Inpatient management of community-acquired pneumonia at the European Gaza Hospital: a clinical audit

Background Disease severity scores such as CURB-65 are often used to guide the management of patients with community-acquired pneumonia. Early and adequate empirical antibiotic treatment reduces mortality. The aim of this study was to examine the severity assessment and management of patients presenting with community-acquired pneumonia at the European Gaza Hospital in the Gaza Strip and to compare this to the best available evidence. Methods Medical records of all patients admitted to the European Gaza Hospital with a diagnosis of community-acquired pneumonia between Dec 1, 2015, and March 31, 2016, were reviewed retrospectively. Clinical practice was compared with recommendations for severity assessment and the management of community-acquired pneumonia, as reported in guidelines by the National Institute for Health and Care Excellence and the American Thoracic Society

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

ثقافة سلامة المرضى بين الممرضبن العاملين في المستشفىات الحكومية في فلسطين: طريق إلى سياسة جديدة

Providing safe care helps to reduce mortality, morbidity, length of hospital stay and cost. Patient safety is highly linked to attitudes of health care providers, where those with more positive attitudes achieve higher degrees of patient safety. This study aimed to assess attitudes of nurses working in governmental hospitals in the Gaza-Strip toward patient safety and to examine factors impacting their attitudes. Methods This is a cross-sectional, descriptive study with a convenient sample of 424 nurses, working in four governmental hospitals. The Attitudes to Patient Safety Questionnaire III, a validated tool consisting of 29 items that assesses patient safety attitudes across nine main domains, was used. Results Nurses working in governmental hospitals showed overall only slightly positive attitudes toward patient safety with a total score of 3.68 on a 5-point Likert scale, although only 41.9% reported receiving patient safety training previously. The most positive attitudes to patient safety were found in the domains of ‘working hours as a cause of error’ and ‘team functioning’ with scores of 3.94 and 3.93 respectively, whereas the most negative attitudes were found in ‘importance of patient safety in the curriculum’ with a score of 2.92. Most of the study variables, such as age and years of experience, did not impact on nurses’ attitudes. On the other hand, some variables, such as the specialty and the hospital, were found to significantly influence reported patient safety attitudes with nurses working in surgical specialties, showing more positive attitudes. Conclusion Despite the insufficient patient safety training received by the participants in this study, they showed slightly positive attitudes toward patient safety with some variations among different hospitals and departments. A special challenge will be for nursing educators to integrate patient safety in the curriculum, as a large proportion of the participants did not find inclusion of patient safety in the curriculum useful. Therefore, this part of the curriculum in nurses’ training should be targeted and developed to be related to clinical practice. Moreover, hospital management has to develop non-punitive reporting systems for adverse events and use them as an opportunity to learn from them.توفير الرعاية الآمنة يساعد على تقليل الوفيات والمراضة وطول الإقامة في المستشفى والتكلفة. ترتبط سلامة المرضى ارتباطًا وثيقًا بمواقف مقدمي الرعاية الصحية ، حيث يحقق أصحاب المواقف الإيجابية درجات أعلى من سلامة المرضى. تهدف هذه الدراسة إلى تقييم مواقف الممرضات العاملات في المستشفيات الحكومية في قطاع غزة تجاه سلامة المرضى ودراسة العوامل التي تؤثر على مواقفهم. طرق هذه دراسة وصفية مستعرضة مع عينة ملائمة من 424 ممرضة ، يعملون في أربعة مستشفيات حكومية. تم استخدام استبيان المواقف تجاه سلامة المرضى ، وهو أداة تم التحقق من صحتها وتتألف من 29 عنصرًا تقيّم مواقف سلامة المرضى عبر تسعة مجالات رئيسية. النتائج أظهرت الممرضات العاملات في المستشفيات الحكومية بشكل عام فقط مواقف إيجابية قليلاً تجاه سلامة المرضى بدرجة إجمالية بلغت 3.68 على مقياس ليكرت من 5 نقاط ، على الرغم من أن 41.9٪ فقط أبلغوا عن تلقي تدريب على سلامة المرضى سابقًا. تم العثور على المواقف الأكثر إيجابية تجاه سلامة المرضى في مجالات "ساعات العمل كسبب للخطأ" و "أداء الفريق" بعشرات من 3.94 و 3.93 على التوالي ، في حين تم العثور على المواقف الأكثر سلبية في "أهمية سلامة المرضى في منهج "برصيد 2.92. معظم متغيرات الدراسة ، مثل العمر وسنوات الخبرة ، لم تؤثر على مواقف الممرضات. من ناحية أخرى ، تم العثور على بعض المتغيرات ، مثل التخصص والمستشفى ، تؤثر بشكل كبير على مواقف سلامة المرضى المبلغ عنها مع الممرضات العاملات في التخصصات الجراحية ، مما يدل على مواقف أكثر إيجابية. استنتاج على الرغم من عدم كفاية التدريب على سلامة المرضى الذي تلقاه المشاركون في هذه الدراسة ، فقد أظهروا مواقف إيجابية بعض الشيء تجاه سلامة المرضى مع بعض الاختلافات بين المستشفيات والأقسام المختلفة. سيكون هناك تحد خاص يتمثل في قيام اختصاصيي التمريض بإدماج سلامة المرضى في المناهج الدراسية ، لأن نسبة كبيرة من المشاركين لم يجدوا أن إدراج سلامة المرضى في المناهج الدراسية مفيد. لذلك ، ينبغي استهداف هذا الجزء من المناهج الدراسية في تدريب الممرضات وتطويره ليرتبط بالممارسة السريرية. علاوة على ذلك ، يتعين على إدارة المستشفيات تطوير أنظمة الإبلاغ غير العقابية للأحداث السلبية واستخدامها كفرصة للتعلم منها