The aim of this study is to measure the degree of compliance with hand hygiene practices among health-care workers (HCWs) in intensive care facilities in Aseer Central Hospital, Abha, Saudi Arabia, before and after a multimodal intervention program based on WHO strategies. Data were collected by direct observation of HCWs while delivering routine care using standardized WHO method: "Five moments for hand hygiene approach". Observations were conducted before (February-April 2011) and after (February-April 2013) the intervention by well-trained, infection-control practitioners during their routine visits. The study included 1182 opportunities (observations) collected before and 2212 opportunities collected after the intervention. The overall, hand hygiene compliance increased significantly from 60.8% (95% CI: 57.9-63.6%) before the intervention to reach 86.4% (95% CI: 84.9-97.8%) post-intervention (P=0.001). The same trend was observed in different intensive care facilities. In logistic regression analyses, HCWs were significantly more compliant (aOR=3.2, 95% CI: 2.6-3.8) after the intervention. Similarly, being a nurse and events after patient contact were significant determinants of compliance. It is important to provide sustained intensified training programs to help embed efficient and effective hand hygiene into all elements of care delivery. New approaches like accountability, motivation and sanctions are needed.

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Background: Pulmonary embolism (PE) is associated with short-and long-term adverse events including mortality. Prompt diagnosis, risk stratification and treatment can improve the outcome. The objective of the present study is to determine the predictors of early death within 30 days in the course of acute pulmonary embolism (APE). Patients and methods: One hundred patients with APE were recruited from both inpatients department and ICUs at Cardiothoracic Minia University Hospital .All patients subjected to detailed history, general and local chest examination. Laboratory investigation included CBC, Hs-CRP, troponin and D-dimer. CT pulmonary angiogram (CTPA) with calculation of pulmonary artery obstructive index (PAOI) using Qandali Score and measurement of right ventricle to left ventricle (RV/LV) ratio, Echo with measurement of pulmonary artery systolic pressure (PASP) were done for all patients. Patients were monitored for 30 days from the onset of symptoms to assess the mortality. Results: Patients classified according to outcome into survivors, 80 (80%) patients and 20 (20%) non-survivors patients. Po2 and Sao2 were significantly higher in survivors (P values 0.0001 and 0.05, respectively). Pulmonary Embolism Severity Index (PESI) was significantly higher in the non-survivor group (P value 0.001). PAOI and RV/LV ratio were higher in non survivors with (P value 0.001 and 0.001, respectively). Also central location of emboli was higher in non survivors representing. PASP was higher in non survivors (P value 0.001). Conclusion: The non-survivor group showed decrease Po2 and Sao2, higher PESI, PAOI, RV/LV ratio, and dilated RV compared with the survivor group. Thus these parameters could be predictors for poor patient outcome.

Background: Noninvasive mechanical ventilation (NIV) decreases the need for endotracheal intubation (ETI) and also decreases mortality in severe acute exacerbation of COPD (AECOPD). Objective: The aim of the current study is to assess determinants of NIV effectiveness in patients with COPD exacerbation. Patients and methods: Our study was a cross-sectional comparative study. A total 100 patients with AECOPD were included in this study. Patients were admitted to the Respiratory Intensive Care Unit (RICU) in Minia Cardiothoracic University Hospital. All patients were evaluated at the time of admission, at the start of NIV, after 1 hour (hr) of NIV and at the end of NIV. This evaluation included heart rate, respiratory rate, systolic blood pressure, diastolic blood pressure, and arterial blood gases (ABG) which include PaO2, PaCO2, PH, HCO3, as well as PaO2 /FiO2 ratio. Results: Patients were divided into 2 groups; 85 (85%) patients improved with NIV (success group, Group I) and 15 (15%) patients failed NIV and were intubated (Group II). PH, PO2, as well as PCO2 revealed significant improvement after 1 hr, which persisted till the end of the study in the success group. Clinical data including heart rate, respiratory rate, systolic blood pressure, and diastolic blood pressure showed significant difference between the two groups at time of hospital admission and the initiation of NIV. After 1 hr, these variables showed significant improvement in the success group that continued till the and at the end of the study. Also, PaO2/FiO2 ratio showed a significant improvement in the success group after 1 hr of NIV. Multivariate analysis showed PH <7.26 and RR ≥ 35 (at hospital admission) are predictors of failure of NIV. Conclusion: Clinical parameters including HR, RR and blood pressure, as well as ABG, could predict success of NIV in patients with AECOPD. Improvement in these parameters within 1 hr of NIV could be a good predictor of success.