How do nurses manage their occupational exposure to cytotoxic drugs? A descriptive survey in chemotherapy settings, Shiraz, Iran

Occupational exposure to cytotoxic drugs is a global concern. We conducted this cross-sectional study in 2012 to describe the adverse effects experienced by nurses working in one of chemotherapy facilities affiliated to Shiraz University of Medical Sciences, Shiraz, southern Iran, and their proper use of personal protective equipment and educational programs. The frequency of side effects reported by participants was noticeably high. Approximately, 60% of the nurses used all personal protective equipment. There were air conditioner ventilation systems in all facilities, but they were not standard. Clinics did not have any dedicated room. Lack of adequate training was noticeable among all participants. We concluded that establishment of safety regulations, health care workers safety surveillance systems as well as continuous training for nurses are of paramount importance

Second generation of HIV surveillance system: a pattern for Iran

For the purpose of minimizing the HIV/AIDS epidemic effects, one of the programs is the promotion of scientific methods and setting of the suitable surveillance systems. The present research was conducted to design the HIV/AIDS surveillance system in Iran applying WHO recommendations and the experience of some countries. In 2009, based on the country's requirements, the HIV/AIDS surveillance system was proposed and designed for Iran. The Delphi technique was utilized to find the views of experts. Data analysis was conducted based on a comparison of the attributes of the HIV/AIDS surveillance systems in the countries under consideration using a descriptive and theoretical analysis. The model was approved obtaining the final score of 36.3 out of 44, viz 82.5%. Designing and performing of the HIV/AIDS surveillance pattern in the direction of "second generation of HIV/AIDS surveillance" can be considered as an important step in the improvement of the patient's control and precaution of HIV/AIDS

Economic burden of inappropriate antibiotic use for prophylactic purpose in Shiraz, Iran

Because economic data on the prophylactic usage of antibiotic in Iran are scant, we have conducted a cross-sectional study with provider perspective to measure costs and appropriate use of antibiotics in surgical wards of 6 training hospitals affiliated to Shiraz University of Medical Sciences [SUMS], Iran. Over a six-month period 1,000 consecutive patients undergoing surgical operation were enrolled and information on prophylactic antibiotic administration was collected. The information included basic patient's demographic data, types of surgery, category of antibiotic, dosage, dosage intervals, route of administration, number of doses, initiation times and duration of administration. In order to determine the agreement between prescribed antibiotics and medical indication, the American Society of Health-System Pharmacists [ASHP] guidelines were applied. Nine hundred and ninety three out of 1,000 patients [99.3%] had received at least one antibiotic and 908 patients [91.4%] received antibiotics because of a medical indication. Five out of 913 patients who had indications for antibiotic prophylaxis did not receive any antibiotic. Antibiotics were prescribed for 85 out of 87 [98%] procedures in which an antibiotic was not indicated. The average cost of antibiotic prescription per surgical procedure was 786,936 Iranian Rials [corresponding to 99.60 USD or Eng. pound 82.90]. The most frequent prescribed antibiotic was cefazoline adding 53.3% of the total cost of antibiotics. In total, 36,516,190 Iranian Rials [corresponding to 4,622.95 USD or Eng. pound 3,845.20] were spent for cefazoline alone. The results of this study showed that all surgical patients received at least one antibiotic as prophylaxis for any infection in the surgical site. Our results indicate over- and misuse of antibiotics in Iran leading to a great amount of economic burden, since in 98% of all procedures, antibiotics were used inappropriately

Precautions for Health Care Workers to Avoid Hepatitis B and C Virus Infection

The burden of exposure to blood-borne pathogens [such as hepatitis B and C viruses] is considerable for health care workers. Hepatitis virus transmission requires a non-immune host, an infectious source, and skin or mucous membrane injury. These three aspects are the main fields for preventional interventions. We reviewed major recent studies on this topic to identify precautions health care workers should take to avoid hepatitis B [HBV] and C virus [HCV] infections. Accordingly, this review looks at aspects of epidemiology, risk factors, economy, knowledge, attitudes, practice, and ethics of HBV and HCV that affect health care workers. The risk of transmission depends on the load of pathogen, infectious characteristics and exposure frequency. Health care workers skill levels and the specific hospital department involved appear to be the most important factors in the exposure of health care workers to blood-borne pathogens. However, many health care workers surveyed, believed that educational programs about standard precautions in their setting were not adequate. Obviously, more detailed studies will be needed to clarify risks and opportunities for health care workers precautions aimed at avoiding HBV and HCV infection, especially in emerging health research communities

Study of antibiotic prescribing among dental practitioners in Shiraz, Islamic Republic of Iran

Inappropriate prescribing of antibiotics by health care professionals is a worldwide concern. This study evaluated the knowledge and practices of dental practitioners in the city of Shiraz, Islamic Republic of Iran regarding their therapeutic use of antibiotics for patients with dentoalveolar infections. Of 219 [48.6%] dentists responding to the questionnaire more than 40% would prescribe antibiotics for localized fluctuant swelling and for problems for which antibiotics are not required according to good practice guidelines [acute pulpitis, chronic apical infection, periodontal abscess, chronic gingivitis, chronic periodontitis, pericoronitis and dry socket]. A majority correctly prescribed antibiotics for acute periapical infection [77.2%], cellulitis [75.3%] and acute ulcerated gingivitis [63.0%]. Amoxicillin was the most frequently prescribed antibiotic for all clinical conditions but there was a wide variation in dosage, frequency and duration for all antibiotics used. Guidelines on rational antibiotic use are needed for dental practitioners in the Islamic Republic of Iran

efficiency of general public hospitals in Fars province, southern Iran

Regarding the increase in expenses for health care services in inpatient settings, much effort has been made to compare the performance of hospitals in recent years and measure their efficiency. In this study, Data Envelopment Analysis [DEA] is applied to measure the technical, scale and economic efficiency of the general public hospitals in Fars Province, southern Iran. Twenty one general public hospitals in Fars province, southern Iran in the first and second six months of the years 2005 and 2006 were enrolled. There was an attempt to compare their rate of development or otherwise, using Malmequist index and also to determine their return to scale and rank during these years. The data, were collected through a questionnaire by interview and the existing documents were analyzed separately for each year by Algebraic Modeling System [GAMS] software. Fifteen hospitals [71.4%] were technically efficient and in the next three periods, 14 hospitals proved to be efficient. With respect to scale efficiency in the first 6 months of 2005, 7 hospitals were completely efficient [33.3%], but in the second 6 months of the same year, the number of efficient hospitals was reduced from 7 to 5. In the next two periods, 4 hospitals [19%] were recognized as highly efficient systems. As to the economic efficiency in all 4 studied periods, 4 hospitals [19%] were recognized as completely efficient. As to the average technical efficiency, state-run public hospitals in Fars Province are in a higher level as compared with those in other studies. However, their average of the scale efficiency is less than that reported in other studies. It seems that the hospitals under the study do not seek profitability since they are public; therefore, they lack any motivation to select a combination of inputs in order to minimize the expenses. It is recommended that hospital managers and decision makers should use DEA to determine the best method of using the available resources

Low dose, short-term iron supplementation in female blood donors of childbearing age: a randomized, double-masked, placebo-controlled study

Iron supplementation for blood donors is a controversial concept. However, to maintain regular blood donors, as a source of blood supply, the present paradigm is not appropriate and dose not prevent harms to blood donors. A randomized, double-masked, placebo-controlled study, was conducted by enrolling 95 female regular blood donors of childbearing age [18-49 years]. The participants were selected randomly [systematic random sampling] from 300 donors who donated one unit of whole blood. These individuals were randomly assigned to receive 50 mg elemental iron or placebo once daily. Each donor was scheduled for serum ferritin determination at the beginning of the study, and 28th and 56th days after donation. Adverse effects of the treatment were evaluated on 7th, 28th and 56th days. After one blood donation, mean serum ferritin concentration remained largely constant in the iron group on 28th day of the treatment, [P= 0.064] whereas it was lower in the placebo group [P= 0.001]. There was no significant difference between the placebo and iron group in terms of the incidence of gastrointestinal adverse effects. The results of the present study indicate that short-term, low dose iron supplementation replace iron loss caused by phlebotomy, protect the female regular blood donors from iron deficiency, and assist retaining this group of donors for future donation

Relation between school's stressor factors and physical-psychological complaints in high school students of Yasouj City, 2003-2004

Human being is usually facing a series of stressor factors in each step of his life. Specially in case of students whom stimulation will be arise in reaction with school's environment in order to prepare them to promote their psychological hygiene or psychological and behavioral disorders. In this respect, the present study was done in order to determine the school's stressor factors and their relation with student's physical complaints which was also measured according to age, sex, last year's average, etc variables. This is a correlation type of study in which 340 students [girls and boys] from pre-university level of Yasouj city with simple way based on objective were selected. The tools of data collection is a three section questionnaire consisting of information regarding personal characteristics, questions about stressors factors of the school [34 cases] and questions about physical complaints [19 cases] in students, which was done by questionnaire presenting at schools. Then, with the use of SPSS software descriptive and deductive statistics the data were analyzed. Results showed that, 50.3% of cases were boys and 49.7% of them were girls. The mean age and last year's average of samples was 17.54 +/- 1.11 and 16.25 +/- 2.03 respectively. The most stressor factors was anxiety for their future's studying and business, less average comparing with last year's average, to be deferred from studying, etc respectively and the most prevalent physical complaints of students was fast angriness, angst, headache, forgetting of lesson, etc. Also Pearson's correlation coefficient between school's stressor factors and students physical-psychological complaints showed significant relation [r=0.43, P<0.01]. Meanwhile, girls were facing stressor factors and physical complaints more than boys [t=-2.94, P<0.01, t=-3.15, P<0.01 respectively]. As it was mentioned in findings, there was a significant relation between school's stressor factors and student's physical complaints. Therefore stressor factors can be introduced to the students by teaching, helping them to select the ways of facing those factors. So that, an efficient step can be take up to promote the physical and psychological hygiene of this group of society

Epidemiology of hospitalized female burns patients in a burn centre in Shiraz

During 2000 to 2001, all 170 female burn patients admitted to the Ghotbeddin burn centre in Shiraz were studied to determine the epidemiological characteristics and outcome of burn for these patients. The overall mortality rate was 64%. The highest frequency of burns [53.5%] occurred among 16-25-year-olds. The commonest cause of burn was flame [98.2%]. The mean [SD] length of hospital stay was 13 [14.3] days. Mean [SD] of total body surface area [TBSA] burned among all patients was 56% [28.5%]; among those who survived it was 29% [13.4%] and among those who died it was 72% [21.7%]. The relation between TBSA and mortality was statistically significant

Vancomycin use in a large teaching hospital in Shiraz, Islamic Republic of Iran, 2003

We investigated adherence to the Hospital Infection Control Practice Advisory Committee [HICPAC] guidelines on vancomycin prescription in a large university-affiliated hospital in Shiraz. From August to December 2003, 200 hospitalized patients received vancomycin. For only 12 [6%] of these patients was vancomycin prescribed appropriately according to HICPAC guidelines. The main reasons why vancomycin use did not comply with HICPAC recommendations were: surgical prophylaxis in patients with negative cultures for resistant Gram-positive organisms, no investigation of vancomycin serum levels in patients receiving > 48 hours of vancomycin, vancomycin serum levels not repeated in patients receiving > 1 week of vancomycin, no appropriate adjustment of dosage with respect to serum levels in patients receiving vancomycin

Personal hygiene and safety of governmental hospital staff in Shiraz, Islamic Republic of Iran

Complying with infection control standards is essential to prevent nosocomial infections. We aimed to determine health workers' hygiene practices and compliance with recommended instructions for personal hygiene among staff in all 30 hospitals affiliated to Shiraz University of Medical Sciences. The results showed that physicians and nurses were less compliant with personal hygiene practices than cleaners. Availability of protective measures was better in teaching hospitals than non-teaching hospitals as were vaccination rates among staff [hepatitis B and tetanus/ diphtheria] with physicians scoring highest. Measures are needed to improve health workers' compliance

[The frequency of needlestick and sharps injuries during clinical training setting in dental students of Shiraz University of Medical Sciences in 2005]

Dental students are at high risk for occupational exposure to blood borne pathogens [including HBV, HCV and AIDS] via sharps and needle stick injuries [NSIs]. The aim of this study was to evaluate sharps and needle stick injuries among dental students and students' practice regarding protective strategies against blood borne pathogens. This cross-sectional study was performed on 137 dental students during clinical training setting at Shiraz/Iran dental school in 2004. A self-administered questionnaire was used for data gathering and completed by 137 [50.4%female and 49.6%male] students. From 137 students, 73.7.% reported at least one NSI that most commonly [53%] had occurred in the patient room .From all, 85% had information about standard precautions and 94.9% had been vaccinated against hepatitis B. Mean score of practice in protection strategies against blood borne pathogens was 14.3 [of 25]. Females' practice in regard to protection strategies was significantly better in comparison to males [P<0.01]. These data confirm that dental students have a high rate of NSIs and attention should be directed to increase their knowledge about standard protective strategies against blood borne pathogens

Survey on adoption of measures to prevent nosocomial infection by anaesthesia personnel

To assess the knowledge, attitudes and practices of anaesthesia personnel regarding infection control in hospitals, a questionnaire was distributed to anaesthesiology personnel of different educational levels in the hospitals of southern Islamic Republic of Iran. Chi-squared significance, Fisher exact and Spearman rho correlation coefficient tests were used to analyse the responses. The results suggest that measures to prevent infection transmission during anaesthesia are inadequate in our hospitals. The implementation of adequate measures to control infection was significantly associated with respondents' beliefs as to whether anaesthesia can cause infection in anaesthesia personnel and/or patients. Increasing the knowledge base of anaesthesia personnel and raising their awareness as to the risk of infection are necessary to improve infection control procedures by anaesthesia personnel

Tuberculosis among never-jailed drug abusers

The best way to control tuberculosis in a community is active case-finding and treatment among high-risk groups. Upon admission to a correctional centre in 1997, 319 never-jailed drug addicts were enrolled in the present study. Statistically significant differences in skin-test positivity were found among males over 40 years old, those unemployed and injecting drug abusers. Among the sample, 8 cases of pulmonary tuberculosis were found. This is approximately 170 times the rate in the general population. Because of cost and time, we recommend the screening of drug addicts by mini-radiography instead of tuberculin skin test at admission