Epidemiological patterns of bacterial and fungal healthcare-associated infection outbreaks in Ministry of Health hospitals in Saudi Arabia, 2020-2021

BACKGROUND

Healthcare-Associated Infections (HAI) outbreaks remain a huge challenge to the healthcare sectors worldwide. Their impact on morbidity and mortality, economic and healthcare burden remains a public health problem and a challenge to the HAI surveillance system, infection control, and HAI management strategies.

AIM

This study aimed to investigate the epidemiological patterns, distribution, causative agents of HAI outbreaks and the influence of age, COVID-19 co-infection, medical invasive procedures, and hospital units on mortality among HAI outbreaks cases.

METHODS

This chart review study involved HAI outbreak cases recorded in Ministry of Health hospitals during 2020-2021 in Saudi Arabia. HAI outbreak notification and investigation forms were used for data collection. A binary logistic regression model was performed to determine the significant predictors of mortality. Univariate analyses were performed to determine the association between hospital units, organisms, and COVID-19 co-infection to the site of infection.

RESULTS

A total of 217 HAI outbreaks with 1003 cases were recorded in 2020-2021. Gram-negative bacteria were isolated from 73.8% of the cases. The overall specific case fatality rate was 47.5%. The significant predictors of mortality were age, invasive medical procedures, COVID-19 co-infection, and intensive care units' admission. Moreover, ventilator-associated events were more associated with cases co-infected with COVID-19.

CONCLUSION

HAI outbreaks were most prevalent in the Western and Central region and in intensive care units. Gram negative bacteria were responsible for most of cases while ventilator-associated events and central line-associated bloodstream infections were the most common infection sites. Implementing targeted and effective prevention and control strategies is recommended.

National Healthcare-Associated Infections Report 2022 - Saudi Arabia

BACKGROUND

Surveillance data are very essential for the effective use of available resources, the prioritization of infection control practices, and setting goals for intervention. The aim was to present the current rates of healthcare-associated infections (HAIs) and device utilization ratios (DUR) among the Saudi Ministry of health (MOH) hospitals.

METHODS

MOH analyzed the surveillance data collected from 106 MOH hospitals enrolled in the health electronic surveillance network (HESN) between January 2022 and December 2022. The surveillance methodology was similar to the methods of the US National Healthcare Safety Network (NHSN) and the Gulf Cooperation Council (GCC) center for infection control.

RESULTS

More than one million device-days of surveillance were analyzed. The rate of central line associated bloodstream infection (CLABSI) was 2.57 per 1000 central lines days. The rate of catheter-associated urinary tract infection (CAUTI) was 1.08 per 1000 urinary catheter days. The rate of ventilator-associated events (VAE) was 4.21 per 1000 ventilator days. The average rate of pediatric/neonatal ventilator-associated pneumonia (VAP) was 1.53 per 1000 ventilator days. The average DURs were 0.33 for central line, 0.61 for urinary catheter, 0.44 for ventilator in adult patients, and 0.26 in ventilator in pediatric/neonatal patients. In 238632 months of surveillance, the rate of dialysis events (DE) was 0.97 per 100 patient-months. In 86324 surgeries monitored, the rate of surgical site infection (SSI) was 0.87 per 100 surgeries surveyed.

CONCLUSIONS

The current report can serve as a national benchmark for MOH hospitals and a regional benchmark for similar hospitals in the region.

Epidemiological and clinical characteristics of COVID-19 mortality among healthcare workers in Saudi Arabia: A nationwide study

Background

Healthcare workers (HCWs) have been highly affected by COVID-19 due to their fundamental duties in diagnosing, caring, and treating the rapidly increasing number of infected patients. Thus, are facing the occupational risk of COVID-19 infection and mortality.

Purpose

To investigate the COVID-19 disease clinical characteristic and associated factors among HCWs in Saudi Arabia.

Methods

This was a nationwide, retrospective analytical study conducted from 5th of March 2020–21 st of August 2021. All deceased HCWs who were diagnosed with COVID-19 were included in this study.

Results

As of August 21, 2021, a total of 305 deaths were recorded due to COVID-19 infection among HCWs in all Saudi healthcare facilities. The case fatality rate was 0.35%. Deaths were highest among physicians (40.0%). Most of deceased HCWs acquired the infection from the community (80%). 71% of deceased HCWs had at least one chronic medical condition. Most of them were admitted to ICU before they passed away (83.6%). Three significant variables predicting ICU admission were presence of one or more comorbidities, hypertension, and chronic respiratory diseases

Conclusion

HCWs are at higher risk for exposure to COVID‐19 due to their occupational risk. Our study encourages future research to provide more comprehensive information regarding COVID-19 morbidity and mortality among HCWs.

Incidence and epidemiological characteristics of COVID-19 among health care workers in Saudi Arabia: A retrospective cohort study

INTRODUCTION

Novel coronavirus (SARS-CoV-2) is a highly infectious serious acute respiratory syndrome that has emerged in Wuhan, China, and has spread rapidly throughout the world including Saudi Arabia. An important source of infection of 2019 novel coronavirus (2019-nCoV) is healthcare-associated infection (HAI). Healthcare workers (HCWs) have a greater risk of acquiring COVID-19 infection than the general population. Globally, thousands of HCWs have lost their lives due to COVID-19 infection.

AIM

Identify Incidence Rate and epidemiological characteristics of COVID-19 infection among health workers in Saudi Arabia.

METHODOLOGY

A retrospective cohort study carried from March to November 2020. HCWs selected by a Complete Enumeration Survey method. Data analyzed in frequencies and percentage tables. To test the differences, post hoc after chi-square-(χ²) tests were used.

RESULTS

As of November 30, 2020, a total of 57,159 HCWs tested positive with COVID-19. Their median age was 34 years, and 53% were male. Nurses were the most infected HCWs category (36%). The most common source of infection was from the community (78%). The majority of HCWs who acquired the infection from healthcare facilities got the infection from another HCW (63%). There was a significant difference between community and healthcare-acquired COVID-19 in relation to gender (P < 0.001) nationality (P < 0.001) job categories (P < 0.001) three age groups (<26: P = 0.012, 26-35 and 36-45: P < 0.001), and among HCWs who worked in MOH and private healthcare facilities (P < 0.001). The total number of reported deaths among HCWs during the study period was 198, with a case fatality rate of (0.35%).

CONCLUSION

This study findings show that infected HCWs characteristics were similar to the previous studies and indicate incidence rates of 10% among COVID-19 infected HCWs in Saudi Arabia. Analysis of the infection status of HCWs is critical, to understand their needs and challenges, improve protective measures, and provide effective recommendations for policymakers.

Diabetes Mellitus, Hypertension, and Death among 32 Patients with MERS-CoV Infection, Saudi Arabia

Diabetes mellitus and hypertension are recognized risk factors for severe clinical outcomes, including death, associated with Middle East respiratory syndrome coronavirus infection. Among 32 virus-infected patients in Saudi Arabia, severity of illness and frequency of death corresponded closely with presence of multiple and more severe underlying conditions.

Middle East Respiratory Syndrome Coronavirus Infection Dynamics and Antibody Responses among Clinically Diverse Patients, Saudi Arabia

Middle East respiratory syndrome coronavirus (MERS-CoV) shedding and antibody responses are not fully understood, particularly in relation to underlying medical conditions, clinical manifestations, and mortality. We enrolled MERS-CoV–positive patients at a hospital in Saudi Arabia and periodically collected specimens from multiple sites for real-time reverse transcription PCR and serologic testing. We conducted interviews and chart abstractions to collect clinical, epidemiologic, and laboratory information. We found that diabetes mellitus among survivors was associated with prolonged MERS-CoV RNA detection in the respiratory tract. Among case-patients who died, development of robust neutralizing serum antibody responses during the second and third week of illness was not sufficient for patient recovery or virus clearance. Fever and cough among mildly ill patients typically aligned with RNA detection in the upper respiratory tract; RNA levels peaked during the first week of illness. These findings should be considered in the development of infection control policies, vaccines, and antibody therapeutics.

Scope and extent of healthcare-associated Middle East respiratory syndrome coronavirus transmission during two contemporaneous outbreaks in Riyadh, Saudi Arabia, 2017

OBJECTIVE

To investigate a Middle East respiratory syndrome coronavirus (MERS-CoV) outbreak event involving multiple healthcare facilities in Riyadh, Saudi Arabia; to characterize transmission; and to explore infection control implications.

DESIGN

Outbreak investigation.

SETTING

Cases presented in 4 healthcare facilities in Riyadh, Saudi Arabia: a tertiary-care hospital, a specialty pulmonary hospital, an outpatient clinic, and an outpatient dialysis unit.

METHODS

Contact tracing and testing were performed following reports of cases at 2 hospitals. Laboratory results were confirmed by real-time reverse transcription polymerase chain reaction (rRT-PCR) and/or genome sequencing. We assessed exposures and determined seropositivity among available healthcare personnel (HCP) cases and HCP contacts of cases.

RESULTS

In total, 48 cases were identified, involving patients, HCP, and family members across 2 hospitals, an outpatient clinic, and a dialysis clinic. At each hospital, transmission was linked to a unique index case. Moreover, 4 cases were associated with superspreading events (any interaction where a case patient transmitted to ≥5 subsequent case patients). All 4 of these patients were severely ill, were initially not recognized as MERS-CoV cases, and subsequently died. Genomic sequences clustered separately, suggesting 2 distinct outbreaks. Overall, 4 (24%) of 17 HCP cases and 3 (3%) of 114 HCP contacts of cases were seropositive.

CONCLUSIONS

We describe 2 distinct healthcare-associated outbreaks, each initiated by a unique index case and characterized by multiple superspreading events. Delays in recognition and in subsequent implementation of control measures contributed to secondary transmission. Prompt contact tracing, repeated testing, HCP furloughing, and implementation of recommended transmission-based precautions for suspected cases ultimately halted transmission.