Public Hospitals In Kuwait Research Articles

Combined impact of heat and dust on diabetes hospitalization in Kuwait

IntroductionIn Kuwait, a severe diabetes and obesity epidemic coexists with intense dust storms and harsh summer heat. While, theoretically, this interplay between dust, heat, and diabetes presents a serious public...

#75 Extracorporeal membrane oxygenation (ECMO) in patients with acute kidney injury (AKI): a prospective, observational, multi-center study

Abstract Background and Aims Extracorporeal membrane oxygenation (ECMO) is a life-saving therapy for patients with severe respiratory and/or cardiovascular failure. Acute kidney injury (AKI) is a frequent complication in ECMO, resulting in increased morbidity and mortality. We aim to evaluate impact of ECMO on AKI outcome in Kuwait. Method Demographics, comorbidities, management, and 30-day kidney and patient outcome data for adult inpatients with native kidneys with AKI who received ECMO in seven public hospitals in Kuwait from 1/January to 31/December 2021, were prospectively collected and analyzed. Results Total number of AKI cases during study period was 3744, but only 121 patients received ECMO, or only 3.2%, with mean age of 56.3 years; and mean baseline eGFR of 81.6 ml/min. Males were 62.8% of the cohort, and 91.7% of cases were hospital-acquired AKI. Only 21.5% had pre-existing CKD (mainly diabetic kidney disease), and only 26.5% were older than 65, however, 58.7% were diabetics, and 48% were hypertensive. COVID-19 infection was a cause for AKI in 69% of patients. ECMO was veno-venous in 90% of cases, and AKI developed before ECMO initiation in 62.8% of cases. Dialysis was provided for 92% with continuous kidney replacement therapy (CKRT) accounting for 97%, and 93% of patients were in ICU (all on inotropic support). At 30 days, 86.8% of the whole group died (91% of those died on dialysis), six patients remained alive on dialysis, and only four patients recovered kidney function completely. Conclusion Although ECMO utilization in patients with AKI is limited in our AKI cohort, and despite relatively young age and reasonable baseline eGFR for the cohort, ECMO is associated with high need for ICU admission, high incidence of AKI, high need for dialysis, and high mortality rates.

#226 Outcome of intermittent hemodialysis vs. continuous kidney replacement therapy for acute kidney injury: observational prospective multi-center study

Abstract Background and Aims Continuous hemodialysis in hemodynamically stable acute kidney injury (AKI) patients may impact outcome differently compared to intermittent hemodialysis, although this issue is controversial. We look at differences in AKI outcomes between patients treated with intermittent hemodialysis (IHD) and patients treated with continuous kidney replacement therapy (CKRT) modalities in in Kuwait. Method Clinically and hemodynamically stable adult inpatients with native kidneys (i.e., did not need inotropic support or mechanical ventilation) who received IHD or CKRT for AKI, in seven public hospitals in Kuwait between 1/January to 31/December 2021 were recruited. CKRT was selected due to lack of access to water treatment in patients wards in some of the participating hospitals. Demographics, comorbidities, dialytic and non-dialytic management data, and 30-day kidney and patient outcome data for, were prospectively collected and analyzed. Results Total number of AKI patients not on inotropic support and not mechanically ventilated who received dialysis during study period was 229 (age: 59.9 years; males: 60.3%; baseline eGFR: 56 ml/min). IHD (group 1) was performed in 27.1% of the cohort whereas CKRT (group 2) was performed in 72.9%. There was no statistically significant difference between the two groups in age (58.4 for IHD and 59.9 for CKRT, p=0.6), baseline eGFR (55 ml/min for IHD and 56.4 for CKRT, p=0.8), sex ratio, incidence of diabetes, hypertension or cardiovascular disease, or cause of AKI. However, renin angiotensin aldosterone system inhibitors (RAASi) were precipitating factors for AKI more significantly in the IHD group (25.8% vs. 6% for CKRT, P ≤ 0.001). Intensive care unit (ICU) contributed 21% of cases (14.5% for IHD and 23.4% for CKRT, insignificant p value of 0.1). Also, there was no statistically significant difference in receiving intravenous fluids between the two groups (71% for IHD vs. 71.5% for CKRT, p=0.8), however, more patients in the IHD group received diuretics (62.9% vs 43.1% for CKRT, p=0.008). Dialysis vascular access was right internal jugular vein in 59% (75.8% FOR IHD vs. 52.7% for CKRT) followed by femoral vein in 35% of cases (19.4%). Extracorporeal membrane oxygenation (ECMO) was used in only two cases in the CKRT group. Of the total cohort, 21.8% died, with no difference between the two groups (16.1% for IHD vs 24% for CKRT, p=0.2). Partial recovery was higher in IHD group (30.8% vs.17.3%, p=0.046) and complete recovery higher in CKRT group 33.1% vs 13.5%, p=0.009). eGFR at 30 days was 53.2 ml/min with no statistically significant difference between the two groups (44.6 for IHD vs 56.1 for CKRT, p=0.15). Conclusion The IHD group and the CKRT group were statistically similar in basic characteristics and received similar lines of management, except for the diuretics. At 30 days, they had similar death rates but CKRT group had higher rates of complete recovery than the IHD group. This is in line with published literature that suggest CKRT may not improve mortality but may improve kidney recovery.

Machine learning-based remission prediction in rheumatoid arthritis patients treated with biologic disease-modifying anti-rheumatic drugs: findings from the Kuwait rheumatic disease registry.

Rheumatoid arthritis (RA) is a common condition treated with biological disease-modifying anti-rheumatic medicines (bDMARDs). However, many patients exhibit resistance, necessitating the use of machine learning models to predict remissions in patients treated with bDMARDs, thereby reducing healthcare costs and minimizing negative effects. The study aims to develop machine learning models using data from the Kuwait Registry for Rheumatic Diseases (KRRD) to identify clinical characteristics predictive of remission in RA patients treated with biologics. The study collected follow-up data from 1,968 patients treated with bDMARDs from four public hospitals in Kuwait from 2013 to 2022. Machine learning techniques like lasso, ridge, support vector machine, random forest, XGBoost, and Shapley additive explanation were used to predict remission at a 1-year follow-up. The study used the Shapley plot in explainable Artificial Intelligence (XAI) to analyze the effects of predictors on remission prognosis across different types of bDMARDs. Top clinical features were identified for patients treated with bDMARDs, each associated with specific mean SHAP values. The findings highlight the importance of clinical assessments and specific treatments in shaping treatment outcomes. The proposed machine learning model system effectively identifies clinical features predicting remission in bDMARDs, potentially improving treatment efficacy in rheumatoid arthritis patients.

Dementia awareness among healthcare professionals in Kuwait

Background/Aims Dementia is a progressive disease that can lead to functional limitations, poor quality of life, and dependency among older people. Healthcare professionals play an essential role in assisting individuals who have dementia and their caregivers. This research aimed to investigate the level of knowledge about dementia among healthcare professionals in Kuwait. Methods Healthcare professionals from seven public hospitals in Kuwait participated in the study. The participants’ knowledge level was measured using the Dementia Knowledge Assessment Scale. Results A total of 1005 participants (36.5% males and 63.5% females) from various healthcare occupations were included in this study; physicians (n=120), occupational therapists (n=31), physical therapists (n=107), pharmacists (n=90), and nurses (n=657). The overall knowledge about dementia was generally low, with an overall mean score of 18.99 out of 50 (standard deviation 5.54). Conclusions A lack of knowledge about dementia was identified among healthcare professionals in Kuwait. The findings demonstrate the need for more training to improve knowledge and increase awareness about this disease. Improved knowledge of dementia should lead to improved health care provided to patients living with dementia and support caregivers in managing the disease.

Efficiency evaluation of public hospitals in Kuwait: An application of data envelopment analysis

Background: Kuwait overall health expenditure, in 2019, was 5.5% from the gross-domestic product and the state is the biggest healthcare provider in secondary and tertiary hospitals. Hospital efficiency and productivity are, therefore, an important issue to analyse, specifically in terms of number of visits to outpatient clinics, the number of surgical procedures performed, bed turnover and bed occupancy. Data envelopment analysis has been used to provide insights in the understanding of this growth in other countries. Methods: Data envelopment analysis (DEA) was used to estimate technical and scale efficiency scores for seventeen public hospitals in Kuwait from 2015 to 2019 using a two-stage DEA. Technical efficiency scores were regressed against institutional characteristics using Tobit regression to investigate the determinants of efficiency differences amongst hospitals. Results: The mean technical efficiency score for all hospitals was 75%, and it improved by 1% since 2015. The mean pure technical efficiency score was 85% in 2015 and improved to 86% in 2019. The mean scale efficiency score was 89% in 2015 and decreased to 88% in 2019. Only five hospitals were constantly technically and scale efficient. Tobit regression showed that hospital efficiency was significantly associated with the hospital level (secondary or tertiary), number of beds, bed occupancy rate and the average length of stay. Conclusions: Most public hospitals in Kuwait were not technically and scale efficient, but improvements were observed in the overall scores and pure technical efficiencies of these hospitals throughout the study. The identification of the factors influencing efficiency is crucial for hospital managers and policymakers to take evidence-based decisions to improve the technical efficiency of the main health-producing units in the country.

Efficiency evaluation of public hospitals in Kuwait: An application of data envelopment analysis

Efficiency evaluation of public hospitals in Kuwait: An application of data envelopment analysis

COVID-19 Pandemic

The COVID-19 pandemic has been affecting world economies, business revenues, and the livelihood of many individuals, and has also resulted in accumulated medical waste. Countries, governments, and health workers are striving to contain this virus by applying different strategies and protocols. This research investigates and identifies the significant determinants that influence the acceptance and Adoption of non-hazardous medical waste recycling behaviour in Kuwait. This article questions whether healthcare workers in Kuwait are actually behaving differently regarding non-hazardous medical waste recycling during the pandemic as opposed to previously. The study uses a deductive research approach involving a quantitative methodology by applying the theory of planned behaviour as a framework. From an overall perspective, individuals have positive intentions and behaviours toward recycling. However, COVID-19 and the fear of spreading the virus had a positive impact on the healthcare workers' recycling behaviour in public hospitals in Kuwait.

MO296: Seasonal Variations in AKI Incidence and Outcomes

Abstract BACKGROUND AND AIMS Kuwait enjoys a cool winter but suffers a very hot summer. We aim to evaluate the relationship between weather temperature and acute kidney injury (AKI) incidence and outcome. METHOD We prospectively collected demographic (age, sex and nationality), clinical (CKD status, cause of AKI and comorbidities), management (fluids, diuretics, inotropes, ventilatory support and dialysis) and 30-day patients and kidney outcome data for all adult nephrology consultations for AKI in seven major public hospitals in Kuwait during January, February and March/2021 and compared them to those of June, July and August/2021. RESULTS A total of 2038 patients with AKI were enrolled (mean age: 64; males: 59%, Kuwaitis: 58%; mean eGFR: 66.5; mean initial Hgb: 106). Of the cohort, 42% had baseline eGFR < 60 (with a mean eGFR of 37, a mean age of 68 and a mean Hgb of 102 versus a mean eGFR of 88, a mean age of 59 and a mean Hgb of 109 for the group with baseline eGFR > 60). Higher percentage of AKI cases took place in cooler months (63% versus 37%). Patients with AKI in cooler months were significantly older (65 versus 59), with lower baseline eGFR (63 versus 72.5) and more comorbidities (DM, HTN, CAD). There was no difference between the two groups in the use of IV fluids (saline, bicarbonate, blood products, etc.) or IV diuretics (loop, thiazide or potassium-sparing); however, IV vasopressors were used more often in cooler months in cases of AKI. Mechanical ventilation was more frequently used in the summer cases (44% of summer AKI cases versus 40% of winter AKI cases) but not statistically significant. Dialysis was needed for 44% of the entire cohort, 56% of dialysis cases were in cooler months (31% of winter AKI cases) and 44% in summer months (40% of summer AKI cases). Dialysis modality was continuous in 85% of all cases. At 30 days, 36.5% of the total cohort died; 72% of them died while on dialysis. Larger proportion of deaths in AKI cases in cooler months (58% of total deaths or 33% of the winter AKI cases versus 42% of the total death or 42% of the summer AKI cases), with more deaths while on dialysis seen in cooler months too (56% versus 44% of deaths while on dialysis). However, lower rates of complete recovery from AKI were seen in summer cases (33% versus 67%), with a mean final eGFR of 57 for the winter AKI cases versus 41 for the summer AKI cases. CONCLUSION AKI is more common in the cooler months of the year affecting an older group of patients with more comorbidities, and is associated with higher usage of dialysis and higher rates of death, but probably better chances of kidney recovery in those who survive.

POS-163 AKI IN RAMADAN: A PROSPECTIVE OBSERVATIONAL MULTI-CENTER STUDY

Fasting during Ramadan from dawn to sunset is one of the 5 pillars of Islam. Islamic lunar calendar is 11 days shorter than the Gregorian solar calendar, so the start of Ramadan changes every year and hours spent on fasting vary from 12 hours in Australia, to 21 hours in Sweden, with most countries have 11-16 hours of fasting on average. Patients with certain medical illness are exempted from fasting, however, many such patients partake in fasting. 1,2The long hours of fasting may be a risk factor for AKI in certain populations. We assess AKI in Ramadan of 2021, where the weather was moderately hot. Demographics, comorbidities, treatment, and 4 weeks outcome data for all nephrology consultation for AKI in four public hospitals in Kuwait during Ramadan of 2021 (13/April to 12/May/2021) prospectively collected and analyzed. We compare AKI in people fasting prior to admission to non-fasting. Total number of AKI cases during Ramadan was 158, 55% males, mean age 64, and 61% were Kuwaiti citizens. Community acquire cases were 15%. DM affected 75%, HTN 72%, and cardiac disease 25% of patients. Median baseline eGFR before AKI was 66.5. Baseline eGFR < 60 seen in 43%, and those compared to patients with eGFR > 60, had median baseline eGFR of 37.5 (vs 92), were older (69 vs 62), 87% had DM (vs 66%) and 87% had HTN (vs 61%). Cause of AKI was pre-renal / ischemic ATN in 69%, COVID-19 related in 17%. Many had more than one possible cause. IV fluids used in 76%, IV diuretics in 39%, IV vasopressors in 31%, and steroids in 21.5%. KRT needed in 27%. Volume overload and electrolytes / acid-base disorders were most common indication (21% and 19% respectively and 15% had more than one indication. Death within 30 days occurred in 11.4%. Of the total AKI cases, 24% were fasting before admission, with mean age of 56 (compared to 63 for non-fasting). No significant difference in baseline eGFR between fasting and non-fasting, nor in use of IV fluids, IV diuretics, or IV vasopressors. Dialysis needed in 21% of the fasting group, not significantly different from non-fasting group. Mortality rates were lower in the fasting group but not statistically significant (8% vs 12.5%). AKI affect both fasting and non-fasting population similarly, with no increased risk of need for dialysis or mortality.

Results from the first Kuwait National Bariatric Surgery Report

BackgroundCurrently, more than 30% of the population in the gulf demonstrate a body mass index (BMI) exceeding 30. This burden of obesity has proven to take a toll on the population; therefore, we created the first Kuwait National Bariatric Surgery Database to report on bariatric surgeries performed in Kuwait.MethodsData was collected from the six public hospitals in Kuwait. This data was then submitted to a merged National Registry. Data web portal were used to upload, merge, and analyze the data.ResultsThe average age for participants was 32.6 years. The average preoperative BMI was 45.9 kg/m2 for males and 43.3 kg/m2 for females. 16.4% of males and 12.3% of females presented with type 2 diabetes, while the most prevalent obesity related disease was a poor functional status in both males and females (90.8% and 90.5%, respectively). Most procedures performed in Kuwait are sleeve gastrectomy. The most encountered in-hospital complication after primary bariatric surgery was bleeding (1.5%), with Roux-en-Y gastric bypass (RYGB) having the highest recorded rate of post-operative complications (3.6% bleeding). The overall rate of operative complications was 2.6%, which was most prevalent post-RYGB (10.3%) and lowest post-sleeve gastrectomy (2.5%).ConclusionThe importance of tracking and documenting the journey and change in the rates of obesity and effectiveness of bariatric procedures in individual countries with significantly high obesity rates is imperative to be able to create a plan of action to tackle this worldwide epidemic. This report will be able to provide the population with an accurate accounting that demonstrates further the safety of bariatric/metabolic surgery.

Antibiotic resistance and typing of the methicillin-resistant Staphylococcus aureus clones in Kuwait hospitals, 2016\u20132017

BackgroundMethicillin-resistant Staphylococcus aureus (MRSA) belong to diverse genetic backgrounds that differ in antibiotic resistance. Knowledge of the local clonal composition of MRSA strains is important for patients’ management and for designing effective control and eradication methods. The aim of this study was to compare the antibiotic resistance patterns and genotypic characteristics of MRSA isolates obtained in public hospitals in Kuwait in 2016 and 2017 for changes in their resistance patterns and clonal composition.MethodsA total of 4726 MRSA isolates obtained in 2016–2017 from clinical specimens in Kuwait public hospitals were characterized using antibiogram, SCCmec typing, spa typing and DNA microarray.ResultsThe isolates expressed resistance to fusidic acid (52.9%), kanamycin (41.6%), gentamicin (32.5%) and erythromycin (36.2%). The prevalence of high-level mupirocin resistance decreased from 3.7% in 2016 to 2.4% in 2017, while the proportion of resistance to other antibiotics remained relatively stable. A total of 382 spa types were detected with eight spa types, t688 (N = 547), t304 (N = 428), t860 (N = 394), t127 (N = 306), t044 (N = 230), t311 (N = 243), t223 (N = 184) and t002 (N = 181) constituting 53.1% of the MRSA isolates in 2016–2017. Of the 3004 MRSA isolates obtained in 2016 (N = 1327) and 2017 (N = 1677) selected for DNA microarray analysis, 26 clonal complexes (CCs) were identified. Most of the isolates belonged to CC1 (N = 248), CC5 (N = 833), CC6 (N = 241), CC8 (N = 292), CC22 (N = 421), CC30 (N = 177), CC80 (N = 177) and CC97 (N = 171). The prevalence of CC5 isolates has significantly (p ≤ 0.05) increased from 294 isolates in 2016 to 539 isolates in 2017. Although CC22 increased from 196 isolates in 2016 to 225 isolates in 2017, CC1 increased from 112 isolates in 2016 to 136 isolates in 2017, CC6 increased from 103 isolates in 2016 to 138 isolates in 2017, these changes were not significant (p ≥ 0.05).ConclusionThese results revealed the diversity in the genetic backgrounds of MRSA isolates and the stable maintenance of the dominant MRSA clones in Kuwait hospitals in 2016 and 2017 suggesting an on-going transmission of these clones. Novel and creative infection prevention and control measures are required to curtail further transmission.

Measuring the Efficiency of Public Hospitals in Kuwait: A Two-Stage Data Envelopment Analysis and a Qualitative Survey Study

The recent drop in oil prices has challenged public sector financing in Kuwait. Technical and scale efficiency scores for fifteen public hospitals in Kuwait from 2010 to 2014 were estimated using a two-stage data envelopment analysis (DEA). Technical efficiency scores were regressed against institutional characteristics using Tobit regression to investigate the determinants of efficiency differences in hospitals. Semi-structured interviews were also carried out with fourteen public and private hospital managers to qualitatively explore their perceptions and experience about about factors affecting hospital efficiency.&#x0D; &#x0D; The mean technical efficiency score for all hospitals was 85.8%, an improvement of 2% since 2010. The mean pure technical efficiency score was 79.6%, improving from 75% in 2010 to 81.2% in 2014. The mean scale efficiency score was 91.8%, improving from 87.6% in 2010 to 94.2% in 2014. Only three hospitals were constantly technically and scale efficient. Tobit regression showed that hospital efficiency was significantly associated with the average length of patient stay. Hospitals with more than 400 beds were potentially more technically and scale efficient. The qualitative study revealed that external factors affecting efficiency commonly included implemention of legislative changes and decreasing bureaucracy, while internal factors included increasing bed capacity and improving qualifications and training of human resources.&#x0D; &#x0D; Most public hospitals in Kuwait were not technically and scale efficient, but improvements were observed. Potential factors that affected the efficiency of hospitals in Kuwait were identified. These findings are useful to decision-makers in Kuwait for developing strategies to improve public hospital efficiency.

Availability of Antidotes in Kuwait: A National Audit.

Effective management of poisoning requires adequate stocking of antidotes in hospitals that provide emergency care. Antidote stocking represents a major challenge to hospitals all over the world, including Kuwait. This study aimed to evaluate antidote stocking in public and private hospitals that provide emergency care in Kuwait. A cross-sectional study using a self-administered questionnaire was conducted from January to December 2018. The questionnaire was designed to assess immediate and non-immediate availability of 41 antidotes in 6 public and 13 private hospitals in Kuwait that provided emergency care. The questionnaire was provided to the pharmacy departments of these hospitals, which were asked to report the availability of antidotes and the reasons for non-availability. Descriptive statistics were used to report demographical data and independent t-test analysis was used to analyze continuous variables. All of the six public hospitals in Kuwait and eight private hospitals returned the completed questionnaires. Among the 14 hospitals surveyed, none had a complete stock of all essential antidotes. The mean (standard deviation [SD]) availability of immediate antidotes in public hospitals was 79.6% (32.6%) compared to 52.1% (44.4%) in private hospitals. Moreover, the mean (SD) availability of non-immediate antidotes was 64.5% (37.7%) in public hospitals compared to 14.7% (22.8%) in private hospitals. Public and private hospitals in Kuwait have suboptimal stocks of essential antidotes. There is an urgent need to develop expert consensus guidelines to assist hospitals to reduce costs and improve patient care by adequately stocking essential antidotes.

Understanding health information management practices in public hospitals in Kuwait.

Health information technology (IT) solutions can aid healthcare reform efforts, but without proper information management, these efforts are futile. In this study, we used Kuwait as an example of a high per-capita gross domestic product country that faces information management challenges to draw insights that can be generalised to other developed countries. (i) to uncover the status quo of information management practices in public hospitals and (ii) to offer recommendations to improve them. This study analysed qualitative and quantitative accreditation-related data pertaining to the compliance with the information management standard at all secondary care public hospitals over two accreditation cycles. Overall, public hospitals had made positive progress in their compliance with the information management standard. However, issues still existed with (i) developing and implementing an information management plan, (ii) involving the appropriate stakeholders in selecting health IT solutions and (iii) access to the Internet by staff and patients. Evidence underscored the importance of proper information management driven by clear centralised strategic plans. With the rapid adoption of digital health systems, the role of health information management leaders should not be undervalued. Embracing health IT solutions with strong information management practices can aid healthcare reform efforts.

Measuring the Efficiency of Public Hospitals in Kuwait: A Two-Stage Data Envelopment Analysis and a Qualitative Survey Study

The recent drop in oil prices has challenged public sector financing in Kuwait. Technical and scale efficiency scores for fifteen public hospitals in Kuwait from 2010 to 2014 were estimated using a two-stage data envelopment analysis (DEA). Technical efficiency scores were regressed against institutional characteristics using Tobit regression to investigate the determinants of efficiency differences in hospitals. Semi-structured interviews were also carried out with fourteen public and private hospital managers to qualitatively explore their perceptions and experience about about factors affecting hospital efficiency. The mean technical efficiency score for all hospitals was 85.8%, an improvement of 2% since 2010. The mean pure technical efficiency score was 79.6%, improving from 75% in 2010 to 81.2% in 2014. The mean scale efficiency score was 91.8%, improving from 87.6% in 2010 to 94.2% in 2014. Only three hospitals were constantly technically and scale efficient. Tobit regression showed that hospital efficiency was significantly associated with the average length of patient stay. Hospitals with more than 400 beds were potentially more technically and scale efficient. The qualitative study revealed that external factors affecting efficiency commonly included implementation of legislative changes and decreasing bureaucracy, while internal factors included increasing bed capacity and improving qualifications and training of human resources. Most public hospitals in Kuwait were not technically and scale efficient, but improvements were observed. Potential factors that affected the efficiency of hospitals in Kuwait were identified. These findings are useful to decision-makers in Kuwait for developing strategies to improve public hospital efficiency.

Baseline assessment of patient safety culture in public hospitals in Kuwait

Conducting patient safety culture assessments can provide hospitals with information on how structures and processes within their system can impact patient outcomes. This study used the Hospital Survey on Patient Safety Culture (HSOPSC) to conduct an assessment of patient safety culture in public hospitals in Kuwait and benchmark against regional and international studies that utilized the same tool. This objective of this study is to examine the association between the predictors and outcomes of patient safety culture. This cross sectional study adopted a customized version of HSOPSC developed by the Agency for Healthcare Research and Quality. The survey targeted selected public hospital staff with at least one year of experience. Data was analyzed using SPSS 24 at a significance level of 0.05. Univariate analysis was utilized to obtain an overview of respondent demographics. The association between patient safety grade and the number of events reported and the remaining patient safety culture composites was analyzed using ANOVA f-test. Four regression models were constructed, two adopted Generalized Estimating Equations and the others were linear models. Results were benchmarked against similar initiatives in Lebanon, Saudi Arabia and USA. A total of 12,092 employees from 16 public hospitals in Kuwait completed the survey. The overall response rate was 60.5% (20,003 distributed surveys). Areas of strength were Teamwork within Units, Organizational Learning—Continuous Improvement, Management Support for Patient Safety, Supervisor/Manager Expectations & Actions Promoting Patient Safety, and Feedback and Communication about Error. Regression findings highlighted significant association between patient safety outcomes and composites. Benchmarking analysis revealed that Kuwaiti hospitals are performing at or better than benchmark on several composites compared to regional and international findings. This is the first major study addressing patient safety culture in public hospitals in Kuwait. Despite having some areas for improvement, public hospitals in Kuwait were found to have multiple areas of strength. Improving patient safety culture is critical if hospitals want to improve quality and safety of medical services. Study findings can guide and inform country level strategies to further improve the systems governing patient safety practices.

Clinical pharmacy in Kuwait: Services provided, perceptions and barriers

IntroductionPharmacy practice has considerably evolved from a dispensing role to a patient-centered profession. Kuwait has minimal clinical pharmacy services established in its healthcare settings. ObjectivesThe objectives of this study were to document existing clinical pharmacy services in public hospitals, identify barriers to their implementation and assess perceptions regarding pharmacists providing clinical services. Material & MethodA cross sectional study using self-administered questionnaires among a total of 166 pharmacists and 284 physicians across 6 public hospitals in Kuwait was conducted. ResultsOver half of pharmacists (54%) provided clinical services, with the most common service being education and drug information (86%). Forty percent (40%) of the pharmacists reported that clinical services offered were of their own initiative but most of them (71%) were not sure whether they would offer additional services in the future. The majority of physicians were receptive to an expanded patient-centered role of the pharmacist (97%), believed pharmacists add to patient clinical care (92%) and considered pharmacists members of the healthcare team (96%). Major barriers reported by pharmacists to implement clinical pharmacy services included lack of policy (49%), time (36%) and clinical skills (28%), which is similar to barriers reported by physicians. ConclusionAlthough clinical pharmacy is in its infancy in Kuwait, it is well perceived and requested by physicians. Major barriers must be addressed and in this context, having a national framework for pharmacy practice from Ministry of Health, supported by cutting edge education and a pro-active professional association would be key assets to evolve the practice in Kuwait.

Computing Capabilities of Knowledge Workers in the Kuwaiti Health Sector

Knowledge workers in health care can function well in their clinical and professional practice if they have adequate computing capabilities and they apply them optimally in their work setting. Health information systems (HIS), patient health records (PHR), health databases, health portals, etc. are becoming the essential work-context for these knowledge workers. These professionals have to be equipped with relevant IT competencies in order to be usefully functional, productive and value-driven. HIS was implemented in 2006 in one of the major public hospitals in Kuwait. Thus far the system is partially functional and many of its strengths are not adequately exploited. The Purpose of this study was to examine whether health professionals possess needed computing capabilities and what role did these play in the optimization of the HIS. We conducted a survey administering a questionnaire to a stratified random sample of 210 knowledge workers. We received 130 responses and analyzed data using 124 of the usable responses. In this paper we have reviewed perceptions about the computing capabilities of these professionals, inadequacies they had reported, problems they had encountered, and the role of IT unit in the organization.

Microbiological contamination of mobile phones of clinicians in intensive care units and neonatal care units in public hospitals in Kuwait.

BackgroundThe objective of this study was to explore the prevalence of microbiological contamination of mobile phones that belong to clinicians in intensive care units (ICUs), pediatric intensive care units (PICUs), and neonatal care units (NCUs) in all public secondary care hospitals in Kuwait. The study also aimed to describe mobile phones disinfection practices as well as factors associated with mobile phone contamination.MethodsThis is a cross-sectional study that included all clinicians with mobile phones in ICUs, PICUs, and NCUs in all secondary care hospitals in Kuwait. Samples for culture were collected from mobile phones and transported for microbiological identification using standard laboratory methods. Self-administered questionnaire was used to gather data on mobile phones disinfection practices.ResultsOut of 213 mobile phones, 157 (73.7 %, 95 % CI [67.2–79.5 %]) were colonized. Coagulase-negative staphylococci followed by Micrococcus were predominantly isolated from the mobile phones; 62.9 % and 28.6 % of all mobile phones, respectively. Methicillin-resistant Staphylococcus aureus (MRSA) and Gram-negative bacteria were identified in 1.4 % and 7.0 % of the mobile phones, respectively. Sixty-eight clinicians (33.5 %) reported that they disinfected their mobile phones, with the majority disinfecting their mobile phones only when they get dirty. The only factor that was significantly associated with mobile phone contamination was whether a clinician has ever disinfected his/her mobile phone; adjusted odds ratio 2.42 (95 % CI [1.08–5.41], p-value = 0.031).ConclusionThe prevalence of mobile phone contamination is high in ICUs, PICUs, and NCUs in public secondary care hospitals in Kuwait. Although some of the isolated organisms can be considered non-pathogenic, various reports described their potential harm particularly among patients in ICU and NCU settings. Isolation of MRSA and Gram-negative bacteria from mobile phones of clinicians treating patients in high-risk healthcare settings is of a major concern, and calls for efforts to consider guidelines for mobile phone disinfection.