, 2021): 2848–52. http://dx.doi.org/10.53350/pjmhs2115102848.

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Background: Colistin is an effective treatment option, recommended for carbapenem resistant gram-negative bacilli (CR-GNB) in critically ill patients. Due to high nephrotoxicity, dose management of Colistin is a tough decision to make. At standard dosage the efficacy of Colistin is not well defined. Consequently, strategies involving higher dosages were suggested. Objective: To evaluate the high dose of Colistin as non-inferior to standard dose in the treatment of CR-GNB in critically ill patients. Study Design: Retrospective comparative study Place and Duration of Study: Intensive Care Unit, King Saud Medical City Riyadh, Saudi Arabia from 1st January 2015 to 31st December 2017. Methodology: One hundred and ninety two patients that met the inclusion criteria from all participants were further divided into two groups. Group H (High dose) given the high dose of Colistin (9 million units intravenously (IV) loading dose, and then 9 million units/day in 2 or three divided doses) whereas group S was administered with standard dose (no loading dose, 6 million units/day). The primary endpoint of the study was the assessment of nephrotoxicity after the start of Colistin and secondary endpoints were the mortality within 14 days of commencing Colistin along with clinical effects and microbial clearance upon completion of treatment. Results: The results of the study established the non-inferiority of high dose of Colistin for the renal safety and also showed significant improvement in microbial clearance and length of ICU stay as compared to the standard dose. The other secondary end points such as mortality (p = 0.99), length of hospital stay (p = 0.39), and global improvement (p value of 0.06) revealed no significant difference between the two groups. Conclusion: The high dose of Colistin for the treatment of carbapenem resistance gram negative bacilli (CRGNB) was as safe as the standard dose for renal safety. But we also found that it also accelerates microbial clearance and reduces the time spent in the intensive care unit. Key words: Colistin, Colestimethate sodium, Gram negative bacteraemia, Sepsis, Multi-drug resistant organisms, Acute kidney injury

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Alhasan, Khalid A., Mohamed A. Shalaby, Mohamad-Hani Temsah, Fadi Aljamaan, Reem Shagal, Talal AlFaadhel, Mohammed Alomi, et al. "Factors That Influence Mortality in Critically Ill Patients with SARS-CoV-2 Infection: A Multicenter Study in the Kingdom of Saudi Arabia." Healthcare 9, no. 12 (November 23, 2021): 1608. http://dx.doi.org/10.3390/healthcare9121608.

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Background: SARS-CoV-2 infection has a high mortality rate and continues to be a global threat, which warrants the identification of all mortality risk factors in critically ill patients. Methods: This is a retrospective multicenter cohort study conducted in five hospitals in the Kingdom of Saudi Arabia (KSA). We enrolled patients with confirmed SARS-COV-2 infection admitted to any of the intensive care units from the five hospitals between March 2020 and July 2020, corresponding to the peak of recorded COVID-19 cases in the KSA. Results: In total, 229 critically ill patients with confirmed SARS-CoV-2 infection were included in the study. The presenting symptoms and signs of patients who died during hospitalization were not significantly different from those observed among patients who survived. The baseline comorbidities that were significantly associated with in-hospital mortality were diabetes (62% vs. 48% among patients who died and survived (p = 0.046)), underlying cardiac disease (38% vs. 19% (p = 0.001)), and underlying kidney disease (32% vs. 12% (p < 0.001)). Conclusion: In our cohort, the baseline comorbidities that were significantly associated with in-hospital mortality were diabetes, underlying cardiac disease, and underlying kidney disease. Additionally, the factors that independently influenced mortality among critically ill COVID-19 patients were high Activated Partial Thromboplastin Time (aPTT )and international normalization ratio (INR), acidosis, and high ferritin.

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Almutairi, Masaad Saeed, Ahmed M. Assiri, and Omar A. Almohammed. "Predictors of Poor Outcome among Critically Ill COVID-19 Patients: A Nationally Representative Sample of the Saudi Arabian Population." Journal of Clinical Medicine 11, no. 10 (May 17, 2022): 2818. http://dx.doi.org/10.3390/jcm11102818.

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The outbreak and continuing impact of COVID-19 have significantly increased the rates of hospitalization and admissions to intensive care units (ICU). This study evaluates clinical outcomes in critically ill patients and investigates variables tied to poor prognosis. A secondary database analysis was conducted to investigate the predictors of poor outcome among critically ill COVID-19 patients in Saudi Arabia. Multivariable logistic regression analysis was used to assess the association between various demographic characteristics, comorbidities, and COVID-19 symptoms and patients’ poor prognosis, as a composite outcome. A total of 2257 critically ill patients were identified (male (71.8%), and elderly (37.3%)). The mortality rate was 50.0%, and the composite poor outcome was 68.4%. The predictors of poor outcome were being elderly (OR = 4.79, 95%CI 3.19–7.18), obesity (OR = 1.43, 95%CI 1.1–1.87), having a severe or critical case at admission (OR = 6.46, 95%CI 2.34–17.8; OR = 22.3, 95%CI 11.0–45, respectively), and some signs and symptoms of COVID-19 such as shortness of breath, feeling fatigued or headache, respiratory rate ≥ 30/min, PaO2/FiO2 ratio < 300, and altered consciousness. In conclusion, identifying high-risk populations that are expected to have a poor prognosis based on their criteria upon admission helps policymakers and practitioners better triage patients when faced with limited healthcare resources.

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Al-Abdely, Hail M., Areej Dhafer Alshehri, Victor Daniel Rosenthal, Yassir Khidir Mohammed, Weam Banjar, Pablo Wenceslao Orellano, Abdullah Mufareh Assiri, et al. "Prospective multicentre study in intensive care units in five cities from the Kingdom of Saudi Arabia: Impact of the International Nosocomial Infection Control Consortium (INICC) multidimensional approach on rates of central line-associated bloodstream infection." Journal of Infection Prevention 18, no. 1 (October 22, 2016): 25–34. http://dx.doi.org/10.1177/1757177416669424.

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Objective: To analyse the impact of the International Nosocomial Infection Control Consortium (INICC) Multidimensional Approach (IMA) and INICC Surveillance Online System (ISOS) on central line-associated bloodstream infection (CLABSI) rates in five intensive care units (ICUs) from October 2013 to September 2015. Design: Prospective, before-after surveillance study of 3769 patients hospitalised in four adult ICUs and one paediatric ICU in five hospitals in five cities. During baseline, we performed outcome and process surveillance of CLABSI applying CDC/NHSN definitions. During intervention, we implemented IMA and ISOS, which included: (1) a bundle of infection prevention practice interventions; (2) education; (3) outcome surveillance; (4) process surveillance; (5) feedback on CLABSI rates and consequences; and (6) performance feedback of process surveillance. Bivariate and multivariate regression analyses were performed. Results: During baseline, 4468 central line (CL) days and 31 CLABSIs were recorded, accounting for 6.9 CLABSIs per 1000 CL-days. During intervention, 12,027 CL-days and 37 CLABSIs were recorded, accounting for 3.1 CLABSIs per 1000 CL-days. The CLABSI rate was reduced by 56% (incidence-density rate, 0.44; 95% confidence interval, 0.28–0.72; P = 0.001). Conclusions: Implementing IMA through ISOS was associated with a significant reduction in the CLABSI rate in the ICUs of Saudi Arabia.

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Johnstone, Jennie, Diane Heels-Ansdell, Lehana Thabane, Maureen Meade, John Marshall, Francois Lauzier, Erick Huaileigh Duan, et al. "Evaluating probiotics for the prevention of ventilator-associated pneumonia: a randomised placebo-controlled multicentre trial protocol and statistical analysis plan for PROSPECT." BMJ Open 9, no. 6 (June 2019): e025228. http://dx.doi.org/10.1136/bmjopen-2018-025228.

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IntroductionVentilator-associated pneumonia (VAP) is the most common healthcare-associated infection in critically ill patients. Prior studies suggest that probiotics may reduce VAP and other infections in critically ill patients; however, most previous randomised trials were small, single centre studies. The Probiotics: Prevention of Severe Pneumonia and Endotracheal Colonization Trial (PROSPECT) aims to determine the impact of the probioticLactobacillus rhamnosusGG on VAP and other clinically important outcomes in critically ill adults.MethodsPROSPECT is a multicentre, concealed, randomised, stratified, blinded, controlled trial in patients ≥18 years old, anticipated to be mechanically ventilated ≥72 hours, in intensive care units (ICUs) in Canada, the USA and Saudi Arabia. Patients receive either 1×1010 colony forming units ofL. rhamnosusGG twice daily or an identical appearing placebo. Those at increased risk of probiotic infection are excluded. The primary outcome is VAP. Secondary outcomes are other ICU-acquired infections includingClostridioides difficileinfection, diarrhoea (including antibiotic-associated diarrhoea), antimicrobial use, ICU and hospital length of stay and mortality. The planned sample size of 2650 patients is based on an estimated 15% VAP rate and will provide 80% power to detect a 25% relative risk reduction.Ethics and disseminationThis protocol and statistical analysis plan outlines the methodology, primary and secondary analyses, sensitivity analyses and subgroup analyses. PROSPECT is approved by Health Canada (#9427-M1133-45C), the research ethics boards of all participating hospitals and Public Health Ontario. Results will be disseminated via academic channels (peer reviewed journal publications, professional healthcare fora including international conferences) and conventional and social media. The results of PROSPECT will inform practice guidelines worldwide.Trialregistration numberNCT02462590; Pre-results.

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Al-Abdely, Hail M., Yassir Khidir Mohammed, Victor D. Rosenthal, Pablo W. Orellano, Mohamed ALazhary, Eman Kaid, Anan Al-Attas, et al. "Impact of the International Nosocomial Infection Control Consortium (INICC)’s multidimensional approach on rates of ventilator-associated pneumonia in intensive care units in 22 hospitals of 14 cities of the Kingdom of Saudi Arabia." Journal of Infection and Public Health 11, no. 5 (September 2018): 677–84. http://dx.doi.org/10.1016/j.jiph.2018.06.002.

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Ruggeri, Matteo, Alessandro Signorini, Silvia Caravaggio, Basem Alraddadi, Alaa Alali, Sam Kozma, Camille Harfouche, and Tariq AlMusawi. "The estimation of direct hospital costs and Intensive Care Units (ICU) admissions for COVID-19 patients and the assessment of the impact of remdesivir administration in the Saudi Arabian context." International Journal of Antimicrobial Agents 58 (September 2021): 21003484. http://dx.doi.org/10.1016/j.ijantimicag.2021.106421.77.

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Al Hashmi, Hani, Deia Alawami, Syed Ziauddin A. Zaidi, Nawal F. Alshehry, Hazza A. Alzahrani, Abdul Rehman Z. Zaidi, Ahmed Al Sagheir, et al. "A National Collaborative Multicenter Phase II Study for Potential Safety Efficacy of Convalescent Plasma to Treat Severe COVID-19 Patients." Blood 136, Supplement 1 (November 5, 2020): 42–43. http://dx.doi.org/10.1182/blood-2020-138496.

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Introduction Coronavirus disease (COVID-19) pandemic has started to affect Saudi Arabia in the beginning of March 2020 and is expected to cause significant morbidity to many patients, especially to elderly, who might require intensive care unit (ICU) support to survive as its lethality increases with the increasing age. Recent publications suggested the benefit of utilizing convalescent plasma from recovered donors as a therapeutic approach in treating COVID-19 patients. Convalescent plasma could provide our first-line defense for people with COVID-19, especially those who are older and at a much higher risk for complications., therefore, we developed a national protocol to investigate the safety, benefit and applicability at larger scale and at different health care facilities in Saudi Arabia (KSA). Objectives Primary endpoints are 1. ICU (or designated area for critical patients) length of stay 2. Safety of convalescent plasma> Secondary endpoints included: 1. 30 days mortality 2. Number of days on mechanical ventilation 3. Days to clinical recovery Method Eligible convalescent plasma donors will be invited to participate in trial. The arrangement for plasmapheresis will start after obtaining donor informed consent. The collected plasma will be treated with pathogen reduction system. The convalescent plasma units will be labelled, stored and shipped as per the standard transfusion medicine protocols. It will be used only for eligible patients' "recipients" as per the following eligibility criteria: 1. Inclusion criteria: - Confirmed case of SARS-CoV-2 infection with POSITIVE rRT PCR test -18 or older -Must have been requiring ICU care or severe or immediately life-threatening care (any one of the following): 1. Patient requiring ICU care/admission. 2. Severe disease is defined as: a. Dyspnea b. Respiratory frequency ≥ 30/min c. Blood oxygen saturation ≤ 93% d. Partial pressure of arterial oxygen to fraction of inspired oxygen ratio < 300, and/or Lung infiltrates > 50% within 24 to 48 hours 3. Life-threatening disease is defined as: a. Respiratory failure b. Septic shock, and/or c.Multiple organ dysfunction or failure Exclusion criteria: 1. Negative or non-conclusive test COVID-19 rRT PCR test 2. Mild symptoms 3. Hospitalization not requiring ICU care/admission Eligible Patients will be infused with the convalescent plasma (200-400 ml / treatment dose)at least once & if possible, daily, for up to 5 sessions. Other supportive and therapeutic measures should continue according to the locally approved protocols with due diligence. Sample size was calculated with 80% power and 5% level of significance based on the recently published data to detect statistical difference in the study outcome. Therefore, we plan to recruit total of 575 patients. Convalescent plasma Recipient Group: 115 patients (recipients) who have COVID 19 as per the inclusion criteria. Comparative control Group: 460 Patients who are eitherCOVID 19 historical control or only consent for sharing their clinical and laboratory data Matching for age, gender, Hypertension, Diabetes and intubation status were done based on the propensity score. Continuous variables will be presented as the median and interquartile range (IQR). Statistical software SPSS 24.0 will be used. Demographic, Clinical, imaging and laboratory information of all enrolled patients will be retrieved from the hospital electronic/paper records system to be used for the outcomes analysis. Results 22 sites across KSA that participated in the study. Tertiary, secondary, academic and non-academic centers participated (real world data). There were no unusual safety issues related to convalescent plasma infusion since all mortalities in the plasma group were not related to plasma infusion which represent similar finding from other the published international reports. Keeping in-mind that our data is still maturing, 30 survival probability in the plasma group was 69% compared to 56% in the comparative group (p value = 0.066) (figure-1). This benefit to seem to be more noticeable in the COVID-19 cases who did not meet the criteria for life-threatening disease (figure-2). Conclusion Our study supports the safety of convalescent plasma in treating COVID-19 patients. Patients who are in the category of life-threating/end organs failure do not seem to benefit. There might be a benefit in the other subgroups. Disclosures No relevant conflicts of interest to declare.

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Alshaikh, Zahra, Mohammed Alkhodari, Taina Sormunen, and Pernilla Hilleras. "Nurses’ Knowledge about Palliative Care in an Intensive Care Unit in Saudi Arabia." Middle East Journal of Nursing 9, no. 1 (January 2015): 3–6. http://dx.doi.org/10.5742/mejn.2015.92614.

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Aldawood, Abdulaziz S., Mohammad Alsultan, Samir Haddad, Saad M. Alqahtani, Hani Tamim, and Yaseen M. Arabi. "Trauma profile at a tertiary intensive care unit in Saudi Arabia." Annals of Saudi Medicine 32, no. 5 (September 2012): 498–501. http://dx.doi.org/10.5144/0256-4947.2012.498.

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