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ASSESSING THE PREVALENCE OF PHARMACEUTICAL RESIDUES IN WADI ZOMAR CATCHMENT AREA IN PALESTINE: RISK ASSESSMENT FOR REUSE AND IMPACT ON HUMAN HEALTH
(2023-06-08) Ala'a Monther Hassan Jaddou
Abstract The occurrence of various classes of antibiotics and pharmaceuticals (PhCs) in the environment and their contribution to Antimicrobial resistance (AMR) development is questionable. AMR is recognized as a major health threat. Discharges from wastewater treatment plant (WWTP) is considered to be the major source contributing to the vast bulk of different pharmaceuticals in the environment. The researcher intends to investigate the prevalence of pharmaceutical residues in diverse aquatic matrices with more attention to the removal capacity of West Nablus WWTP with respect to the detected pharmaceuticals. Method: 2 raw wastewater, 2 treated wastewater, and 2 surface wastewater run-offs were collected in two grab sampling campaigns. An additional ground water sample was collected using a Passive Organic Chemical Integrative Sampler (POCIS). All samples were analyzed using LC-MS/MS. The Risk Quotient (RQ) was used for Measured Environmental Concentration (MEC) of detected antibiotics against Predicted No-Effect Concentration ((PNEC) to evaluate the risk for antibiotic resistance development according to the detected antibiotics residues. Sulfamethoxazole, Trimethoprim, Diclofenac, and Carbamazepine were the most frequently detected in all water samples. West Nablus WWTP delivered a significant removal efficiency in both campaigns. However, it was noticed that there was a significant spatial difference between the WWTP effluent discharge point and the Anabta-Zomar point of sampling directly after the rainy season. Ofloxacin residual concentration in immediate WWTP effluent discharges and surface run-offs along the sampling point is found to pose risk for AMR development in the environment. Groundwater is found to be polluted with Carbamazepine, Diclofenac, Ciprofloxacin, and Sulfamethoxazole. The local status indicates the need for further in-depth investigation regarding the risk of antibiotics to the environment and its role in the emergence of AMR concerning the detected antibiotics. Additional wastewater treatment methodologies are needed for better removal yield. Groundwater pollution requires urgent ecotoxicological studies for both human and animal health and environmental life forms. Keywords: Antibiotics; Antimicrobial resistance; Bacteria; Environment; Health; Pharmaceuticals; Wastewater; WWTP.
ASSESSMENT OF ADHERENCE TO IRON CHELATION THERAPY AMONG PALESTINIANS WITH THALASSEMIA AT AL-WATANI GOVERNMENTAL HOSPITAL, NABLUS, PALESTINE
(An-Najah National University, 2024-09-19) Ieran, Zein
Introduction: Adherence to iron chelation therapy is a crucial step in reducing excess iron levels in the body, as all patients aim to decrease iron levels beyond the normal range. Factors such as age, having a sibling with thalassemia, lack of parental supervision, lower family income, infrequent blood transfusions, and psychological issues are likely to be investigated as significant predictors of nonadherence. Additionally, the relationship between disease knowledge and adherence status will be examined. It is important for healthcare providers to be aware of the high prevalence of poor adherence to iron chelation therapy among patients. Therefore, nurses should regularly assess, monitor, and encourage adherence behaviors that could impact patient outcomes. Aim: To assess different barriers to adherence patients with Beta thalassemia included patient-related factors, medications-related factors, sociocultural-related factors, environmental context and resources, and patient–health care provider relationship factors Method: A descriptive cross-sectional design is adopted to assess the adherence for thalassemia patients of the National Thalassemia Center at the National Hospital, Nablus. The sample size of 120 thalasemia patients. Data was collected using an direct interview or by phone that composed questionnaire of three parts. The first part of the questionnaire Sociodemographic and clinical characteristics of the samples in Thalassemia center the second part of the questionnaire included Assessment of disease knowledge gaps among thalassemia patients. And the third part of the questionnaire on adherence patient to iron chelation therapy.Collected data was entered and analyzed in SPSS version 21. P value of <0.05 was taken as significant. Results: Nearly equal gender distribution (63% males, 57% females) and a predominant age range of 18 to 26 years were studied. Adherence to iron c helation therapy correlated with lower ferritin levels, indicating treatment efficacy. Notably, both adherent and non-adherent patients demonstrated a good understanding of thalassemia, suggesting sufficient disease knowledge among the participants. However, adherence positively influenced patient satisfaction with hospital treatment and medical services, highlighting the importance of patient education and support systems in enhancing treatment adherence and overall healthcare experience. Conclusion: The study concluded that many patients at the National Governmental Hospital in Nablus show adherence to iron chelation therapy. However, challenges remain, including difficulties in obtaining medication and external influences that affect adherence despite adequate knowledge. The role of health care providers is important in strengthening relationships between the patient and the service provider, providing multidisciplinary care, highlighting the importance of education and continuous support for patients, in addition to addressing the obstacles that lead to patients’ non-compliance with treatment.
ASSESSMENT OF CURRENT PRE-DISCHARGE NEONATAL JAUNDICE SCREENING PRACTICES IN GOVERNMENTAL HOSPITALS OF WEST BANK
(An-Najah National University, 2024-02-07) Barhoush, Abeer
About (60%) of mature and (80%) of premature newborns experience jaundice in the first 7 days of life, and about (10%) of themstay jaundiced till one month. Pre-Hospital discharge jaundice screening for early detection of newborns who are at risk is essential. This is the first study to assess the current practice of pre-discharge neonatal jaundice screening in governmental hospitals inthe West Bank. A questionnaire-based quantitative study was conducted among all pediatrician doctors who work at 8 West bank governmental hospitals, between September 2022 and May 2023. A structured Self-administered questionnaire was administered to participants who obtained from Personnel Affairs in selected Palestinian governmental hospitals a month before the data acquisition. A full of 138 pediatrician doctors participated in this study, which showed a relative weakness in adherence to jaundice screening guidelinesand the results of pediatricians' practices regarding the screening of neonatal jaundice were relatively low. pediatricians doctors shows low adherence levels and inadequate practices regarding screening of neonatal jaundice pre-hospital discharge. Studies are needed in our country to evaluate the impact of this practice on infants with jaundice.
ASSESSMENT OF DENTAL MALPRACTICE AND ITS ASSOCIATION WITH INFECTIOUS DISEASE TRANSMISSION: A CROSS-SECTIONAL STUDY IN NABLUS GOVERNORATE
(An-Najah National University, 2025-05-07) Ghanem, Haitham Fawzi
Background: Infectious diseases pose significant health risks globally, and dental clinics are not exempt from these challenges. Inadequate infection control practices continue to pose significant health risks. This study aims to identify malpractices within dental clinics in the city of Nablus. Methodology: A cross-sectional research design was used in the current study on 90 dentists and 120 patients, who visited dental clinics during March 2024. The sampling technique was convenience. Data was collected using a questionnaire. The study was conducted in all dental clinics in the city of Nablus. Results: The results indicated that (84.4%) of the dentists received hepatitis B vaccine. Also, 73.3% of dentists were tested for hepatitis B or human immunodeficiency virus (HIV). About 10.0% of participants monitored the health of employees and ensured that there was no infection. Nearly, 97.8% of dentists wear face masks while working and 35.6% reported change their face masks when treating each patient. Almost, 92.2% of dentists indicated that they wear gloves during treatment procedures and 91.1% of reported changing gloves. Only 23.3% of dentists used eye or face protection. While 76.7% indicated that they don’t use eye or face protection tools. About, 75.6% of dentists reuse the carpule on another patient, while only 24.4% dispose of the cartridge after one use. The results also indicated that 66.0% of patients have knowledge and awareness about medical practices in dental clinics. Conclusions: The results highlighted how critical it is to improve training, enforce stricter infection control guidelines, and conduct routine monitoring in order to reduce these risks. In order to raise infection control standards and guarantee patient safety in dentistry clinics in Nablus, policymakers and healthcare professionals can implement the practical recommendations reported in this study.
ASSESSMENT OF THE COST OF SELECTED CHEMISTRY LABORATORY TESTS USING ACTIVITY-BASED COSTING: A CASE STUDY FROM AN-NAJAH NATIONAL UNIVERSITY HOSPITAL TITLE OF THESIS AS APPROVED BY FACULTY OF GRADUATE STUDIES
(An-Najah National University, 2025-06-29) Abo ALola, Husam Taiseer Hassan
This study aims to assess the application of the Activity-Based Costing (ABC) system in the chemistry laboratory at An-Najah National University Hospital, with the purpose of evaluating its effectiveness in improving cost calculation accuracy and resource management. The study adopted a descriptive cross-sectional methodology, using the “Cooper” model, which consists of two main stages: cost analysis and activity identification, where indirect costs are determined and linked to the activities that drive them. Data were collected from the hospital’s financial records as well as interviews with financial managers and laboratory staff. The results showed that the ABC system provides greater accuracy and transparency in allocating costs by identifying the activities that consume resources and directly linking them to costs. This approach improved resource utilization and offered valuable insights into laboratory operations. The study further demonstrated that the ABC system contributed to enhancing financial and administrative decision-making by providing managers with a precise understanding of the costs of different laboratory activities. This enabled the identification of unnecessary activities or those consuming resources without adding value, leading to improved processes and reduced waste. However, the study also indicated that implementing the ABC system requires additional time and effort at the initial stage, particularly with respect to training financial and administrative staff to use the new system. It also necessitates the provision of appropriate information systems to facilitate the tracking of activities and their associated costs. The study recommends the wider adoption of the ABC system in other hospital departments, especially those that require high accuracy in cost allocation, such as surgical operations and intensive care. It also emphasizes the importance of updating the hospital’s accounting systems to keep pace with modern developments in financial management, as well as developing human resources and providing the necessary information systems to ensure successful implementation. In conclusion, the study indicates that the ABC system is a powerful tool for improving financial transparency and reducing unnecessary costs in the complex environment of hospitals. Although it requires additional resources initially, it provides significant long-term benefits in terms of enhancing resource management and enabling more accurate financial decision-making.
ASSOCIATION BETWEEN NURSES’ QUALITY OF WORK LIFE AND COMPLIANCE WITH STANDARD PRECAUTIONS: A CROSS-SECTIONAL STUDY FROM PALESTINE
(2023-06-11) Salwa Mohammad Asaad
In nearly all healthcare facilities globally, nurses constitute the most populous cadre of healthcare practitioners. The quality of nursing work life and adherence to the standard precautions were less than optimal. The objective of this investigation was to evaluate the degree to which nurses in governmental healthcare institutions in Palestine adhere to established guidelines for universal precautions and to assess the quality of their professional livelihood. This study was carried out in a descriptive cross-sectional design in six government hospitals in the West Bank. The questionnaire contained compliance with the standard precautions scale (CSPS) and the Brooks Quality of nursing work life (BQNWL) survey. A total of 257 nurses participated in this study and returned completed questionnaires. The mean percentage of ideal compliance was 77.1% ± 9.8% and 10 (3.9%) nurses had a CSPS % of ideal compliance of < 60%. Nurses in obstetrics, operations room, incubator unit, internal medicine, surgery, and renal unit were more likely to score ≥ 60% of ideal compliance. The BQNWL total score mean was found to be 177.0 ± 30.2. In detail, the mean scores were 28.5 ± 6.5, 43.2 ± 7.8, 88.5 ± 17.3, and 16.8 ± 5.5 in the work life-home life, work design, work context, and work world domains, correspondingly. Moreover, a statistically significant weak positive association was observed between CSPS scores and BQNWL scores, with a Pearson’s r of 0.16 and p-value of 0.011. Furthermore, a significantly low positive correlation was identified between CSPS scores and work context scores, with a Pearson’s r of 0.19 and p-value of 0.003. Nurses working in different hospitals in Palestine reported moderate adherence to standard precautions. Conversely, the nurses who participated in the study reported a moderately elevated quality of professional nursing livelihood. Specifically, female nurses reported a greater degree of compliance with universal precautions and a higher caliber of nursing work in comparison to their male counterparts. Additionally, a statistically significant weak positive correlation was detected between CSPS and BQNWL scores. In light of these results, healthcare policymakers and administrators may benefit from taking these findings into account to enhance nurses' adherence to established protocols and to improve the quality of their professional work life. Keywords: Infection control; Nursing; Quality of nursing work; Standard precautions.
BACTERIOLOGIC PROFILE AND ANTIBIOTIC SUSCEPTIBILITY PATTERN OF SEPTICEMIA IN NEONATAL INTENSIVE CARE UNITS, PALESTINE (2019-2021)
(2022-12-29) Bayan Asem Mohammad Ibrahim
Background: Neonatal sepsis (NS) is a public health concern worldwide because of its high morbidity and mortality, in addition to the growing resistance towards World Health Organization (WHO) recommended empiric regimens. The aim of this study is to evaluate the matching status of WHO empiric antibiotic regimens with the causative pathogens of NS at three tertiary care hospitals in Palestine. Methods: This is a retrospective study where records of neonates with suspected NS admitted to neonatal intensive care units of three tertiary care units in the period of January 2019 to December 2021 were extracted from the Ministry of Health electronic database. Univariate analysis and multivariate logistic regressions were performed for factors associated with culture-proven NS, generating odds ratios and confidence intervals. Results: Out of 6090 suspected cases of NS, 884 (14.5%) cases had positive blood cultures. The prevalence rate of NS was 9 per 1000 live births and 4 per 1000 live births for early-onset sepsis, with an overall mortality prevalence of (17.2%). The predominantly isolated organisms were 499/884 (56.4%) Coagulase-negative Staphylococcus (CoNS), 119/884 (13.5%) Klebsiella pneumonia, and 66/884 (7.5%) Streptococcus spp. Moreover, most of the isolated bacteria (79.6%) didn’t match any of the WHO empiric regimens and the probability of matching for both WHO regimens among EOS was found 2.4 times the matching probability among LOS by doing multiple logistic regressions. (21.6%) of the Isolated bacteria (excluding CoNS) were multi-drug resistant (MDROs). Antibiotic susceptibility for Gram-negative bacteria was high among amikacin (63%), meropenem (70%), piperacillin-tazobactam (65.6%), and colistin (100%). Alternately, it was low for ampicillin (7.1%), cefotaxime (21.8%), and ceftazidime (29%). On the other hand, Gram-positive bacteria were sensitive to vancomycin (99.8%), and (81%) of Gram-positive other than Staphylococcus spp. were sensitive to ampicillin. Conclusions: The culture-proven NS prevalence rate is 10 folds the rate of high-income countries, and the majority of isolated pathogens were resistant to empiric WHO regimens. Hence, a careful review of empiric treatment for NS is warranted. Moreover, strict infection control and antimicrobial stewardship programs should be implemented to slow down the emergence of resistant organisms among the neonatal population. Keywords: Aantibiotic susceptibility; Empiric regimens; Neonatal sepsis; Prevalence rate of NS.
CHARACTERISTICS OF SHARP INJURIES AND FLUID SPLASH AMONG HEALTHCARE CARE WORKERS IN THE WEST BANK "PALESTINE"
(An-Najah National University, 2025-09-09) Mahmoud, Aashraf Deeb
Background: Sharp injuries and fluid splash exposures (SISE) are major occupational hazards for healthcare workers (HCWs), increasing the risk of transmitting bloodborne pathogens. Despite the widespread occurrence of these incidents worldwide, data from Palestine remain limited. The study aimed to determine characterize and risk factors sharp injuries and fluid splash exposures among healthcare workers in the West Bank, Palestine. Methods: A mixed-methods approach was employed. On the one hand, reviewed injury register records from 2019 to 2024 in five major tertiary hospitals, identifying 452 documented cases of sharp injuries and fluid splash exposures. On the other hand, a cross-sectional survey was conducted in 2024 among HCWs in the same institutions completing a structured questionnaire assessing the frequency, circumstances, and outcomes of sharp injuries and fluid splash exposures, as well as knowledge, attitudes, and preventive practices. Descriptive and analytical data analysis was performed using IBM SPSS Statistics, version 21. A level of significance of 5% was used. Ethical approval was obtained from the Institutional Review Board (IRB) at An-Najah National University. Results: A total of 452 sharp injury and splash exposure cases were identified in the reviewed incident report. Nurses accounted for the majority of incidents (53.8%), with most events occurring during morning shifts (71.3%) and in patient rooms (74.8%). Needles were the most common cause of sharp injuries, while blood was the sole fluid in splash exposures. Among 473 surveyed HCWs, 52.9% reported at least one sharp injury, and 45.3% reported at least one fluid splash exposure during their careers. Notably, 51.4% of those with sharp injuries also experienced fluid splashes. Underreporting was prevalent: 80% of unreported cases were attributed to the perceived lack of seriousness. Hepatitis B vaccination coverage was suboptimal, and only 62.8% adhered to recommended post-exposure protocols. Although 92% reported using personal protective equipment (PPE), gaps in training and compliance were observed. Significant associations were found between SISE occurrence and job category, department, and shift timing (p < 0.05). Conclusion: Sharp injuries and fluid splash exposures are frequent among HCWs in West Bank hospitals, particularly during routine procedures such as intravenous access and blood draws. Despite widespread use of personal protective equipment, gaps in vaccination coverage and post-exposure management persist. Enhanced preventive strategies, improved reporting systems, and targeted training are urgently needed to mitigate occupational risks and protect healthcare personnel.
EFFECTIVENESS OF QUALITY HEALTHCARE SERVICES FROM A PATIENT PERSPECTIVE: A HOSPITAL BASED CASE STUDY
(2023-02-13) Ahmad Nidal Ahmad Rashid
Abstract This study aims to identify the effectiveness of quality healthcare services from a patient perspective: a hospital based case-study. To achieve the objectives of the study and answer its hypotheses the researcher used the descriptive analytical approach which is based on the study of the problem, a method that does not stop at collecting information. The research instrument used to collect data was the questionnaire: The sample of the study consists of (365) patients in governmental hospitals (Rafidia Hospital and the Ittihad Hospital) and private (Arab Specialist Hospital and Nablus Specialist Hospital) in Nablus Governorate. Results show that the degree of tangibility factor practice, that 80% of the participants have agreed on considering it as one of the factors of the effectiveness of healthcare services quality from patient perspective to the extent that its degree has been very high. Hence, 67.9% of the participants agreed on considering the degree of reliability factor practice as one of effectiveness healthcare services quality factors from patient perspective that its degree has been "high". Also, 65.6% of the participants have agreed on considering the degree of empathy factor practice as one of effectiveness healthcare services quality factors from patient perspective that its degree has been "high". Furthermore, 72% of the participant considered the degree of responsiveness factor practice as one of effectiveness healthcare services quality factors from patient perspective that its degree reaches "high". Thus, 66.4% of the participants have agreed that the degree of assurance factor practice as one of effectiveness healthcare services quality factors from patient perspective reaching "high" degree. Finally, 70.8% of the participants have agreed that the degree of doctor’s skills from patient perspective indicating a "high" degree. In addition, the results of Pearson correlation test of the hypotheses shows that doctors skills in dealing with patients is jointly affected quality healthcare services factors including tangibility, reliability, empathy, responsiveness, and assurance. Based on the results of the previous study, the researcher recommends a set of recommendations, which focus on developing assessment tool for patients to detect the healthcare services quality, arranging training courses for doctors to train them to help patients during their treatment in hospitals, and providing a fully organized structure that illustrate the main criteria for healthcare services quality. Keywords: Effectiveness; Hospitals; Nablus city; Patients; Quality healthcare services
ENGAGING PATIENTS AND HOSPITAL HEALTHCARE WORKERS WITH MEDICAL RECORDS ANALYSIS IN THE BALANCED SCORECARD IMPLEMENTATIONS
(An-Najah National University, 2025-07-03) Mousy, Sujood
Background: The Balanced Scorecard (BSC) has been increasingly adopted as a strategic framework for evaluating healthcare performance, emphasizing service quality, patient satisfaction, and organizational effectiveness. The framework assesses performance across four perspectives: financial, customer, internal processes, and learning and growth. Although widely implemented internationally, limited research has addressed its integration with medical records in Palestine. This study aimed to assess patient experiences and healthcare workers’ (HCWs) attitudes toward healthcare delivery at An-Najah National University Hospital in Nablus, Palestine, using BSC principles to provide localized evidence for healthcare improvement. Methodology: A cross-sectional study was conducted between November and December 2024at An-Najah National University Hospital. Two structured and validated self-administered questionnaires were distributed: one to HCWs and another to patients. The patient survey evaluated perceptions of service quality, satisfaction, and engagement with medical records, while the HCWs’ survey measured work engagement and attitudes toward BSC implementation. A total of 185 patients and 195 HCWs participated. Data were analyzed using SPSS, employing descriptive statistics, Pearson correlation, and multiple regression analysis. Results: Strong correlations were found between patient activation and positive attitudes. The mean service quality score was 75.4%. Price information experience scored 72%, while pricing satisfaction was slightly lower at 66.3%. Among HCWs, high engagement was reflected in the Utrecht Work Engagement Scale Dedication (93.3%). However, areas such as workload–time–life balance (59.2%) highlighted opportunities for improvement. Conclusions: Service quality and access to medical records were significant contributors to patient satisfaction. Integrating medical records into BSC implementation can enhance engagement among both HCWs and patients by improving transparency and performance monitoring. These findings provide evidence to guide hospital-level healthcare policy and align future improvements with international benchmarks.
EPIDEMIOLOGY AND ANTIMICROBIAL SUSCEPTIBILITY OF METHICILLIN RESISTANT STAPHYLOCOCCUS AUREUS ISOLATES: A RETROSPECTIVE STUDY AT A TERTIARY CARE HOSPITAL IN PALESTINE BETWEEN 2020-2021
(2023-06-14) Hala Zidan Masri
Increased rates of resistance of Staphylococcus aureus (S. aureus) to different classes of antibiotics, makes the researchers think about studying the antimicrobial profile of it, and other risk factors that may be associated with infection. The goals of our study are to determine the prevalence of methicillin-resistant S. aureus (MRSA) among Palestinian patients, and to identify risk factors, susceptibility patterns, and to determine the most suitable antibiotics to be used empirically. Data of positive S. aureus cultures from patients’ specimens during the time period between January 2020 and December 2021 was collected from An-Najah National University Hospital, Nablus-Palestine, classified to methicillin-sensitive S. aureus (MSSA) or MRSA by using Vitek 2 system which is available in the hospital. Each isolate was tested for susceptibility to each oxacillin, cefuroxime, amoxicillin, piperacillin-tazobactam clindamycin, erythromycin, gentamycin, levofloxacin, linezolid, moxifloxacin, ciprofloxacin, quinopristin/dalfopristin, rifampicin, tetracycline, tigecycline, trimethoprim-sulfamethoxazole (TMP-SMX), and vancomycin by Vitek2 system. Other information related to patients and other comorbidities were collected from the hospital information system. 126 (49.6%) of 254 patients with S. aureus were infected with MRSA, with no significant association with various age groups and gender. Prevalence of MRSA was highest in pediatric unit followed by emergency room, 61.1% and 59.6% respectively, followed by surgical unit with MRSA prevalence of 52.7%. There is a significant difference in MRSA and MSSA distribution in the kidney unit (p-value = 0.009). Lung diseases are the co-morbidities which are associated with MRSA. Skin and soft tissues, and pus/wound specimen are associated with MRSA infection. All isolated were still susceptible to vancomycin. The prevalence of MRSA seemed to be similar to other Asian countries. Vancomycin is the most suitable option to be used empirically for serious MRSA infections. Keywords: Methicillin-resistant Staphylococcus aureus, resistance, risk factors, susceptibility pattern.
EPIDEMIOLOGY OF ACINETOBACTER BAUMANNII INFECTIONS AMONG PATIENTS ADMITTED TO THREE INTENSIVE CARE UNITS IN PALESTINE: A RETROSPECTIVE CHART REVIEW STUDY
(An-Najah National University, 2024-10-30) Arjan, Shaden
Background: Multidrug-resistant (MDR) strains of Acinetobacter baumannii pose significant treatment challenges. This study aimed to evaluate the sociodemographic and clinical characteristics of patients with A. baumannii infections in medical intensive care units (ICUs) across three hospitals in the West Bank, Palestine. It also sought to determine the prevalence of multidrug-resistant and extensively drug-resistant strains and assess patient survival and mortality rates. Methods: A retrospective cohort design was conducted from 2019 to 2020, spanning a period of two years, and including patients from adult medical ICUs from three hospitals of the north (NICU), the center (CICU), and the south (SICU) of in the West Bank, Palestine. Data on infections acquired during ICU stays or present at admission were analyzed using patient medical records, where sociodemographic, clinical, and treatment-related information, including comorbidities, infection history, diagnostic results, therapies, device usage, and outcomes such as ICU length of stay and mortality, were collected, and prevalence was calculated. Results: The study encompassed 231 patients, with 136 (58.9%) from CICU Hospital, 56 (24.2%) from SICU Hospital, and 36 (16.9%) from NICU Hospital. The median patient age was 63 years. Prevalence rates of A. baumannii infections were 11.5% at CICU Hospital, 6.5% at NICU Hospital, and 5.3% at SICU Hospital, with an overall rate of 8.2%. Of the patients, 46 (19.9%) had infections upon admission, while 185 (80.1%) developed infections during their ICU stay. The isolates included 154 (66.7%) extensively drug-resistant (XDR), 61 (26.4%) multidrug-resistant (MDR), and 16 (6.9%) non-resistant strains. Factors associated with increased mortality included recent ICU admission (2.65 times more likely), heart failure (4.95 times more likely), and central line catheter use (3.46 times more likely). Higher white blood cell counts, lower platelet counts, longer ICU and mechanical ventilation durations, and shorter hospital stays, shorter therapy were linked to survival. Conclusions: This study provides a comprehensive understanding of A. baumannii infections in the medical ICUs, highlighting the critical need for multidisciplinary infection control, especially for critically ill patients with comorbidities. The rise of drug-resistant bacteria underscores the importance of antimicrobial stewardship and infection control. Findings suggest a need for ongoing research and collaboration to address this growing hospital-acquired issue effectively.
EPIDEMIOLOGY, CHARACTERISTICS, AND RISK FACTORS OF SURGICAL SITE INFECTIONS IN A TERTIARY CARE HOSPITAL IN WEST BANK: A RETROSPECTIVE COHORT STUDY
(An-Najah National University, 2024-12-26) Jeetawi, Rawan
Background: Surgical site infections (SSIs) are one of the major problematic complications that appear after surgery. These complications do not only impact patient recovery but also healthcare costs. Ultimately, SSI may result in prolonged hospitalization, excessive medical expenses, and, in the worst cases, death. Only by identifying the risk factors for SSIs, devising their effective prevention and management we can alleviate the issue and improve patients’ safety. Due to multiple administrative and technical challenges, the frequency is higher in developing nations, with estimates ranging from 2.5% to 41.9% globally. Nevertheless, data from Palestine is lacking. The goal of this study is to determine the incidence of SSIs for patients admitted to surgery at An-Najah National University Hospital (NNUH) during 2018–2020 in Nablus, Palestine, and associated risk factors. Methods: This is an analytical retrospective cohort study of all patients admitted for surgery between January 2018 and December 2020. 1157 patients were included. Sociodemographic and clinical data were gathered and analyzed using descriptive and analytical analysis accordingly and a binary logistic regression was performed to assess the potential risk factors associated with the development of SSI.A level of significance of 5% was used. IBM SPSS (Statistical Package for the Social Sciences) Version 21 was used to analyze the data. Results: A total of 1157 patients who underwent surgery procedures from 2018–2020 at NNUH had a total SSI incidence rate of 7.65%; the rate in 2018 was 18.2% decreasing to 6.6% and 0.6% in 2019 and 2020; Patients with prothesis implantation, longer-term procedures, and non-laparoscopic surgeries had higher incidence rates of SSIs (p≤0.05). In addition, those with an ASA index of IV or more were found to have a higher incidence of SSIs (p<0.001). The logistic regression found that surgeries with longer durations (more than 2 hours) are approximately 17 times more likely to result in an SSI (p<0.001), patients with a prosthesis are 9 times more likely (p = 0.002), and contaminated wounds are 23 times more likely to lead to an infection (p = 0.005). Moreover, each additional day a patient stays in the hospital increases the odds of developing an SSI by 4.6% (p<0.001). Conclusions The SSI surveillance program at NNUH revealed that minimizing surgery duration, managing blood glucose and temperature after surgery, and following the standard care bundle and infection control policies are vital for lowering the incidence of surgical site infections (SSIs). While these strategies can greatly enhance patient outcomes, additional research is necessary to evaluate their effectiveness across various surgical environments and patient demographics.
FACTORS AFFECTING PATTERNS OF MANAGERIAL DECISION-MAKING IN GOVERNMENTAL HOSPITALS IN THE NORTHERN WEST BANK – PALESTINE, QUALITATIVE STUDY
(An-Najah National University, 2025-05-14) Bny-Fadel, Ola Arafat
Background: Decision-making in public hospitals is challenged by multiple, constantly shifting political, financial and leadership considerations. The unstable environments and lack of resources in developing regions such as Northern West Bank present challenges that add further complexity to the intricacies of the decision-making process. The purpose of this study is to explore the factors affecting managerial decision-making in governmental hospitals in Northern West Bank. It looks into the impact of political pressures, monetary constraints, and leadership styles upon decision-making while observing the influence of demographic variables such as age, gender, level of education, and administrative experience. A qualitative approach was used, and data was collected through semi-structured interviews. 15 administrative and technical directors in government hospitals in the northern West Bank were interviewed. Thematic analysis was conducted using NVivo software, coding responses into themes and subthemes, including political factors, financial constraints, and leadership styles. Demographic characteristics were also analyzed to evaluate their influence on the decision-making process. The study found political pressures-such as directives from outside entities and unstable environments-and financial constraints, such as limited resources and budget constraints, as factors with the strongest impact on decision-making. Transformational and participatory leadership styles have strong connotations of effectiveness; however, they do meet with difficulty in implementation owing to systemic reasons. In addition, among demographic characteristics, administrative experience and age are the two that are most influential—experienced managers demonstrate a greater ability to adapt and solve problems. In sheer terms, external political and financial challenges play an overriding role in managerial decision-making in the public hospitals of the Northern West Bank. Although leadership styles may countermeasure these factors, their effectiveness is largely curtailed owing to systemic impediments. Age and experience further enhance decision-making effectiveness. This makes it imperative to call for ensuring adequate authority to hospital managers, independent resource mobilization and investment in leadership development programs directed at improving decision-making in public health systems.
FACTORS ASSOCIATED WITH INPATIENTS' DISCHARGE TIME: PRIVATE HOSPITALS BASED-STUDY AT NABLUS GOVERNORATE
(An-Najah National University, 2024-10-13) Saify, Ahmed
This work explores factors that affect the discharge time of patients from a private Nablus hospital, West Bank, State of Palestine. This study adopts a retrospective observational design with regression analysis and identifies age, patient condition, occurrence of complications, and type of care as key determinants for discharge times. Introduction and Background: The present research is undertaken to get an overview of the various factors that go with the discharge time of patients from a private hospital setup and contribute toward the better understanding of the process, ultimately leading to improved outcomes and enhanced patient satisfaction. Methodology: This was an observational retrospective study with existing quantitative data culled from the electronic health records, management, and financial databases of the hospital. Regression analysis was used to predict the relationships between patient characteristics and times of discharge. Results: There were significant factors that influenced the time for discharge of patients as obtained by regression analysis. Major findings are: age, B = 0.077, p<0.001; patient's condition, B = 2.417, p = 0.016; occurrence of complications, B = 11.649, p<0.001; and type of care, p<0.001, all having a significant effect on the length of stay in the hospital. Conclusion: Timing of discharge remains one of the most critical areas for discharge process optimization and enhancing patient satisfaction. In this regard, the improvement of communication, streamlining the trajectories of care, and rendering priority to patient-centered care are recommended towards the attainment of these objectives.
FACTORS INFLUENCING ACCEPTANCE OF HEALTH INFORMATION SYSTEM AMONG HEALTH CARE PROVIDERS IN PALESTINE MEDICAL COMPLEX –RAMALLAH-PALESTINE
(An-Najah National University, 2024-02-07) Abu Sofyan, Fayez
Most of the Palestinian government hospitals have a unified health information system to deal with health care recipients, which is positively reflected on the quality of medical services. To ensure the continuity of providing the best possible care, the factors affecting acceptance to the health information system among health care providers must be studied, as they are the main user of the system, and they have a direct impact on the success of this system and ensure its development. The purpose of the study is to investigate the factors that affecting acceptance to the health information system among health care providers. A quantitative-based cross- sectional study was conducted among health care providers, attending in Palestine medical complex in Ramallah city between September and October of 2022. A structured Self administred questionnaire was administered on participants who were recruited using the systemic random sampling technique. Linear and Binary logistic regression analysis were conducted using statistical package for the social science version 25. Technological factors which included into the system quality, in which (62.3%) of the participants found HIS to provide all the functions included in completing the job to be very high, while (49%) found its ability to integrate with other systems’ information to be low, as well as its fast response time to be low (31.3%) or medium (54.7%), compared to (74.3%) who found its 24/7 support services to be very high as major factors that influenced them acceptance of health information system. In addition, (37%) of the study participants noticed a low level of HIS features that prevent unauthorized persons from accessing data. Technological and human factors are the main factors that influence acceptance of health information system among health care providers in Palestine.
IMPACT OF ELECTRONIC MANAGEMENT SYSTEM ON THE EMPLOYEE'S PERFORMANCE OF PRIMARY HEALTH CARE, A CROSS-SECTIONAL STUDY, IN NORTHERN WEST BANK, PALESTINE.
(An-Najah National University, 2024-06-23) Hammad, Nawal
Background: This study deals with electronic management systems and their Internet components (Hardware, software, networks, and electronic training) and their impact on job performance from the point of view of primary healthcare workers in the northern West Bank. The Palestinian Ministry of Health seeks to transfer administrative functions from their traditional form to the computerized form, as the electronic form is considered a public benefit and a basic and competitive advantage for health institutions. Aims: This study aims to identify the impact of the electronic management system on job performance from the point of view of employees in primary healthcare in the northern West Bank. Methods: A convenient sample technique, a cross-sectional study, by distributing questionnaires to 228 employees out of a total of 1,201 employees during the study period in primary healthcare centers in the northern West Bank (Nablus, Jenin, Tubas, Tulkarm, and Qalqilya), including all levels of health workers (doctors, nurses, pharmacists, laboratories, radiologists, and administrators). A descriptive analytical approach was used to select all employees eligible to participate in the study. Results: The study found that primary healthcare (PHC) employees viewed the level of use of the electronic management system (EMS) as average, with a total score of 2.89. The highest score was in the hardware field (2.93), and the lowest was in electronic training (2.79). Job performance was rated as high (3.52), indicating a positive relationship with electronic management (r = 0.59, p≤ 0.01). Networking and software were the main factors that contributed to functionality (28.30% and 35.10%, respectively). Gender did not significantly affect electronic management scores. However, the variables of (age, educational level, workplace, work seniority, and job title) influenced perceptions of specific system components. There were no statistically significant differences in job performance according to (gender, age, workplace, and job title). while, the level of education in favor of (Manager), work seniority from (1-5) years, and nature of the current job in favor of (director) showed statistically significant differences and effects. Conclusions: This study provided useful insights into the positive relationship between staff performance in primary health care and electronic management systems (EMS). It highlighted several main topics, the most important of which is improving performance resulting from using the electronic management system in primary health care centers. Together, healthcare organizations and policymakers must overcome implementation obstacles, make ongoing training investments, continue to pay attention to the infrastructure for implementing the electronic management system, and foster a climate that allows the management system to operate to its full potential. By applying these technologies, the primary healthcare sector can improve employee productivity and performance, and create a more beneficial and effective healthcare system. Keywords: electronic management systems, employee performance, Job performance, primary healthcare.
IMPACT OF MARKETING MIX (7PS) ON HOSPITAL SELECTION AMONG PALESTINIAN PATIENTS: A CROSS-SECTIONAL STUDY
(An-Najah National University, 2025-02-11) Snober, Osama
Background: The influence of the marketing mix (7Ps: Product, Price, Place, Promotion, People, Process, and Physical Environment) on hospital choosing is a significant study domain, since healthcare facilities must consistently enhance their offerings to attract and keep consumers. This study was conducted to identify the key components of the marketing mix that most significantly impact patients' decision-making when choosing a hospital in Palestine. Methods: The study used a cross-sectional design to provide a snapshot on patients' preferences and decision-making criteria about hospital choosing in Palestine. The study was conducted in various regions of Palestine to ensure a representative sample that reflected the diverse socio-cultural and economic backgrounds of the population through selecting private hospitals and governmental hospitals in the north of the West Bank. Results: In this study, a total of 385 participants completed the questionnaire. The participants rated how the 7Ps (Product, Price, Place, Promotion, People, Process, and Physical Environment) influenced their choices on hospitals. Multiple linear regression showed that higher product ratings were predicted by moderate or household income (B = 2.12, p-value < 0.001) and having a governmental health insurance (B = -0.74, p-value = 0.030). Similarly, higher people ratings were predicted by moderate or household income (B = 1.57, p-value = 0.002). Moreover, higher process ratings were predicted by moderate or household income (B = -0.41, p-value = 0.048) and spending less nights at the hospitals (B = -0.83, p-value = 0.025). In addition, higher physical environment ratings were predicted by moderate or household income (B = -0.70, p-value = 0.011). Furthermore, higher place ratings were predicted by older age (B = 0.68, p-value = 0.007). Conclusions: The marketing mix (7Ps) strongly influences Palestinian hospital selection, providing healthcare providers with useful information. Patients choose hospitals based on specialist healthcare services, quality of treatment, financial accessibility, and physical surroundings. Patient preferences were shaped by improved services, expert personnel, and reasonable pricing. In addition, income, health insurance status, and the absence of chronic conditions were substantially related with better marketing mix ratings, notably in product, people, and process. These results show that hospitals must strengthen specialized services, provider-patient connections, price transparency, and infrastructure to be patient-centered.
KNOWLEDGE AND ATTITUDES OF PHYSICIANS AND NURSES TOWARDS MENTAL DISORDERS AND RELATED HEALTH SERVICES: A CROSS-SECTIONAL STUDY IN PALESTINE
(An-Najah National University, 2024-10-23) Qattawi, Ayat
Background: The provision of mental health services faces several financial and health challenges, while the healthcare professionals (HCPs) should acquire the appropriate levels of knowledge and attitude towards mental disorders and mentally ill patients, which the current study aimed to identify, as well as the most common demographic and professional factors that related to them. Method: The study utilized a cross-sectional, quantitative design, in which the researcher recruited a convenient sample of 89 doctors and 232 nurses from private and governmental hospitals and primary health clinics (PHC) in Nablus – Palestine. The study questionnaire consisted of demographic data, Mental Health Knowledge Schedule (MAKS) and Attitude to Mental Disorders (AMI) tools, which were analyzed using SPSS. Results: The median age of recruited HCPs was 31 years old (IQR = 8), 46.4% males, 60.4% married, 58.3% of more than 5 years of experience, and 60.1% not received a course on mental disorders. The median knowledge score was 68.42% (IQR = 12.63), with 69.5% having a moderate knowledge level, which was not significantly related to any factor (p-value > 0.05). The median attitude level was 63.70% (IQR = 11.85), with 62.0% having moderate attitude level, and was significantly higher in females (p-value < 0.001), lower income (p-value = 0.002), other social status (p-value = 0.016) and non-hospital workplace type (p-value < 0.001). A significant, moderate, positive correlation between knowledge and attitude was found (r = 0.252, p-value < 0.001). Conclusion: The Palestinian nurses and doctors in Nablus city have moderate knowledge and attitude levels towards mental disorders. More focus on mental disorders is needed and recommended by the policymakers, health sector, universities and HCPs themselves. Further research is needed in the Palestinian context, including longitudinal and qualitative approaches. Keywords: mental health, mental disorders, psychiatric disease, knowledge, awareness, perception, attitude, doctors, physicians, nurses.
NURSES’ PERCEPTION OF THE DISCHARGE PLANNING PROCESS FOR ADULT PATIENTS IN AN ACUTE MEDICAL CARE DEPARTMENTS IN RAMALLAH HOSPITALS
(2023-10-18) Ali Thaher Mohamed Gawabreh
Introduction: Discharge planning is an integral part of patient care in hospital departments because the goal for all patients is that they will leave this setting once acute healthcare needs have been managed or it is clear what the next phase of care will be. All patients who leave hospitals require discharge planning. The discharge planning is different for each patient as a result of the different needs after discharge, from simple and straightforward needs to more complex requirements . Aim: To investigate the nurses’ perception of the discharge planning process for adult patients in acute medical care departments in Ramallah hospitals. Method: 400 modified questionnaires were distributed to fit this study to 400 nurses working in acute departments in several hospitals in Ramallah. Results: The survey consisted of 300 nurses, with a response rate of 75%. 50.7% of the nurses participating in the study were male; 53.3% of them work in government hospitals. Also, most study participants are registered nurses (61.7%), as well as full-time employees (83.3%) and (54.3%) with experience of 5 years or less. 63.8% of nurses have perceptions about discharge planning, and 74.2% are familiar with the coordination of discharge planning and the timing of discharge. In the multivariate analysis models, perception was a strong predictor for discharge planning, skills, and barriers. Conclusion: The results showed a Preparing or implementing discharge planning is one of the tasks of the nurse following up on the patient. and implementing a discharge plan effectively requires nurses' administrative or interpersonal skills. In addition, future research should be directed toward discovering factors that improve the discharge process, and it is recommended that frequent nursing development courses be established in the communication process, especially in cases of developing discharge planning for patients. Keywords: Discharge Planning, Adult Patients, Acute Medical Care.

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