The culture in safety culture: exploration of patient safety culture in Saudi Arabian operating theatres.

Surgical patients are highly susceptible to preventable harm in health systems that tolerate inadequate patient safety: the World Health Organization recognises that half of preventable adverse events happen in surgical care. Each year, seven million surgical patients are estimated to suffer serious complications from adverse events and up to one million die. Improving safety culture and non-technical skills can reduce adverse events and improve patient safety. This study explores safety culture in operating theatres in Saudi Arabia, where many employees work in an environment that is radically different from their own, in a language that they know imperfectly. It targets cultural differences and their relevance to safety culture dimensions, including teamwork, communication, job satisfaction, stress recognition, working conditions, and perceptions of management. The concept of safety culture is complex, and to achieve sufficient breadth and depth this study employs a sequential explanatory mixed methods design. All health care professionals working in operating theatres in the Saudi Arabian Ministry of Health hospitals in Riyadh City were surveyed using the internationally validated Safety Attitudes Questionnaire, administered in both English and Arabic. Items pertaining to local culture were added to assist in measuring cultural factors related to patient safety. Furthermore, twenty semi-structured interviews with non-Arabic-speaking female nurses were also conducted. Returned surveys (n = 649; 60.8 % response rate) were subjected to reliability and validity tests. Cronbach’s alpha values for each dimension ranged between 0.71 and 0.82, except for the perception of management dimension (0.44). Confirmatory factor analysis showed that all dimensions except perception of management had good psychometric properties, indicating the tool’s applicability to Saudi Arabian context. Respondents’ mean perceptions ranged between 3.5 and 4 out of 5 for each dimension, which is comparable to similar studies in different international settings. Along with revealing significant differences between sites, analysis indicates that nurses, younger professionals, females and non-Arabic speaking professionals have significantly lower favourable perceptions of the dimensions under investigation, and that nurses rate their quality of communication with other professionals significantly lower than the ratings they received from them. Cultural background, including language, influences perceptions of the safety culture. Communication, cultural background, and gender are found to comprise a new patient safety dimension, multicultural workplace. This dimension (α = 0.79; ẋ = 3.6; SD = 0.96) has strong, positive correlations with other valid dimensions except stress recognition. Site, profession, and gender are significant predictors of this new dimension. Both the open-ended questions and the semi-structured interviews reveal culture as an important factor, influencing several aspects of safety culture. Many issues were related to the concept of a multicultural workplace, and the strong correlation of this with other dimensions of safety climate indicates its relevance and importance to the safety culture. Nurses, of whom the majority were female and non-Arabic speaking, had significantly lower perceptions of safety culture than other respondents. The influence of context, gender, cultural background and language on safety culture is evident. Cultural integration, initiated in classes about local culture and language, is recommended to bridge gaps between local and multinational workforces. Recommendations of enhancement to teamwork, communication, equity of team members and conflict resolution should provide a better, safer environment for hospital staff and patients if implemented.Thesis (Ph.D.) -- University of Adelaide, School of Nursing, 201

The Prospect of Lactoferrin Use as Adjunctive Agent in Management of SARS-CoV-2 Patients: A Randomized Pilot Study

Background and Objectives: Preventive, adjunctive and curative properties of lactoferrin have been evaluated since the first wave of severe acute respiratory syndrome coronavirus (SARS-CoV), a viral respiratory disease, emerged 18 years ago. Despite the discovery of new vaccine candidates, there is currently no widely approved treatment for SARS-CoV-2 (COVID-19). Strict adherence to infection prevention and control procedures, as well as vaccines, can, however, prevent the spread of SARS-CoV-2. This study aimed to evaluate the efficacy of lactoferrin treatment in improving clinical symptoms and laboratory indices among individuals with mild to moderate coronavirus disease-19 (COVID-19). Materials and Method: A randomized, prospective, interventional pilot study conducted between 8 July and 18 September 2020 used a hospital-based sample of 54 laboratory-confirmed participants with mild to moderate symptoms of COVID-19. Randomization into a control and two treatment groups ensured all groups received the approved Egyptian COVID-19 management protocol; only treatment group participants received lactoferrin at different doses for seven days. Clinical symptoms and laboratory indices were assessed on Days 0, 2 and 7 after starting treatments. Mean values with standard deviation and one-way analysis of variance with least significant difference of demographic and laboratory data between control and treatment groups were calculated. Results: Our study showed no statistically significant difference among studied groups regarding recovery of symptoms or laboratory improvement. Conclusions: Further research into therapeutic properties particularly related to dosage, duration and follow-up after treatment with lactoferrin in individuals with COVID-19 is required

Biogenic Amines and Aflatoxins in Some Imported Meat Products: Incidence, Occurrence, and Public Health Impacts

Background. Since the beginning of humanity, the global burden of foodborne disease has had a decimating effect on populations, with biogenic amines (BAs) and aflatoxins in meat products implicated. While many developed countries have legitimized safety levels for BAs using evidence-based guidelines to attain high food quality standards for consumers of meat products, developing countries are still battling against poor food quality checking. Purpose. This study examines the level of health risk of biogenic amines and aflatoxin in meat products by extracting and estimating their residues and determining their indices as a way of monitoring the potential health impacts of these residues on consumers of meat products. Methods. A total of 40 imported meat products sampled and randomly collected, representing imported luncheon meat, hot dog sausages, corned beef, and minced meat. Using recommended laboratory protocols, eight residues of BAs and aflatoxins were extracted. Results. Eight BAs, histamine, tyramine, tryptamine, cadaverine, putrescine, β-phenyl ethylamine, spermine, and spermidine, were extracted and determined in all tested samples. Tyramine levels in luncheon meat were found to be significantly higher than in other meat products, while significantly high cadaverine levels were reported in corned beef samples. The results of biogenic amine index (BAI) revealed that the quality of imported minced meat and imported hot dog samples was good (BAI 5 µg/kg) in imported luncheon meat and imported hot dog meat samples. Conclusion. The general results indicate that testing meat products for biogenic amines and aflatoxins is a very good indicator for monitoring the freshness and quality of meat products