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- ItemEARLY VERSUS LATE TRACHEOSTOMY IN THE MECHANICALLY VENTILATED CRITICALLY ILL PATIENTS: A RETROSPECTIVE MULTICENTER COHORT STUDY IN PALESTINE(An-Najah National University, 2025-09-02) Abu Tammam, AbdelrauofBackground: Prolonged mechanical ventilation (PMV) is a particularly common reason for tracheostomy in patients hospitalized to intensive care units (ICU). The operation is classified as "early" or "late" based on the date of its execution relative to the start of mechanical ventilation (MV). Although the evidence for early versus late tracheostomy varies, early tracheostomy has been linked to shorter hospital stays and lower mortality rates. No previous studies in Palestine have compared or assessed the optimal timing of tracheostomy, although some hospitals follow an ET protocol for expected PMV patients. Aim: To compare the clinical outcomes of early vs late tracheostomy for mechanically ventilated critically ill patients in the ICU. Methods: This retrospective multicenter observational cohort research was carried out in Palestine from January 2023 to December 2024. Patients who had elective tracheostomies were divided into two groups: early tracheostomy (ET), which was performed during the first 10 days of intubation, and late tracheostomy (LT), which was performed beyond the tenth day. The major outcomes assessed were mortality, duration of MV, length of stay in the ICU and hospital, and incidence of ventilator-associated pneumonia (VAP). These outcomes were evaluated and compared among groups, both overall and stratified by APACHE II scores. Results: About 66 patients were included in the study, 37 in the ET and 29 in the LT. ET was associated with significantly lower mortality (P = 0.033), shorter duration of MV (P <0.001), and reduced length of ICU (P < 0.001) and total hospital stays (P <0.001). VAP rates were not significantly different (P = 0.083). In patients with APACHE II ≤ 20, ET significantly improved all outcomes except mortality (P = 0.405). In patients with APACHE II > 20, ET significantly reduced the total duration of MV (P = 0.009), length of ICU and hospital stays (P = 0.037; P = 0.035, respectively) while having no significant impact on mortality (P = 0.238), duration of post-tracheostomy MV (P = 0.236), and VAP (P = 0.474). Conclusion: ET appears to be associated with improved outcomes compared with LT, particularly in lower-risk patients.
- ItemENGAGING PATIENTS AND HOSPITAL HEALTHCARE WORKERS WITH MEDICAL RECORDS ANALYSIS IN THE BALANCED SCORECARD IMPLEMENTATIONS(An-Najah National University, 2025-07-03) Mousy, SujoodBackground: 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.
- ItemPREVALENCE AND CHARACTERISTICS OF MULTI-DRUG RESISTANT BACTERIA AND ANTIMICROBIAL SUSCEPTIBILITY PROFILE AMONG INTENSIVE CARE UNITS PATIENTS: AN EXPERIENCE STUDY FROM A DEVELOPING COUNTRY(An-Najah National University, 2025-08-20) Abu Arar, YasmineBackground Multidrug-resistant (MDR) organisms pose a major threat to critically ill patients, particularly those in intensive care units (ICUs), where invasive procedures and extensive antibiotic exposure are common. This study aimed to assess the prevalence, resistance patterns, and clinical outcomes of MDR bacterial infections among ICU patients in a tertiary care hospital in Palestine. Methods A retrospective analysis was conducted on 129 ICU patients who developed infections caused by MDR organisms. Data on patient demographics, comorbidities, device use, antibiotic exposure, organism types, sample sources, antimicrobial susceptibility, and outcomes were collected. Descriptive statistics and mortality comparisons were performed. Results The cohort had a mean age of 53 ± 17 years and was predominantly female (64.4%). Comorbid conditions, including hypertension (41%), diabetes (34%), and malignancies (35%), were common. Most patients had prior antibiotic exposure (43%), recent hospitalizations (58%), and invasive devices such as central lines (92%), Foley catheters (93%), and endotracheal tubes (73%). The most prevalent MDR organisms were Acinetobacter baumannii (24%), vancomycin- resistant enterococci (VREs) (25%), and carbapenem-resistant Enterobacteriaceae (CREs) (23%). Additional pathogens included Pseudomonas aeruginosa (12%), MRSA (10%), and ESBL-producing organisms (6%). The overall mortality rate was 59%, which was highest for MRSA infections (70%). Antibiotic resistance is widespread, particularly to ceftazidime, 11 carbapenems, fluoroquinolones, and vancomycin. Colistin, glycylcycline, and amikacin retained partial activity against several pathogens. Conclusion MDR infections in the ICU are associated with high mortality rates and resistance to most conventional antibiotics. The predominance of highly resistant organisms such as A. baumannii, CRE, and VRE, alongside extensive device use and comorbidities, stresses the critical importance of meticulous infection control, regular screening, and the responsible use of antibiotics. Tailored empirical therapy on the basis of local resistance patterns is critical for improving patient outcomes.
- ItemKNOWLEDGE, ATTITUDE amp; PRACTICE TOWARD NEONATAL PAIN ASSESSMENT AND MANAGEMENT IN NICUS OF TWO HOSPITALS IN WEST BANK : EVALUATION OF EDUCATIONAL SESSIONS FOR NICU NURSES(An-Najah National University, 2025-08-12) Abu Asba, LameesIntroduction : Neonatal pain is a critical concern in NICUs, as unmanaged pain can lead to serious short- and long-term developmental consequences. Despite growing awareness, effective pain assessment and management remain inadequate. This study highlights the importance of addressing neonatal pain and explores the key challenges faced by NICU nurses, including limited knowledge, lack of standardized assessment tools, insufficient training, and heavy workloads. Overcoming these barriers through targeted education, clear protocols, and institutional support is essential to improving neonatal outcomes and ensuring high-quality, evidence-based care. Aim : To investigate the knowledge, attitudes, and practices of NICU nurses in the West Bank, as it has a limited number of studies conducted in this region toward neonatal pain assessment and management, as well as to identify the barriers that hinder effective pain assessment & management in this population. In addition, it aims to evaluate the effectiveness of educational sessions provided to these nurses, with the goal of improving clinical practice performance and neonatal pain care outcomes. Method : This study employed a quasi-experimental pre-test–post-test multicentre design, conducted in two hospitals in the Jenin area of the West Bank—Al-Khalil Suleiman Governmental Hospital and Al-Razi Private Hospital—with a voluntary sample of 50 NICU nurses. Data were collected using a self-administered questionnaire covering demographics, knowledge, attitudes, practices, and perceived barriers related to neonatal pain assessment and management. Educational sessions were held over two days, combining lectures and practical training on neonatal pain physiology, assessment tools, and management strategies. The questionnaire was re-administered in two phases: the first, three days post-intervention (assessing knowledge and attitudes), and the second, three months later (full questionnaire), to evaluate both immediate and long-term effects of the sessions. Results : The study demonstrated significant improvements in NICU nurses’ knowledge, attitudes, and practices regarding neonatal pain assessment and management following educational sessions. Knowledge increased from 52% to 82% immediately post-intervention and remained at 74.6% after three months, while attitude scores rose from 63.4% to 87.9%, then stabilized at 73.3%. Practice scores improved from 27.5% to 52.4%, and perceived barriers decreased from 69.8% to 56%, with personal and organizational barriers also showing notable reductions. A positive correlation was found between knowledge and attitude, and a statistically significant negative correlation (r = –0.372, p = 0.008) was observed between knowledge and barriers, indicating that increased knowledge helped reduce perceived barriers. No significant relationships were found between demographics and knowledge, attitudes, or barriers, except for practice, which was significantly associated with education level—diploma-holding nurses scored higher than those with a baccalaureate or higher degree. Conclusion : This study highlights the positive impact of targeted educational interventions on improving NICU nurses’ knowledge, attitudes, and practices regarding neonatal pain assessment and management. The findings demonstrate that enhanced knowledge not only fosters more positive attitudes but also helps reduce perceived barriers in clinical practice. While demographic variables showed limited influence, education level was significantly associated with practice outcomes. These results emphasize the importance of continuous professional development and structured training programs to empower nurses and ensure more effective, evidence-based neonatal pain care.
- ItemCHARACTERISTICS OF SHARP INJURIES AND FLUID SPLASH AMONG HEALTHCARE CARE WORKERS IN THE WEST BANK "PALESTINE"(An-Najah National University, 2025-09-09) Mahmoud, Aashraf DeebBackground: 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.