Objectives: Patient safety at secondary-level public health facilities in low-income and middle-income countries remains critically underevaluated. This study aimed to assess the level of patient safety at secondary health facilities in Eastern Rajasthan, India, using the SaQushal toolkit, and to identify priority areas for improvement. Methods: A cross-sectional facility-based assessment was conducted at 6 secondary health facilities in Eastern Rajasthan. Data were collected from Principal Medical Officers, nonparticipant observation, and record review, in accordance with the SaQushal toolkit, a structured self-assessment instrument developed by India’s National Health Systems Resource Centre. Patient safety was measured across 4 areas of concern: Safe Patient Care Processes, Clinical Risk Management, Safe Care Environment, and Patient Safety System. Scores were expressed as percentages of maximum possible marks; means and medians were calculated for cross-facility comparison. Results: None of the 6 facilities achieved an overall score exceeding 50% (maximum 800 marks). The mean overall score was 245.83 (30.7%). Clinical Risk Management recorded the highest mean score (83.50), driven by performance in Reproductive, Maternal, Newborn, Child and Adolescent Health services. Patient Safety System recorded the lowest mean score (27.33). The Reporting and Learning System standard recorded a mean score of 0.33 out of 50. Conclusions: Patient safety standards across assessed secondary health facilities were substantially below acceptable thresholds. The near-absent Reporting and Learning System represents the most critical systemic gap. Findings provide baseline evidence to guide targeted quality improvement under India’s National Patient Safety Implementation Framework 2018-2025 and the WHO Global Patient Safety Action Plan 2021-2030.
The Saudi Patient Safety Center cross-sectional survey, based on the Agency for Healthcare Research and Quality Hospital Survey on Patient Safety Culture 2.0, was conducted from September 3 to October 28, 2023 to summarize the patient safety culture profile in Eastern Health Cluster hospitals and to identify benchmark, hospital-size, and staff-category patterns relevant for improvement. Ten composites were computed as percent-positive scores and descriptively compared with Saudi and US benchmarks. Of the 13,507 eligible staff, 10,853 responded (80%), and 83% reported having direct contact with patients. The mean percent-positive score for all was 63.29%. Teamwork (74.49%) and organizational learning–continuous improvement (71.76%) had the highest scores. The lowest scores were for Staffing and Work Pace (43.93%), Response to Error (51.09%), and Hospital Management Support for Patient Safety (57.73%). All composites had scores below Saudi benchmarks and smaller hospitals (≤200 beds) had higher scores than larger hospitals (>200 beds). Reporting Patient Safety Events had a score of 66.95%, with 53% of respondents reporting no patient safety events in the past 12 months, suggesting that voluntary reporting may not reflect the true picture of patient safety. The key areas for improvement are staffing, work pace, nonpunitive approach to error, and leadership support. Nurse-to-patient staffing and acuity review should be combined with just culture practices, closed-loop feedback, and active event detection via trigger tools and chart review.
The 2025 webinar: “Combating Infectious Disease Challenges: Have We Gone Twenty Steps Forward or Backward?” explores the need for a paradigm shift in public health strategies to address airborne pathogens. Despite growing awareness, many health care systems still underestimate the complexity of airborne transmission, relying on surgical masks for protection against airborne pathogens and on outdated assumptions that aerosol-generating procedures are required to spread them. Evidence shows that pathogens can be aerosolized through Aerosol-Generating-Activities (AGA), which are undertaken every day, such as breathing, talking, and singing, necessitating the use of respirators (eg, N95 masks), airborne infection isolation rooms, and improved indoor air quality. Upgrading HVAC systems and maintaining indoor CO 2 levels below 800 ppm are critical steps toward safer environments. The importance of One Health was highlighted by a discussion of H5N1, including its impact on our food supply and its potential to mutate, which could allow sustained human-to-human transmission. Vaccination remains a cornerstone of infectious disease prevention, credited with saving an estimated 154 million lives globally over the past 5 decades. However, misinformation continues to erode public trust, with nearly 25% of Americans believing the MMR vaccine may cause autism—threatening herd immunity for diseases like measles. The webinar also highlights the importance of elimination strategies at the onset of pandemics. While such approaches were effective against MERS and SARS-CoV-1, they failed against SARS-CoV-2. A failure associated with implementation delays and insufficient infrastructure. This webinar underscores the need for evidence-based interventions, public education, and systemic reform to better prepare for future infectious disease threats.
Antibiotic resistance is a major global public health threat that compromises the effectiveness of antibiotic agents and increases morbidity, mortality, and health care costs. India faces a substantial AMR burden driven by high infectious disease prevalence, widespread antibiotic use, and variable surveillance capacity. This systematic review and meta-analysis aimed to synthesize evidence on antibiotic resistance patterns in India from 2015 to 2025, estimate the prevalence of resistance among major bacterial pathogens, evaluate molecular resistance determinants, and assess mortality associated with resistant infections. A systematic search of PubMed/MEDLINE, Scopus, Web of Science, Google Scholar, surveillance reports, and grey literature was conducted following PRISMA 2020 guidelines. Studies reporting antibiotic resistance data from India between January 2015 and December 2025 were included. Data extraction and quality assessment were performed independently by 2 reviewers. A random-effects meta-analysis was used to estimate the pooled prevalence of antibiotic resistance, molecular determinants of resistance, and mortality outcomes, and heterogeneity was assessed using the Cochrane Q and I 2 statistics. Forty-six studies met the inclusion criteria. The pooled prevalence of antibiotic resistance was 55.7% (95% CI: 47.4%-63.9%; I 2 =98.6%). High resistance rates were reported among major gram-negative pathogens, particularly Klebsiella pneumoniae, Escherichia coli, Acinetobacter baumannii , and Pseudomonas aeruginosa . Molecular meta-analysis demonstrated a pooled prevalence of resistance-associated genes of 64.5% (95% CI: 46.0%-83.0%), with blaNDM, blaOXA-48-like, and blaKPC being the most frequently reported determinants. Mortality associated with resistant infections was 31.0% (95% CI: 18.2%-43.8%). Substantial heterogeneity was observed across all analyses. Available evidence indicates that antibiotic resistance remains a significant health care challenge in India. High levels of multidrug resistance, widespread dissemination of carbapenemase genes, and considerable mortality associated with resistant infections underscore the need for strengthened antibiotic stewardship, standardized surveillance, expanded molecular diagnostics, and coordinated public health interventions. However, the findings should be interpreted cautiously because of substantial heterogeneity and the predominance of studies from tertiary-care settings. This review was registered with PROSPERO (CRD420261406324).
Objectives: This study aimed to determine the validity and reliability of the Turkish version of the Nursing Quality Improvement Attitude Scale. Methods: A cross-sectional, multisite approach was used between April and November 2022 to collect data from 519 nurses across 4 distinct health care settings, including public and training-research hospitals located in a provincial center and 2 districts of the Black Sea Region, Turkey. Data were collected using a demographic information form and the Turkish version of QINASE. The original scale consists of 35 items, is unidimensional, and uses a 5-point Likert response scale. The original scale showed good psychometric properties, with a Cronbach alpha coefficient of 0.97. The QINASE was linguistically adapted using a forward-backward translation method and evaluated for content validity by experts, while its psychometric properties were assessed through Exploratory and Confirmatory Factor Analyses, along with Cronbach alpha and intraclass correlation coefficients for reliability. Results: Following the expert review, the scale’s Content Validity Index (CVI) was determined to be 0.87. Based on the factor analysis results, 8 items were removed from the instrument to ensure structural integrity. Exploratory Factor Analysis ( EFA) yielded a 27-item structure across 4 dimensions, which was further validated by Confirmatory Factor Analysis ( CFA) and assessments of convergent and divergent validity. The identified factors were labeled as follows: ‘Belief in Quality Improvement,’ ‘Institutional and Safety Culture,’ ‘Teamwork and Collaboration,’ and ‘Error Reporting.’ No significant differences were observed between the test-retest mean scores of the scale or its sub-dimensions ( P >0.05), while a strong, significant correlation was identified between the scores ( P <0.001). Internal consistency analysis revealed a Cronbach alpha coefficient of 0.93 for the overall scale, with sub-dimension values ranging from 0.72 to 0.93. Finally, item-total correlation values ranged between 0.332 and 0.727, indicating that all items were significantly interrelated. Conclusions: In this study, it was determined that the Turkish form of the scale is a valid and Reliable measurement tool for determining nurses’ quality improvement attitudes.
