Healthcare providers as patients: COVID-19 experience

There is compelling evidence for the psychological effects of the COVID-19 pandemic and earlier epidemics. However, fewer studies have examined the subjective meaning experience of healthcare providers who have survived COVID-19 as patients. This qualitative study aimed to understand further and describe the life experiences of healthcare providers who have survived COVID-19 as patients in Saudi Arabia. Data was collected using unstructured in-depth individual interviews among n = 10 healthcare providers from public hospitals in Saudi Arabia. Data were analyzed based on a phenomenological approach, which resulted in five themes: (i) physical and psychological signs and symptoms; (ii) self-healing, hiding pain, and family; (iii) fear of complications; (iv) disease stigma & long-term psychological outcomes; (v) emotional support, mental well-being & resignation. The overall synthesis showed that healthcare providers, as patients, experience the same difficulties and stressors as the general public. In some cases, these factors are even worse, as family members, colleagues, and employers develop a new type of stigma. Given the impact of social media and the flow of information of any type, more research is needed to examine the sources used to obtain information by the general public, whether these sources are reliable, and how the public can be taught to use only scientific data and not social data. Understanding the experience of healthcare providers as patients during the pandemic has allowed to look at the feelings and needs of people during illness from a new perspective. As expressed by participants, being a healthcare provider does not reduce the fear of the disease and does not mitigate its consequences in the form of stigmatization and isolation

Evaluation of bi-lateral co-infections and antibiotic resistance rates among COVID-19 patients

In addition to the pathogenesis of SARS-CoV-2, bacterial co-infection plays an essential role in the incidence and progression of SARS-CoV-2 infections by increasing the severity of infection, as well as increasing disease symptoms, death rate and antimicrobial resistance (AMR). The current study was conducted in a tertiary-care hospital in Lahore, Pakistan, among hospitalized COVID-19 patients to see the prevalence of bacterial co-infections and the AMR rates among different isolated bacteria. Clinical samples for the laboratory diagnosis were collected from 1165 hospitalized COVID-19 patients, of which 423 were found to be positive for various bacterial infections. Most of the isolated bacteria were Gram-negative rods (n = 366), followed by Gram-positive cocci (n = 57). A significant association (p 50% of COVID-19 patients were fever, fatigue, dyspnea and chest pain with a significant association (p < 0.05) in bacterial co-infected patients. The current study results showed a comparatively high prevalence of AMR, which may become a severe health-related issue in the future. Therefore, strict compliance of antibiotic usage and employment of antibiotic stewardship programs at every public or private institutional level are recommended

Global prevalence of Colistin resistance in Klebsiella Pneumoniae from bloodstream infection: A systematic review and meta-analysis

Background: Among gram-negative bacteria, Klebsiella pneumoniae is one of the most common causes of healthcare-related infection. Bloodstream infections (BSIs) caused by Klebsiella pneumoniae are notorious for being difficult to treat due to resistance to commonly used antimicrobials. Klebsiella pneumoniae isolates from bloodstream infections are becoming increasingly resistant to carbapenems. In the fight against carbapenem-resistant Klebsiella pneumoniae, colistin [polymyxin E] is the antimicrobial of choice and is thus widely used.Objective: This study aimed to determine the global prevalence of colistin resistance amongst Klebsiella pneumoniae isolates from bloodstream infections. Methods: PubMed, Medline, Scopus, and the Cochrane Library were searched for published articles without restricting the search period. Studies meeting the predefined inclusion and exclusion criteria were included, and quality was assessed using Joanna Briggs Institute Checklist. We used a statistical random effect model to analyze data with substantial heterogeneity (I2 > 50%) in the meta-analysis. Results: A total of 10 studies out of 2873 search results that met the inclusion criteria were included in the final synthesis for this study. A pooled prevalence of colistin resistance was 3.1%, 95% CI (1.5–4.7%). The highest colistin resistance pooled prevalence was recorded in isolates studied in 2020 and beyond 12.90% (4/31), while Klebsiella pneumoniae isolates studied in 2015 and before and in 2016–2019 showed a pooled colistin resistance rate of 2.89% (48/1661) and 2.95% (28/948), respectively. The highest colistin resistance was found in Klebsiella pneumoniae isolates from Thailand (19.2%), while the least pooled resistance was in Klebsiella pneumoniae from South Korea (0.8%). The pooled prevalence of the multidrug-resistant (MDR) of Klebsiella pneumoniae from bloodstream infection ranged from 80.1%, 95% CI (65.0–95.2%), and the resistance prevalence of other antibiotics by Klebsiella pneumoniae from bloodstream infections were as follows; ciprofloxacin (45.3%), ertapenem (44.4%), meropenem (36.1%), imipenem (35.2%), gentamicin (33.3%), amikacin (25.4%) and tigecycline (5.1%). Klebsiella pneumoniae recovered from the intensive care unit (ICU) showed higher colistin resistance, 11.5% (9/781%), while non-ICU patients showed 3.03% (80/2604) pooled colistin resistance. Conclusion: This study showed low colistin resistance in Klebsiella pneumoniae isolates from global bloodstream infections. However, significant colistin resistance was observed in isolates collected from 2020 and beyond. Significant colistin resistance was also observed in Klebsiella pneumoniae isolates in bloodstream infections from the intensive care unit (ICU) compared to those from non-ICUs. As a result, there is a need to institute colistin administration stewardship in the ICU in clinical settings

Predicting burnout factors among healthcare providers at private hospitals in Saudi Arabia and United Arab Emirates: A cross-sectional study

Background: Burnout is defined as a long-term work stress. The prevalence of burnout syndrome among nurses is 42% of nurses in England. Many countries have conducted studies to measure the level of burnout among health care providers. There is a lack of research on burnout among healthcare providers in the Arabic countries. Aims: This study aimed to assess the burnout level among healthcare providers in Saudi Arabia and United Arab Emirates and to predict the burnout factors of healthcare providers working in tertiary private hospitals. Methods: A descriptive cross-sectional survey was used to evaluate the burnout among healthcare providers. A total of 900 healthcare providers working in the clinical areas of six private hospitals in the Arabia Gulf Region were recruited for the study. A total of 892 healthcare providers were included in the study. A total of eight surveys were excluded due to major missing data. Results: A total of 892 healthcare providers were included in the study. The average age was 32 years ± 7 years for male and female healthcare providers. A high burnout level was found in the results. The participating female healthcare providers had a higher level of emotional exhaustion as compared with their male counterparts. Nurses had more emotional exhaustion as compared with physicians, respiratory therapists, and other colleagues. Conclusions: High burnout levels among healthcare providers can reflect negatively on the healthcare providers well-being, job satisfaction, and mental health. Burnout has been linked with medical errors and physician–patient relationships. We believe that it is important to deal with this issue of public health in Saudi Arabia and UAE. This study aimed to explore burnout levels among healthcare providers in Saudi Arabia and UAE. Results showed a high level of burnout among the healthcare

Outcomes of rapid response team implementation in tertiary private hospitals: A prospective cohort study

Background: Cardiopulmonary arrest may result in high mortality rate in hospitals where the rapid response team is not implemented. A rapid response system can recognize patients at high risk of cardiopulmonary arrest and provide the needed medical management to prevent further deterioration. The rapid response system has shown a dramatic reduction in mortality rate and cardiopulmonary arrest. Objective: To evaluate the effectiveness of the rapid response team (RRT) implementation in reducing the mortality rate, number of cardiopulmonary arrests, and number of ICU admission. Design: A pre- and post-rapid response team system implementation. Setting: Four tertiary private hospitals in Saudi Arabia. Patients: A total of 154,869 patients in the 3-year before rapid response system period (January 2010 to December 2012) and a total of 466,161 during the 2.5-year post-RRT implementation period (January 2014 to June 2016). Results: Results indicated that ward nurses activated RRT more often than physicians (1104 activations [69%] vs. 499 activations [31%]), with cardiovascular and respiratory abnormalities being the most common triggers. Serious concern about the patient condition by the ward staff was the trigger for 181 (11.29%) activations. The RRT provided a variety of diagnostic and therapeutic interventions. Most patients cared for by RRT were admitted to ICU 1103 (68.81%), and the rest 500 (31.19%) were managed in the ward. After the implementation of the RRT project, the hospital mortality rate dropped from 7.8 to 2.8 per 1000 hospital admission. Hospital cardiopulmonary arrest rate has dropped from 10.53 per 1000 hospital admissions to 2.58. Rapid response team implementation also facilitated end-of-life care discussions. Conclusion: Implementation of the RRT project has shown a dramatic reduction in the total ICU admissions, average ICU occupancy rate, total hospital mortality, and total ICU mortality. These findings reinforce the evidence that RRT implementation is effective in reducing hospital mortality and cardiopulmonary arrest rates in addition to other outcomes related to healthcare quality

Sleep Deprivation Etiologies Among Patients in the Intensive Care Unit: Literature Review

BACKGROUND: Sleep deprivation among patients is a common problem in the intensive care unit (ICU). Studies have tried to find the etiologies of sleep deprivation. Poor sleep quality in the ICU has effects such as delirium, weakening the wound healing, and anxiety. Researches have concluded that the etiologies for sleep deprivation are multifactorial. OBJECTIVES: The aim of this review is to discuss the etiologies of sleep deprivation among ICU patients. This review also aims to discuss effects of sleep deprivations and provide implications for promoting sleep quality in the ICU. METHODS: For this literature review, ProQuest, MEDLINE, and Up To Date were used to find articles about sleep deprivation among ICU patients. The search was narrowed to articles between 2008 and 2019. A total of 23 articles were included that were found to match the inclusion criteria. RESULTS: Findings indicated that sleep deprivations etiologies among ICU patients can be environmental and nonenvironmental. Sensory overload, sensory deprivation, and patients\u27 care activities are environmental etiologies for sleep deprivation. The nonenvironmental factors include pharmacological, physical, and psychological factors. DISCUSSION: Sleep deprivation etiologies are multifactorial and have several effects on ICU patients. Sleep protocol and staff training should be introduced to reduce unnecessary interventions by ICU staff. Tele-ICU monitoring can also be introduced to reduce unnecessary interventions where clinicians can monitor patients remotely and therefore enhance sleep in the ICU. During their stay in the ICU, patients can be instructed to wear earplugs and also have aromatherapy massage to reduce stress and enhance sleep quality. More research on the physical pain and the psychological factors using objective methods should be conducted in the future

Hospital-acquired pressure ulcer incident rates among hospitals that implement an education program for staff, patients, and family caregivers inclusive of an after discharge follow-up program in Saudi Arabia

A tertiary public hospital in Saudi Arabia set out in 2015 to establish a team focused on reducing hospital-acquired pressure ulcers (HAPUs). The pressure ulcer prevention program (PUPP) had a multifaceted approach and data were collected for a period of 5 years. The results showed a definite reduction in the incidences of HAPUs. Many such programs show similar positive results and echo many of the same considerations of risk, prevention strategies, and the need for early intervention. However, none of the other studies either replicate the hospital\u27s PUPP nor the extent of the positive and lasting effect of the program. Eager to determine the contributing factor(s) in order that the project success could be continued and possibly replicated in other quality improvement projects, it was decided that an examination and comparison of other similar programs and their results would be necessary in order to uncover the answer. It was determined that the in-person in-home discharge follow-up portion of the program most likely had the largest effect on the outcomes. Outcomes that were supported by the pre-work completed during the hospital portion of the PUPP towards reducing HAPUs and readmissions

A multicenter case-historical control study on short-term outcomes of tele-intensive care unit

Aims: This study aimed to determine the impact of tele-intensive care unit (ICU) on ICU mortality rate (%), and to quantify association of the tele-ICU intervention with ICU length of stay (LOS, days), readmission rates (%), reintubation rates (%), hospital-acquired pressure ulcer (HAPU) rate (%), and discharge against medical advice (DAMA) rate (%) in five hospitals. Methods: A multicenter case-historical control study was conducted on short-term outcomes of tele-ICU program in five private hospitals within Arabian Gulf Region. Critically ill adult patients admitted into ICU without tele-ICU were recorded as control group (pre-tele-ICU), whereas those admitted to tele-ICU were grouped as treatment group (post-tele-ICU). The observed outcomes for each patient were then recorded, namely mortality, reintubation, readmission, HAPU, DAMA, and length of stay (LOS). Results: Chi-square test showed that there are significant differences in mortality rate (χ2 = 6.596, p = 0.010), readmission rate (χ2 = 4.315, p = 0.038), HAPU rate (χ2 = 10.445, p = 0.001), and DAMA rate (χ2 = 4.485, p = 0.034) between pre-tele-ICU and post-tele-ICU, at 0.05 significance difference level. Independent t-test showed that there is significant different in LOS (t = 43.63, p \u3c 0.001) between pre-tele-ICU (mean = 6.72 days) and post-tele-ICU (mean = 5.79 days). Odds ratio showed that critically ill adult patients who admitted to post-tele-ICU have 19% less reduction in mortality rate, 23% less reduction in readmission rate, 43% less reduction in HAPU rate, and 11% less reduction in DAMA rate as compared with those admitted to pre-tele-ICU. Conclusion: Tele-ICU as a step to improve the quality of health care project has shown statistically significant improvement in the adult ICU patients\u27 outcomes, which lead to lesser mortality rate, readmission rate, HAPU rate, DAMA rate, and shorter LOS

Supporting Muslim families before and after a death in neonatal and paediatric intensive care units

Background: The death of a child is regarded as one of the most devastating events for a family. Families are reliant on nurses to not only provide end-of-life care but also to support and care for grieving families in a way that is sensitive to their cultural and religious needs and preferences. Aims: The aim of this study was to explore the perceived impact and influence of cultural diversity on how neonatal and paediatric intensive care nurses care for Muslim families before and after the death of infants/children. Design: A qualitative descriptive approach was used in this study, conducted in Saudi Arabia. Methods: Semi-structured interviews were used to gather data from a convenience sample of registered nurses working in neonatal and paediatric intensive care, with experience in providing end-of-life care. Interviews were conducted between July and November, 2018. Interviews were audio-recorded and transcribed for analysis. Results: Thirteen registered nurses participated; all were born overseas, identified with various faiths and spoke English in the workplace. A respect for diversity and care of the family was prioritized yet impacted by communication challenges. Caring and respect was demonstrated by facilitating important cultural and religious practices important in the Muslim faith. Self-care was identified as important, transcending the culturally diverse nature of the nursing workforce. Conclusions: Significant challenges exist for a culturally diverse nursing workforce in providing care to a Saudi Muslim population of infants/children and families, before and after a death. Their overriding commitment to respect for others, and an openness to cultural diversity and difference, aided in overcoming the inherent challenges in providing culturally sensitive end-of-life care that meets the needs of Muslim families. These findings provide valuable insights for intensive care clinicians in other countries to address challenges associated with cultural diversity

Examining and adapting the psychometric properties of the maslach burnout inventory-health services survey (MBI-HSS) among healthcare professionals

Burnout is known to negatively impact healthcare providers both physically and mentally and is assessed using the Maslach Burnout Inventory-Human Services Survey (MBI-HSS). Many versions of this tool have been developed for different parts of the world, but there is currently no valid version specifically designed for use in the Gulf Cooperation Council Region. This study aims to use data collected across six different regions in the Gulf Cooperation Council Region to assess the validity and reliability of the MBI-HSS model and develop a version of the MBI-HSS best suited for evaluating burnout levels among the healthcare providers in this region. The MBI-HSS questionnaire adapted by Maslach was distributed to 888 healthcare providers aged 32 years ± 7 years, 231 (26.1%) of whom were males and 651 (73.9%) of whom were females, between 2017 and 2018. The data collected were randomly divided into two subsamples, resulting in a sample with the data of 300 healthcare professionals for exploratory factor analysis (EFA) and 588 healthcare professionals for confirmatory factor analysis (CFA). The CFA of the original version of the MBI-HSS yielded a chi-square value of 1897 (p \u3c 0.001), indicating the need for revision. EFA was then used to construct a new model of the MBI-HSS, and a CFA was performed on the second subsample to evaluate the model fit to the data. The EFA produced a 3-factor version that accounted for 56.3% of the total variance, with item 11 of the MBI moved to the Emotional Exhaustion (EE) subscale and item 16 loaded onto Depersonalisation (DP) instead of EE. Additionally, items 18 and 20 were omitted. The reconstructed version had a Root Mean Square Error of Approximation (RMSEA) value of 0.065 (0.90) and an adjusted goodness of fit index (AGFI) value of 0.893 (\u3e0.8). These results when compared to the CFA of the original model, which produced a GFI value of 0.79, an AGFI value of 0.74 and an RMSEA value of 0.09 (\u3e0.08), indicate that this new version has a more satisfactory fit to the data and should be used when assessing burnout in the Gulf Cooperation Council Region