Infectious Diseases Prevention and Control
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- 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.
- ItemTHE EFFECTIVENESS OF MULTIMODAL INTERVENTIONS ON REDUCING BLOOD CULTURE CONTAMINATION RATES IN GOVERNMENTAL HOSPITALS: A PRE- AND POST-STUDY(An-Najah National University, 2025-08-14) Zaid,MariamBackground: Blood Culture (BC) is a diagnostic standard for detecting bloodstream infections, which contribute substantially to hospital morbidity and mortality. However, even with modern medical technology, contamination rates remain a persistent challenge, potentially compromising diagnostic accuracy and clinical decision-making. Objective: This study aimed to assess the effectiveness of a multimodal intervention in reducing the blood culture contamination (BCC) rate to below 3%, in line with the Clinical and Laboratory Standards Institute (CLSI) guidelines, as well as to enhance nurses' knowledge, practice, and adherence to proper BC collection practices. Method: We conducted a six-months pre-post intervention study at secondary governmental hospital in the northern of the Palestine, assessing four primary outcomes in the pre and post intervention phases: (1) BCC rates, (2) nurses' theoretical knowledge, (3) nurses practice, and (4) procedural compliance for both peripheral and central venous access device (CVAD) collections. The intervention package comprised six key components: introducing the standard procedure of the BC collection, structured education sessions, a standardized bundle checklist, visual reminders, performance feedback, and real-time procedural corrections that were used for two months in the intervention phase. Descriptive and analytical analysis were performed to find relationships between different sociodemographic and working conditions variables and the knowledge and practice of nurses. Bloom's criteria were used to evaluate the total knowledge, practice, and compliance for the procedure of blood culture collection. Statistical analyses were performed using SPSS version 21, with significance set at p-value ≤ 0.05. Results: The multimodal intervention demonstrated significant improvements across all measured outcomes. Nurses' knowledge scores increased substantially from 55.48% (poor knowledge) in pre-intervention to 92.54% (good knowledge) in post-intervention phase (p <0.001), and nurses' practice improved significantly post-intervention from 25.36% (poor practice) to 40.19% (bad practice) (p <0.001). Procedural compliance showed marked enhancement for both peripheral vein collections (80.4% (good compliance) to 96.43% (good compliance) and CVAD collections (68.25% (bad compliance to 94% (good compliance)), with both improvements being statistically significant (p <0.001). Most importantly, the BCC rate declined from 9.4% to 2.4%, achieving the study's target of falling below the 3% CLSI benchmark. Conclusion: This study demonstrates that targeted multimodal interventions can effectively reduce BCC rates to meet clinical standards while substantially improving both theoretical knowledge and practical compliance among nursing staff. These findings underscore the value of combined educational and operational strategies in optimizing diagnostic microbiology quality, ultimately enhancing patient care through more reliable bloodstream infection detection.
- ItemEPIDEMIOLOGY, 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, RawanBackground: 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.
- ItemEPIDEMIOLOGY 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, ShadenBackground: 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.
- ItemQUINOLONE RESISTANCE AMONG ESCHERICHIA COLI AND KLEBSIELLA PNEUMONIAE BACTERIA ISOLATED AT RAFIDIA AND AN-NAJAH NATIONAL UNIVERSITY HOSPITALS IN NABLUS DISTRICT: PROSPECTIVE CROSS-SECTIONAL STUDY(An-Najah National University, 2024-10-24) Khatatbeh, MarahBackground: Among several bacterial genera, quinolone resistance has become more prevalent in recent years. This was clear among common nosocomial pathogens such as Escherichia coli and Klebsiella pneumoniae. While quinolones are a valuable part of the current antimicrobial treatment options, growing quinolone resistance poses a threat to their continued efficacy. Objectives: First, this study aimed to determine the prevalence of resistance of E. coli and K. pneumoniae to quinolone antibiotics (ciprofloxacin and levofloxacin) at two major hospitals in Nablus District, Rafidia and An-Najah National University Hospital. Second, the association of resistance to these antibiotics with various demographic and clinical findings was examined. Third, mechanisms of quinolone resistance among E. coli and K. pneumoniae were determined through resistance gene detection by PCR. Methodology: A cross-sectional study design was selected. A total of 219 bacterial isolates (169 isolates of E. coli and 50 isolates of K. pneumoniae) were collected from the first of June 2023 to the last day of September 2023, from all patients infected with those bacterial species. The included bacteria in this study were isolated from patients admitted to the two mentioned Hospitals during the study period. Types of bacteria were already identified by the VITEK 2 system (BioMérieux) in the two mentioned hospitals. Resistance of the included bacteria to ciprofloxacin and levofloxacin was determined by the disk diffusion method. In addition, multiplex PCR was used for detection of resistant genes in order to determine quinolone resistance mechanisms among 118 resistant strains. The detected mechanisms and genes were target modification (qnrA, qnrB, and qnrS genes), enzymatic modification (aac(6’)-Ib-cr gene), and efflux pump mechanism (QepA, OqxA, and OqxB genes). Association of quinolone resistance with clinical symptoms, demographic information, and other risk factors were evaluated. Results: Relatively high frequencies of ciprofloxacin resistance (46.1%) and levofloxacin resistance (47.9%) were found among E. coli isolates. Higher resistance frequency of ciprofloxacin (70%) and levofloxacin (68%) among K. pneumoniae isolates were detected. Escherichia coli and K. pneumoniae ciprofloxacin resistant bacteria isolated at An-Najah National University Hospital (60% and 92.9%, respectively) were significantly higher (P= 0.000 and P= 0.001, respectively) than that of the isolates obtained from Rafidia Hospital (37.3% and 40.9%, respectively). Ciprofloxacin resistance among E. coli isolated from the general surgery unit was significantly higher than that of the emergency ward (54.5%; P=0.002) and the outpatients (36.9%; P= 0.016). However, E. coli levofloxacin resistance frequency in the intensive care unit was significantly higher than that of the outpatients (49.2%; P=0.018), emergency (45.5%; P=0.022), and general surgery (42.9%; P=0.037). Escherichia coli isolation rate from urine (80%) was significantly higher than that of wound swabs (76.3%; P=0.013). Furthermore, K. pneumoniae isolation rate from urine (20%) was significantly higher than that of wound swabs (23.7%; P=0.036). Escherichia coli ciprofloxacin resistance was significantly higher (P=0.008) in male isolates (53.6%) than in female isolates (36.3%). Escherichia coli isolated from patients over 65 years of age had the highest levofloxacin resistance frequency (62.5%), which was also significantly (P= 0.007) higher than that of the 40–65-year age group. Escherichia coli ciprofloxacin resistant bacterium isolated from patients with urinary catheters (91.7%) had a significantly higher frequency than that of hypertension patients (85.5%; P=0.013), diabetes mellitus patients (84.8%; P=0.017), cancer patients (81.9%; P=0.022), and hepatic cirrhosis patients (64.1%; P=0.028). However, K. pneumoniae ciprofloxacin resistant bacterium isolated from hepatic cirrhosis patients (77.8%) had a significantly higher frequency than that of hypertension patients (65.2%; P=0.003), cancer patients (61.9%; P=0.019), and diabetes mellitus patients (58.9%; P=0.032). Frequency of levofloxacin resistant E. coli isolated from diabetes mellitus patients (89.1%) was significantly higher than that of hypertension patients (76.3%; P=0.013), cancer patients (73.6%; P=0.016), patient with the urinary catheter (77.8%; P=0.021), and hepatic cirrhosis patients (51.3%; P=0.028). On the other hand, levofloxacin resistant K. pneumoniae isolated from diabetes mellitus patients (71.8%) had a significantly higher frequency than that of hypertension patients (56.5%; P=0.009), cancer patients (52.4%; P=0.016), hepatic cirrhosis patients (59.3%; P=0.023), and patient with the urinary catheter (48%; P=0.031). With respect to the quinolone resistance mechanisms, the efflux pump among E. coli isolates was the most predominant (43.3%) with OqxA (23.5%) being the most common gene, followed by enzymatic modification by Aac(6’)-Ib-cr enzyme (29.6%) and target modification mechanism (26%) in which the QnrS gene was the most common (13.6%). Similarly, the efflux pump mechanism of quinolones resistance among K. pneumoniae isolates was also the most common (37.8%) with the OqxA gene exhibiting the highest frequency (27%), followed by enzymatic modification by Aac(6’)-Ib-cr enzyme (32.4%) and target modification mechanism (29.7%) with QnrS and QnrB being the most commonly detected genes (10.8%). Conclusion: Our findings showed high rates of ciprofloxacin and levofloxacin resistance among E. coli and K. pneumoniae isolates, also a high percentage of the efflux pump mechanism with OqxA being the most common gene, followed by enzymatic modification by Aac(6’)-Ib-cr enzyme and target modification mechanism in which the QnrS gene was the most common. We emphasize that it is necessary to perform an antibiotic susceptibility test before choosing a prescription. Monitoring the rates of resistance in the nations clinical facilities should be a greater priority for the relevant government health departments.