Qatar Medical Journal - Volume 2017, Issue 2

Background: Direct observation of hand hygiene is the standard practice recommended by the World Health Organization to monitor its compliance. Objective: To evaluate the accuracy of hand hygiene observation performed by units' observers. Methods: A descriptive study was carried out in seven patient care units in a 75-bed community hospital in Qatar. Four trained nurses performed hand hygiene observation in May 2016, any day of the week and in different shifts, following the same methodology as routine units' observers. Hand hygiene opportunities were registered, including hand hygiene moments, staff category, and actions (handrubs, hand washing, missed hand hygiene, and gloves without hand hygiene). Results: During January–May 2016, routine monitoring reported 25,319 opportunities with a compliance of 89.2%, and 91.6% for nurses, 89.6% for physicians, and 85.1% for ancillary staff. Trained external observers reported 815 opportunities and compliance of 54.7%, with the highest compliance observed after blood and body fluid exposure (80.0%) and after patient contact (85.5%), and the lowest figures before patient contact (34.2%) and before aseptic procedure (34.0%). Conclusion: This study provides essential information about the accuracy of the monitoring procedure and the compliance of hand hygiene that requires immediate action to protect patients and staff from healthcare-associated infections.

Background: While few international studies have assessed the association between omeprazole use and the risk of Clostridium difficile infection (CDI), research into this is lacking in Saudi Arabia and the Middle East region. The aim of this study was to determine whether exposure to omeprazole is associated with the risk of Clostridium difficile infection in a sample of hospitalized Saudi patients. Methodology: A retrospective matched case–control study was conducted at the King Abdulaziz Medical City in Riyadh, Saudi Arabia, from 1 August 2010 through 31 July 2015. The analysis included a total of 200 patients: 100 CDI cases and 100 matched controls. Results: The majority (60%, 120 out of 200) of patients had received proton pump inhibitors (PPIs), and a minority (18.5%, 37 out of 200) had received omeprazole. The PPI use was insignificantly higher in CDI cases than in controls. However, the use of omeprazole was significantly higher in CDI cases compared with controls. Specifically, patients receiving omeprazole were two times more likely to develop CDI compared with controls (aOR = 2.1, 95% confidence interval (CI) = (1.007–4.437)). After adjusting for potential predictors of CDI, watery diarrhea (aOR = 59.1, 95% CI = 19.831–175.974) and abdominal pain (aOR = 7.5, 95% CI = 2.184–25.445) were found to be independent predictors of CDI. Conclusions: The data suggests that PPIs were commonly used in patients admitted to King Abdulaziz Medical City in Riyadh: six out of ten patients received PPIs. The findings support a possible association between the use of omeprazole and a high risk of CDI. To confirm causality, the link between omeprazole and CDI should be assessed in a large interventional study.

The increasing incidence of end-stage kidney disease in Qatar has led to growing demand for donor kidneys. The deceased donor kidney program has yet to achieve its full potential; hence, living kidney donation has been widely adopted as an appropriate alternative. The reliance on living kidney donors however, raises a number of social, ethical, and legal concerns surrounding informed consent, voluntarism, psychosocial evaluation, perioperative care, and long-term follow-up of living kidney donors. Many of these concerns become heightened in a multicultural, multilingual society within a Gulf country such as Qatar. This article provides an insight into the challenges that living kidney donation poses in a multiethnic society with significant socioeconomic divides. It also discusses the remedial measures that the Qatari government, healthcare authorities, and transplant community have adopted to address these issues.

Acute appendicitis is the most common surgical condition with which patients present in emergency departments worldwide. It is also a rare cause of intestinal obstruction. Here, we report a case of a 53-year-old man who presented with a clinical picture of mechanical small bowel obstruction. Leucocytosis was not demonstrated on the routine blood investigation in our case, in contrast to the findings for most patients with acute appendicitis. Acute appendicitis, as the cause of the intestinal obstruction, was diagnosed by computed tomography of the abdomen. The patient was treated using diagnostic laparoscopy and laparoscopic appendectomy. This case was compared with those previously reported in the medical literature to determine the frequency of the case and the surgical management.

Background: Nutritional disorders still represent a major problem faced by developing countries. Surveying such problems is a step towards planning proper interventions, which contributes significantly to declines in under-five mortality rates. Aims: To study the state of nutritional trends in children under five years of age, attending a primary healthcare center in Al Shoula district, Iraq, in 2006 and 2012. Demographic features and feeding practices that may have had an effect on the nutritional status of children were also studied. Subjects and methods: Two cross-sectional surveys were conducted on children aged two to five years, in a primary healthcare center in Baghdad. Children attending for immunization were included (500 in 2006 and 570 in 2012), their mothers were interviewed, and the body mass index of the child was calculated. Children who were overweight and obese were identified, according to the Centers for Disease Control and Prevention charts, as those suffering from stunting. Nutritional parameters were compared between the two study groups, using the chi-square test, as well as various epidemiological factors that may have affected the outcomes. Results: The prevalence of both types of nutritional disorders (stunting and overweight and obesity) declined remarkably according to the 2012 survey; overweight and obesity declined from 20% to 7.2%, while stunting decreased from 51.2% to 30.9%. The age group showing the highest rate of improvement were the four to five year olds, as well as children from lower-income families. A higher rate of breastfeeding was reported in 2012, and breastfed babies suffered the least from both types of nutritional disorders, in both study groups. Overall, the study findings showed a high prevalence of stunting (30.9%), together with a significant level of overweight and obesity (7.2%). Conclusion: Children in Iraq suffer from high rates of stunting. With a moderately high rate of obesity, there is an urgent need to evaluate local data available and plan for an active intervention to combat these nutritional problems.