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- Corporate Infection Control Department, Hamad Medical Corporation, Doha, Qatar [2]
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- Infection Control Department, The Cuban Hospital. E-mail: [email protected] ORCID: https://orcid.org/0000-0001-7279-0062 [2]
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- 1Department of Public Health, Ministry of Public Health, Doha, Qatar [1]
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- Infection Control Department, The Cuban Hospital, Hamad Medical Corporation, Doha, Qatar. E-mail: [email protected] ORCID: https://orcid.org/0000-0001-7279-0062 [1]
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Antibiotic Prophylaxis in Surgical Procedures and the Threats of Fecal Carriage of the ESBL Producer Organisms
Healthcare associated infections (HAI) are unnecessary adverse events as they are preventable with proper implementation of the best evidence about the topic. The surgical site infections (SSI) account the 17% of HAI in the U.S. In South Asian countries the pooled estimate of SSI incidence according to a recently published meta-analysis was 8.6% meanwhile a report of Rosenthal and colleagues describes higher incidence in low-income countries compared with U.S. data. In addition to the patient safety issues the economic impact of these infections should be considered. In U.S. the total annual costs for the 5 major infections were $9.8 billion with SSI contributing the most to overall costs (33.7% of the total) followed by the devices associated infections and Clostridium difficile infections.
In European university hospital the mean additional postoperative length of hospital stay was 16.8 days; and the mean additional in-hospital duration of antibiotic therapy was 7.4 days. The perioperative antibiotic prophylaxis constitutes a key prevention practice with a high quality of evidence for its implementation. Antibiotic prophylaxis is aimed to reduce the incidence of SSI by preventing the development of infection caused by organisms that colonize or contaminate the surgical site. The adequate use of perioperative antibiotic prophylaxis can reduce the rate of SSI in up to 50%. Multidrug-resistant organisms Antimicrobial resistance is a worldwide problem with a significant impact in morbidity and mortality at the community level and also in health care facilities. Nearly 20% of pathogens reported from all healthcare associated infections to NHSN (CDC) were multidrug-resistant organisms (MDRO).
The CDC estimates that the annual impact of antibiotic-resistant infections on the U.S. economy is $20–35 billion in excess direct health care costs with additional costs to society for lost productivity as high as $35 billion per year and 8 million additional days in hospitals. Extended-spectrum β-lactamase producing Enterobacteriaceae is frequent in healthcare associated infections and in the community.
Worldwide dissemination of plasmid-borne extended-spectrum b-lactamases (ESBL) is a public health concern since community-acquired infections caused by ESBL-producing Escherichia coli (among other Enterobacteriaceae) are becoming increasingly frequent. The problem of ESBL production is no longer limited to community-onset or hospital-acquired infections. Faecal carriage of ESBL-producing Enterobacteriaceae by asymptomatic individuals has been noted in many parts of the world. There is observed a variable frequency of ESBL carriage in diverse studied population from Korea (9.3%) UK (11.3%) Sweden (6.8%) and Paris (6%). Studies conducted in Eastern Mediterranean countries has shown fecal carriage of 12.7% in Saudi Arabia 13.4% in Lybia and 21% in Egypt. No reports about studies conducted in Qatar have been published. MDRO prevention approaches can be broadly categorized and should include measures to prevent infection among patients who are uninfected carriers of an MDRO. The problem Appendicitis is the most common reason for acute abdominal pain in with a lifetime risk of 8.6% for males and 6.7% for females. Appendectomy constitutes the principal emergency surgical procedure in The Cuban Hospital (Dukhan Qatar). During the period January 2013-October 2015 have been performed 561 appendectomies been reported 22 (4.1%) cases with surgical site infections. As a consequence an excess of the length of stay of 3.8 days and antimicrobial consumption of 77.84 daily defined doses was identified in patients with SSI compared with those without SSI. In culture samples collected during surgical procedure due to the evidence of fluid in the surgical site was identified Escherichia coli ESBL producer in 23.3% of the positive cultures meanwhile in positive cultures of surgical site infections the 65% of the microbial agents identified were extended spectrum beta-lactamase producers (E.coli 12 patients; Klebsiella pneumonia 1 patient). The standard perioperative prophylaxis performed in our patients is a combination of cefuroxime (beta-lactam antimicrobial) and metronidazole. Compliance with antibiotic prophylaxis in patients with surgical site infection was 86.4% 100% and 91% for timely administration proper doses and selection of the antimicrobials and discontinuation before 24 hr after the surgical procedure respectively. – Research questionso Is the fecal carrier of ESBL producer organisms at increased risk of surgical site infections after appendectomy or others surgical procedures that involve intestinal incision? o Could be prevented these surgical site infections with a targeted antimicrobial prophylaxis? – Hypothesiso Fecal carriage of ESBL producer organisms increases the risk of surgical site infections in patients with appendicitis or colon surgeries which could be prevented by a targeted antimicrobial prophylaxis. – Research o A cohort study of patients who underwent to appendectomies and colon surgery. – Expected resultso Identify the prevalence of fecal carriages of ESBL producer organismso Describe the risk of acquired surgical site infection in fecal carriage of ESBL producer organisms. o Analyze the potential use of targeted antimicrobial prophylaxis in surgical procedures that involve the colon. – Conclusiono The prevention of surgical site infections constitutes a challenge in the daily medical practice. o The changing environment of the MDROs in the community imposes of a challenge for healthcare professionals which should review its practices according to the new trends of antimicrobial resistance and the frequency of microbial colonization in the population. Healthcare associated infections (HAI) are unnecessary adverse events as they are preventable with proper implementation of the best evidence about the topic.
The surgical site infections (SSI) account the 17% of HAI in the U.S. (Yokoe DS 2014). In South Asian countries the pooled estimate of SSI incidence according to a recently published meta-analysis was 8.6% (95% CI 5.8%–11.4%) meanwhile a report of Rosenthal and colleagues describes higher incidence in low-income countries compared with U.S. data (Rosenthal 2013; Lin Ling M 2015).
In addition to the patient safety issues the economic impact of these infections should be considered. In U.S. the total annual costs for the 5 major infections were $9.8 billion (95% CI $8.3–$11.5 billion) with surgical site infections contributing the most to overall costs (33.7% of the total) followed by the devices associated infections and Clostridium difficile infections (Zimlichman E 2013).
In European university hospital the mean additional postoperative length of hospital stay was 16.8 days (95% CI 13–20.6 days); and the mean additional in-hospital duration of antibiotic therapy was 7.4 days (95% CI 5.1–9.6 days) (Weber 2008). As is widely shown in the literature from high-income countries including the United States the incidence of HAI can be reduced by as much as 30% and by 55% in the case of SSI through the implementation of an effective surveillance approach (Umscheid CA 2011).
The perioperative antibiotic prophylaxis constitutes a key prevention practice which according to the 2014 SHEA recommendation achieve a high quality of evidence for its implementation (Anderson 2008) (Yokoe 2014). Antibiotic prophylaxis is aimed to reduce the incidence of SSI by preventing the development of infection caused by organisms that colonize or contaminate the surgical site.
The antimicrobial agents for prophylaxis should be: 1) active against the pathogens most likely to contaminate the surgical site 2) given in an appropriate dosage and at a time that ensures adequate serum and tissue concentrations during the period of potential contamination 3) Safe and 4) administered for the shortest effective period to minimize adverse effects the development of resistance and costs. The predominant organisms causing SSIs after clean procedures are skin flora. In clean-contaminated procedures including abdominal procedures and heart kidney and liver transplantations the predominant organisms include gram-negative rods and enterococci in addition to skin flora. (Bratzler DW 2013). The main target of antibiotic prophylaxis is the wound and should be considered in addition of choose the proper antimicrobial (according to the surgical site or procedure) the timing of administration and it duration after the surgical procedure. The adequate use of perioperative antibiotic prophylaxis can reduce the rate of SSI in up to 50%. Multidrug-resistant organisms Antimicrobial resistance is a worldwide problem with a significant impact in morbidity and mortality at the community level and also in health care facilities. Nearly 20% of pathogens reported from all healthcare associated infections to NHSN (CDC) were multidrug-resistant organisms (Sievert DM 2013).
The Centers for Disease Control and Prevention (CDC) estimates that the annual impact of antibiotic-resistant infections on the U.S. economy is $20–35 billion in excess direct health care costs with additional costs to society for lost productivity as high as $35 billion per year and 8 million additional days in hospitals. (Report of the US President 2014). Extended-spectrum β-lactamase producing Enterobacteriaceae (ESBL) is frequent in healthcare associated infections and in the community.
Worldwide dissemination of plasmid-borne extended-spectrum b-lactamases (ESBLs) is a public health concern since community-acquired infections caused by ESBL-producing Escherichia coli (among other Enterobacteriaceae) are becoming increasingly frequent (Pitout JDD 2005).
The problem of ESBL production is no longer limited to community-onset or hospital-acquired infections. Faecal carriage of ESBL-producing Enterobacteriaceae particularly the CTX-M producers by asymptomatic individuals has been noted in many parts of the world. There is observed a variable frequency of ESBL carriage in diverse studied population from Korea (9.3%) UK (11.3%) Sweden (6.8%) and Paris (6%) (Beom King J 2014; Wickramasinghe NH 2012 Stromdahl H 2011 Nicolas-Chanoine MH 2013). Studies conducted in Eastern Mediterranean countries has shown fecal carriage of 12.7% in Saudi Arabia (Kader AA 2009) 13.4% in Lybia (Ahmed SF 2014) and 21% in Egypt (Bassyouni RH 2015). No reports about studies conducted in Qatar have been published. In the face of rising resistance rates and limited treatment options prevention of MDRO infections is paramount. MDRO prevention approaches can be broadly categorized and should include measures to prevent infection among patients who are uninfected carriers of an MDRO. The Goals of the National action plan to combat antibiotic resistant bacteria (White House Washington 2015) define the need of the use of a rapid test for early diagnosis of multidrug-resistant organisms. The problem Appendicitis is the most common reason for acute abdominal pain in with a lifetime risk of 8.6% for males and 6.7% for females (Flum DR 2015). Appendectomy mainly using the laparoscopic technique constitutes the principal emergency surgical procedure in The Cuban Hospital (Dukhan Qatar). During the period January 2013-October 2015 have been performed 561 appendectomies been reported 22 (4.1%) cases with surgical site infections. As a consequence an excess of the length of stay of 3.8 days and antimicrobial consumption of 77.84 daily defined doses was identified in patients with SSI compared with those without SSI. In culture samples collected during surgical procedure due to the evidence of fluid in the surgical site was identified Escherichia coli ESBL producer in 23.3% of the positive cultures meanwhile in positive cultures of surgical site infections the 65% of the microbial agents identified were extended spectrum beta-lactamase producers (E.coli 12 patients; Klebsiella pneumonia 1 patient). The standard perioperative prophylaxis performed in our patients is a combination of cefuroxime (beta-lactam antimicrobial) and metronidazole. Compliance with antibiotic prophylaxis in patients with surgical site infection was 86.4% 100% and 91% for timely administration proper doses and selection of the antimicrobials and discontinuation before 24 hr after the surgical procedure respectively. – Research questions o Is the fecal carrier of ESBL producer organisms at increased risk of surgical site infections after appendectomy or others surgical procedures that involve intestinal incision? o Could be prevented these surgical site infections with a targeted antimicrobial prophylaxis? – Hypothesis o Fecal carriage of ESBL producer organisms increases the risk of surgical site infections in patients with appendicitis or colon surgeries which could be prevented by a targeted antimicrobial prophylaxis. – Research o A cohort study of patients who underwent to appendectomies and colon surgery. – Expected results o Identify the prevalence of fecal carriages of ESBL producer organisms o Describe the risk of acquired surgical site infection in fecal carriage of ESBL producer organisms. o Analyze the potential use of targeted antimicrobial prophylaxis in surgical procedures that involve the colon. – Conclusion o The prevention of surgical site infections constitutes a challenge in the daily medical practice. o The changing environment of the multidrug-resistant organism in the community imposes of a challenge for healthcare professionals which should review its practices according to the new trends of antimicrobial resistance and the frequency of microbial colonization in the population.
Using Surveillance Data To Identify Areas Of Research And Healthcare System Improvement: The Case Of Diagnosis Delay.
One of the key objectives of the surveillance of communicable disease (CDs) is the identification of areas for research and healthcare system improvement. In a recent paper published in Qatar Medical Journal (http://dx.doi.org/10.5339/qmj.2014.9) is shown the delay in diagnosis of CDs of cases reported at The Cuban Hospital (TCH) during 2012 and 2013. Examples of delay in diagnosis was for tuberculosis 61.7 days acute hepatitis 18.5 days typhoid fever 17 days food poisoning 9.5 days measles 8.0 days and meningitis 3.8 days. These are diseases that require immediate reporting because of their public health importance and some of them are highly transmissible (e.g. tuberculosis and measles). Additional evaluation of patients with tuberculosis admitted at The Cuban Hospital (many reported in Hamad General Hospital and referred to TCH because of bed crisis) from January 2013 to June 2014 (105 patients) show diagnosis delay of 49.5 days (standard deviation 51.9 years) with a maximum figure of 365 days. In patients with positive smear (highly infectious) the delay was 49.7 days (SD 53.5 days) (minimum 2 days maximum 365 days). The delay was superior in cases with pulmonary tuberculosis (51.3 days (SD 52 days)) than in non pulmonary (36.1 days (SD 51.9 days). Delay in diagnosis of CDs is significant with regard to not only disease prognosis at the individual level but also transmission within the community. The delay could be divided in ¨patient delay and system delay¨. Patient delay refers to the time between onset of symptom and the first contact with a healthcare professional. The system delay refers to the time between this first contact to the diagnosis or confirmation of the disease. The knowledge of the two components of the delay is essential to identify actions to minimize the delay and reduce the probability of disease transmission at the community. In summary data from the surveillance of CDs suggest the need of research to identify the causes of diagnostic delay and subsequently implement actions its reduction which will contribute to the prevention and control of CDs in Qatar.
Retrospective study of risk factors for mortality in critically ill patients with COVID-19
Background: Mortality associated with COVID-19 varies in various reports with minimal data on the factors associated with in-hospital mortality.
Objective: To identify the risk factors for in-hospital death of patients with COVID-19 in an intensive care unit (ICU) in Qatar.
Methods: A retrospective observational study of patients confirmed with COVID-19 and admitted to the medical-surgical ICU at The Cuban Hospital was carried out from April 12 2020 to September 12 2020. From patients’ electronic medical records demographic clinical laboratory and radiology data was collected.
Results: 275 patients with COVID-19 were admitted to the ICU and 32 (11.6%) died. 56.1% were men and the mean age was 52.2 years. According to the univariate analysis patients with diabetes mellitus with end-organ damage (37.5%) cardiovascular disease (31.3%) dementia (9.4%) kidney disease (28.1%) chronic obstructive pulmonary disease (31.3%) and higher Charlson index had higher mortality. According to the multivariate analysis an increase of mortality risk by 9% was observed for each additional year of age (Odds ratio [OR] 1.09; 95% confidence interval [CI] 1.04–1.14) patients on mechanical ventilation (OR 27.33; 95% CI 3.21–232.46) and those with adult respiratory distress (OR 15.85; 95% CI 1.45–172.82) and elevated procalcitonin (OR 7.30; 95% CI 1.25–42.58) and the PiO2/FiO2 ratio between 100 and 299 decreased the risk of death by 92% (OR 0.08; 95% CI 0.02–0.39) in comparison to a PiO2/FiO2 ratio less than 100 or greater than 300.
Conclusion: The study provides evidence about the risk of mortality among COVID-19 patients with a significant contribution of age respiratory failure and co-infections.
Diagnostic Delay of Tuberculosis in Qatar: Results of an Exploratory Study
Background
According to the World Health Organization Report on Tuberculosis in 2013 it is estimated that 9 million people developed tuberculosis and 1.5 died of the disease. In Qatar the incidence of tuberculosis is the highest in the Gulf countries but this mainly depends on migrant laborers from countries with high incidence especially Nepal India and the Philippines. It is important to consider that only India contributes with the 25% of the global burden of tuberculosis. Among the strategies for the prevention and control of tuberculosis are included measures to promote the early diagnosis and the compliance with treatment. The delay in the diagnosis has a critical role in the control of tuberculosis and it constitutes a threat for the community and it worsens the prognosis for the patient's improvement in the clinical status. In a literature review of 52 studies Sreeramareddy CT et al reported that (median or mean) total delay patient delay healthcare system delay for diagnosis of tuberculosis were ranging from 25 to 185 days 4.9 to 16.2 days and 2 to 8.9 days respectively. The overall average patient delay was similar to health system delay (31.03 versus 27.2 days). According to a multinational study about diagnostic delay carried out in the Eastern Mediterranean Region (EMR) in 2003–2004 the mean duration of delay between the onsets of symptoms until treatment with anti-tuberculosis drugs ranged from one month and a half to 4 months in the different countries. The mean delay was 46 days in Iraq 57 in Egypt 59.2 in Yemen 79.5 in Somalia 80.4 in the Syrian Arab Republic 100 in Pakistan and 127 in the Islamic Republic of Iran. This report comments that the infection control programs are able to detect an average of one third of smear-positive tuberculosis cases while the rest continue to transmit infection in the community until treated whether adequate or inadequate by other health sectors. Recently published papers report total diagnosis delay of 60 days (Porto Alegre and Yemen 2013) and 36 days (Guimaraes 2015) patient delay of 15 days (Brazil 2013 - Porto Alegre 2013) and system delay of 15 days (Croatia 2013) and 18 days (Porto Alegre 2013). No previous reports have been published about the topic in Qatar. Based on the previous information and on the national goal for prevention and control of communicable diseases we considered necessary to conduct an epidemiological research to describe the diagnostic delay in tuberculosis as an initial step for a population-based study.
Objective
– To identify the diagnostic delay in patients with tuberculosis and to describe the patient and healthcare system components.
– To test the method of collection of information for the design of a population-based study.
Methods
An exploratory study was carried out in 49 newly diagnosed tuberculosis patients admitted to a hospital facility during the period of May-October 2015 Criteria for inclusion:
– Patient who accepts to answer the questions during a regular clinical interview.
– Patient with a clinical status who allows the interview regardless of the type of tuberculosis (pulmonary or extra pulmonary) Criteria for exclusion
– Unstable clinical status that interferes with a proper communication
– Language barrier that could not be overcome due to unavailability of interpreter for any specific language.
Procedure During the admission period and during the regular clinical evaluation the patients answered the study questions. The interview was conducted by a nurse using an interpreter if considered necessary. It was collected information about the first time the patient arrived in Qatar and the date of onset of symptoms related with tuberculosis. If the patient visited an outpatient or emergency department of another healthcare facility during the symptomatic period and before the admission it was defined the date and the type of facility (primary level facility hospital facility) and if the treatment recommended included antibiotics. The date of diagnosis was considered to be the date of the collection of the confirmatory laboratory test (acid fast bacilli or GeneXpert PCR positive for mycobacterium tuberculosis complex in clinical samples).
Definitions
– Patient delay was considered as the time between symptoms onset and first contact with the healthcare system regardless the category or level of care provided by the facility (primary healthcare facility hospital).
– System delay was considered as the time between the first contact with the healthcare system and the diagnosis.
Analysis
Data were entered in JMP 10.0 (SAS Institute http://www.jmp.com). Descriptive statistical methods were used. Median and percentile distribution was calculated for patient and healthcare system delay and boxplot graph was obtained. The interquartile range [IQR] was calculated (Q3 – Q1).
Results
The patients have lived in Qatar a mean time of 5.5 years with a maximum of 32 years. All patients were confirmed with pulmonary or pleural tuberculosis by means of a smear positive for acid fast bacilli PCR positive for mycobacterium tuberculosis complex in clinical samples (sputum pleural fluid biopsy samples). The median total delay was 30 days (IQR 23.5 days maximum 365 days) the patient delay was 21 days (IQR 22 days maximum 362 days) and the system delay was 3 days (IQR 8 days maximum 60 days). 26 patients out of 42 who visited another facility before admission (61.9%) were attended in a primary healthcare facility and 16 patients (38.1%) in a hospital facility. The 92% of these patients received antibiotic treatment for the management of the respiratory symptoms and were discharged from these ambulatory contacts. After that due to no improvement of their clinical status they were admitted to hospital and the diagnosis of tuberculosis was confirmed. The above-mentioned results highlight the contribution of the patient component in the diagnosis delay in tuberculosis which constitutes a significant risk for community transmission. Consequently this finding should guide the actions for the prevention and control of tuberculosis. It is important to stand out the strengths of the tuberculosis program in Qatar including the availability of the latest technology for its diagnosis (Gene Xpert PCR Quantiferon TB Gold PCR for rifampicin resistance) which is performed in a central laboratory at a national level and a devoted Tuberculosis clinic for diagnosis and follow up with devoted staff with expertise on this field. In addition the national law supports the free of charge healthcare services for tuberculosis patients including the admission in hospital anti tuberculosis treatment and follow-up.
Conclusion
Our findings provide insights about the delay of tuberculosis diagnosis and the need to identify strategies for its reduction especially the patient component.
Recommendations
To conduct a population-based or cohort study to identify the risk factors and determinants for delay in the diagnosis of tuberculosis including detailed information about the health-seeking behavior of patients with suspected tuberculosis.
Healthcare-associated infection and antimicrobial consumption in critically ill COVID-19 patients: An observational study
Background: The COVID-19 pandemic has impacted patient and safety issues globally with special reference to device-associated infection in critical care patients.
Objective: To describe the incidence of device-associated infections non-device-associated respiratory tract infections (RTIs) and antimicrobial use in critical COVID-19 patients during the first six months of the pandemic.
Methods: An observational study was conducted in an intensive care unit of a COVID-19-dedicated facility in Western Qatar from April 1 to September 30 2020. Healthcare-associated infections (HAIs) were confirmed using the CDC definitions as per the corporate infection control program except for other RTIs. Antimicrobial consumption was registered as days of therapy.
Results: During the study period 30 patients (10.9%) with HAIs were reported from 275 patients admitted. Patients with HAI had a higher median Charlson index hospital stay mortality and APACHE II score on admission. The use of devices (central and peripheral lines urinary catheters and ventilators) was more frequent in patients with HAI. The RTI (16 cases) and ventilator-associated pneumonia (VAP) (10 cases) were the most frequent localizations. The infection rate for device-associated infections was 7.84 3.23 and 2.75 per 1000 device days for VAP central line-associated bloodstream infection and catheter-associated urinary tract infection respectively. 49 isolates related to HAI were identified with 20 isolates being multidrug-resistant organisms (40.8%). A longer duration of antibiotic therapy was observed in HAI patients (34.1 days versus 9.39 days).
Conclusion: The study provides evidence of the impact of COVID-19 on the incidence of device-associated infections in critically ill patients antibiotics consumption and antimicrobial resistance.
Direct observation of hand hygiene can show differences in staff compliance: Do we need to evaluate the accuracy for patient safety?
Background: Direct observation of hand hygiene is the standard practice recommended by the World Health Organization to monitor its compliance. Objective: To evaluate the accuracy of hand hygiene observation performed by units' observers. Methods: A descriptive study was carried out in seven patient care units in a 75-bed community hospital in Qatar. Four trained nurses performed hand hygiene observation in May 2016 any day of the week and in different shifts following the same methodology as routine units' observers. Hand hygiene opportunities were registered including hand hygiene moments staff category and actions (handrubs hand washing missed hand hygiene and gloves without hand hygiene). Results: During January–May 2016 routine monitoring reported 25319 opportunities with a compliance of 89.2% and 91.6% for nurses 89.6% for physicians and 85.1% for ancillary staff. Trained external observers reported 815 opportunities and compliance of 54.7% with the highest compliance observed after blood and body fluid exposure (80.0%) and after patient contact (85.5%) and the lowest figures before patient contact (34.2%) and before aseptic procedure (34.0%). Conclusion: This study provides essential information about the accuracy of the monitoring procedure and the compliance of hand hygiene that requires immediate action to protect patients and staff from healthcare-associated infections.
Evaluation of the timeliness and completeness of communicable disease reporting: Surveillance in The Cuban Hospital, Qatar
Public health surveillance systems should be evaluated periodically and should involve an assessment of system attributes. Objective: Evaluate hospital-based surveillance of communicable diseases using the elements of timeliness and data quality. Method: Descriptive study was conducted of communicable diseases reported at The Cuban Hospital Qatar during January 2012 to December 2013. The completeness of notifications were assessed for contact number address place of work and date of symptom onset. Time between the symptoms onset and physician notification time between physician and Supreme Council of Health notification and time between physician notification and lab confirmation were calculated for each case. Analysis: Percentage of cases with documented essential information and 95% confidence interval (CI) were determined. Mean and standard deviation (SD) of time were calculated. Results: 1065 patients were reported 75% were male 80% non-qataries and 91.5% were group 1 (high priority) diseases. Symptom onset date was documented in 91.5% (95% CI 89.8; 93.2) of cases; contact number in 84.7% (82.5;86.8) with lower frequencies for address (68.1% 65.3;70.9) and place of work (60.5% 57.5;63.4). Diagnostic time for tuberculosis was 61.7 days (SD 93.0) acute hepatitis 18.5 days (SD 17.6) typhoid fever 17.0 days (SD 11.6 days) other diseases of sexual transmission 300.2 days chronic hepatitis 165 days and AIDS 154.5 days. The time of notification to the Supreme Council of Health for group 1 diseases was 1.2 days (SD 1.4). Conclusion: Our results show that the quality of essential data and timeliness is not sufficient to meet the needs of the health system. Additional studies should focus on the evaluation of time delay for diagnosis of high priority diseases.
Impact of the COVID-19 pandemic on the incidence, etiology, and antimicrobial resistance of healthcare-associated infections in a critical care unit in Western Qatar
Background: Healthcare-associated infections (HAIs) in critical patients affect the quality and safety of patient care and increase patient morbidity and mortality. During the COVID-19 pandemic an increase in the incidence of HAIs particularly device-associated infections (DAIs) was reported worldwide. In this study we aimed to estimate the incidence of HAIs in an intensive care unit (ICU) during a 10-year period and compare HAI incidence during the preCOVID-19 and COVID-19 periods.Methods: A retrospective observational study of HAIs in the medical–surgical ICU at The Cuban Hospital was conducted. DAIs included central line-associated bloodstream infections (CLABSI) catheter-associated urinary tract infections (CAUTI) and ventilator-associated pneumonia (VAP). Data included the annual incidence of HAIs etiology and antimicrobial resistance using definitions provided by the Centers for Disease Control and Prevention except for other respiratory tract infections (RTIs).Results: 155 patients with HAI infections were reported from which 130 (85.5%) were identified during the COVID-19 period. The frequencies of DAIs and non-DAIs were higher during the COVID-19 period except for Clostridium difficile infections. Species under Enterobacter Klebsiella and Pseudomonas dominated in both periods and higher frequencies of Acinetobacter Enterococcus Candida Escherichia coli Serratia marcescens and Stenotrophoma maltophila were noted during COVID-19 period. Device utilization ratio increased to 10.7% for central lines and 12.9% for ventilators while a reduction of 15% in urinary catheter utilization ratio was observed. DAI incidence was higher during the COVID-19 pandemic with risks for CLABSI VAP and CAUTI increased by 2.79 (95% confidence interval 0.93–11.21; p < 0.0050) 15.31 (2.53–625.48) and 3.25 (0.68–31.08) respectively.Conclusion: The incidence of DAIs increased during the pandemic period with limited evidence of antimicrobial resistance observed. The infection control program should evaluate strategies to minimize the impact of the pandemic on HAIs.
Ten-year incidence and impact of coronavirus infections on incidence, etiology, and antimicrobial resistance of healthcare-associated infections in a critical care unit in Western Qatar
Background: Healthcare-associated infections (HAI) in critical patients affect the quality and safety of patient care as they impact morbidity and mortality. During the COVID-19 pandemic an increase in the incidence rate was reported worldwide. We aim to describe the incidence of HAI in the intensive care unit (ICU) during a 10-year follow-up period and compare the incidence during the pre-COVID-19 and COVID-19 periods.
Methods: A retrospective observational study of HAI in the medical-surgical ICU at The Cuban Hospital was conducted. The data collected include the annual incidence of HAI its etiology and antimicrobial resistance using the Centers for Disease Control and Prevention definitions except for other respiratory tract infections (RTIs).
Results: A total of 155 patients had HAI of which 130 (85.5%) were identified during COVID-19. The frequency of device-associated infections (DAI) and non-DAI was higher during COVID-19 except for Clostridium difficile infections. Etiology was frequently related to species of Enterobacter Klebsiella and Pseudomonas in both periods and a higher frequency of Acinetobacter Enterococcus Candida Escherichia coli Serratia marcescens and Stenotrophomonas maltophilia was noted during the COVID-19 period. Device utilization ratio increased by 10.7% for central lines and 12.9% for ventilators while a reduction of 15% in urinary catheter utilization ratio was observed. DAI incidence was higher during the COVID-19 with a 2.79 higher risk of infection (95% CI: 0.93–11.21; p < 0.0050) 15.31 (2.53–625.48) and 3.25 (0.68–31.08) for CLABSI VAP and CAUTI respectively.
Conclusion: The incidence of DAI increased during the pandemic period as compared to the pre-pandemic period and limited evidence of the impact on antimicrobial resistance was observed. The infection control program should evaluate strategies to minimize the impact of pandemics on HAI.
Catheter-associated urinary tract infection and urinary catheter utilization ratio over 9 years, and the impact of the COVID-19 pandemic on the incidence of infection in medical and surgical wards in a single facility in Western Qatar
Introduction: Catheter-associated urinary tract infection (CAUTI) is a frequently reported healthcare-associated infection in critical and non-critical patients. Limited data are available about CAUTI incidence in non-critical patients. We aim to describe the incidence of CAUTI over 9 years and evaluate the impact of the pandemic on the incidence in non-critical acute care patients.
Methods: A retrospective observational study of CAUTI in medical-surgical and maternity wards was carried out at a public hospital in the west of the State of Qatar. Data collected included the annual CAUTI incidence (per 1000 device days) urinary catheter utilization ratio (UC-UR) etiology and antimicrobial resistance.
Results: 115238 patient days and 6681 urinary catheters (UC) days were recorded over the study period and 9 and 4 CAUTI were confirmed in medical-surgical and maternity wards respectively. The infection rate was 1.9 per 1000 UC days and the UC-UR was 0.06. The CAUTI rate was higher in medical-surgical wards over the COVID-19 period (2.4 × 1000 UC days) in comparison with the non-COVID-19 period (1.7 × 1000 UC days) (RR 1.46; 1.12–1.80). However in the maternity ward the result was 0 and 2.5 × 1000 UC days during these periods respectively. No differences were observed in the infection rate among periods for all patients (RR 1.06; 0.81–1.31). Multidrug-resistant organisms were identified in 7 patients and non-multidrug-resistant in 6 cases.
Conclusion: The study findings describe a lower CAUTI risk over 9 years in non-critical acute care patients. The impact of COVID-19 on the CAUTI risk is mainly related to medical patients who had previously been admitted to critical care. The infection control program should consider these data as a benchmark for quality improvement.
Risk factors for surgical site infection: An observational study in appendectomies performed in a community hospital in Qatar
Background: Surgical site infections (SSIs) after appendectomies constituted a significant patient safety issue and impacted the efficiency of healthcare. Various risk factors had been linked to SSI after appendectomies including risk to patients and procedures and compliance with infection control practices. This study aimed at identifying the risk factors for SSI in appendectomies due to acute appendicitis in a single facility in Qatar.
Methods: A historical observational study of appendectomies performed from January 2013 to February 2023 at a single facility in Qatar was conducted. Demographics surgical procedure data compliance with antibiotic prophylaxis and histopathological findings were recorded from the patient’s electronic medical records.
Results: A total of 2377 appendectomies and 52 SSIs were described mainly in male patients (93.3%) with a mean age of 32.4 years and non-complicated appendicitis (66.7%). SSI risk was 3.86 times higher when appendicitis was perforated in comparison to other appendicitis types [odds ratio (OR) = 3.86; 95% confidence interval (95% CI) OR 1.93–7.70]. Procedures longer than 81 minutes had 4.84 times more SSI risk (OR = 4.84; 95% CI 2.25–10.42) the improper timing of antibiotic prophylaxis had 5.97 times higher SSI risk (OR = 5.97; 95% CI 1.10–32.56) and the improper antibiotic selection had 9.08 times higher SSI risk (OR = 9.08; 95% CI 1.81–45.42).
Conclusion: This study identifies the risk factors linked to SSI risk including perforated appendectomies longer surgical procedures and improper timing and selection of antibiotic prophylaxis. The infection control program should focus on interventions to improve compliance with antibiotic prophylaxis and evaluate additional strategies to minimize the SSI risk in complicated appendicitis.
A retrospective epidemiological study on the incidence of salmonellosis in the State of Qatar during 2004–2012
Background:Salmonella is a food- and water-borne pathogen that can be easily spread in a population leading to the outbreak of salmonellosis that is caused by ingestion of mixed salads contaminated by the pathogen. Most cases occur in the late spring months and can be seen as single cases clusters or episodes. Objective: The aim of this study was to describe the incidence and epidemiological characteristics of salmonellosis in the State of Qatar. Methods: This was a retrospective descriptive study carried out in laboratory-confirmed cases of salmonellosis during 2004–2012 from all Salmonella surveillance centers. Therapeutic records of patients who were clinically suspected of having Salmonella diseases were analyzed. Initially cases with typhoid fever were investigated in the laboratory by means of Widal agglutination tests while non-typhoidal Salmonella diseases were determined based on culture technique. Results: The annual incident of salmonellosis cases were 12.3 23.0 30.3 19.4 15.3 18.0 22.7 18.5 and 18.1 per 100000 population in 2006–2011 and 2012 respectively. The number of salmonellosis cases was high among less than 2-year-old females and 3-year-old males. In addition one-fourth of patients (27.7%) were Qatari when compared to other nationalities. A significant difference in age was found between Qatari (6.08 ± 12.28 years) and non-Qatari (15.04 ± 19.56 years) patients. Of the reported cases 79.8% included the onset date of the first symptoms. Contact phone numbers were available for 94% of the cases but addresses were available for only 50.4% of cases. The time difference between onset of symptoms and diagnosis was 5.4 ± 5.7 days. The most frequent serotype reported were type b (41.9%) type d (26.9%) and type c1 (12.2%). Conclusion: The present surveillance data showed a high incidence of salmonellosis in Qatar that poses a serious public health problem. Special intervention and health awareness programs are required for early screening detection and treatment as well as for strengthening the surveillance system of salmonellosis with special emphasis on the laboratory study of cases.