Awareness and observance of patient rights from the perspective of Iranian patients: a systematic review and meta-analysis

Background: Recipients of healthcare services have rights, which must be acknowledged and protected. Such rights include observance of acceptable patient physical, mental, spiritual, and social needs guided by commonly accepted rules and regulations. The objective of this study was to conduct a systematic review and meta-analysis of awareness rates and observance of patient rights in Iran from the perspective of the patient

Methods: In this study, various references such as Medline [PubMed], Scopus, Scientific Information Database [SID], Google scholar, Magiran, and IranMedex were searched [from August to December 2015]. Heterogeneity was assessed using the Q statistic. English and Persian search keywords and combinations included terms such as "patient bill of rights, patient rights, Iranian patient bill of rights, and Persian patient rights." A meta-analysis of the primary search sources was accomplished using STATA [version 11.0]

Results: Initial review included 20 articles of which 12 assessed observance rates of patient rights and three described service awareness rates of recipients concerning their personal rights. Five articles covered both topics and had an estimated 54.2% coverage based on the results of meta-analysis and the randomeffects model with the heterogeneity

Conclusion: An Observance rate of patient bills of rights was considered somewhat adequate. However, contradictions in findings noted in this study suggest deficiencies do exist and need to be resolved. There appears a need to better describe and increase awareness rates of healthcare services by patients concerning their own bill of rights

Using queuing theory and simulation modelling to reduce waiting times in An Iranian emergency department

Background: Hospital emergencies have an essential role in health care systems. In the last decade, developed countries have paid great attention to overcrowding crisis in emergency departments. Simulation analysis of complex models for which conditions will change over time is much more effective than analytical solutions and emergency department [ED] is one of the most complex models for analysis. This study aimed to determine the number of patients who are waiting and waiting time in emergency department services in an Iranian hospital ED and to propose scenarios to reduce its queue and waiting time

Methods: This is a cross-sectional study in which simulation software [Arena, version 14] was used. The input information was extracted from the hospital database as well as through sampling. The objective was to evaluate the response variables of waiting time, number waiting and utilization of each server and test the three scenarios to improve them

Results: Running the models for 30 days revealed that a total of 4088 patients left the ED after being served and 1238 patients waited in the queue for admission in the ED bed area at end of the run [actually these patients received services out of their defined capacity]. The first scenario result in the number of beds had to be increased from 81 to179 in order that the number waiting of the "bed area" server become almost zero. The second scenario which attempted to limit hospitalization time in the ED bed area to the third quartile of the serving time distribution could decrease the number waiting to 586 patients

Conclusion: Doubling the bed capacity in the emergency department and consequently other resources and capacity appropriately can solve the problem. This includes bed capacity requirement for both critically ill and less critically ill patients. Classification of ED internal sections based on severity of illness instead of medical specialty is another solution

Relationship between family-work and work-family conflict with organizational commitment and desertion intention among nurses and paramedical staff at hospitals

Background: High turnover intention rate is one of the most common problems in healthcare organizations throughout the world. There are several factors that can potentially affect the individuals' turnover intention; they include factors such as work-family conflict, family-work conflict, and organizational commitment. The aim of this research was to determine the relationship between family-work and work-family conflicts and organizational commitment and turnover intention among nurses and paramedical staff at hospitals affiliated to Shiraz University of Medical Sciences [SUMS] and present a model using SEM

Methods: This is a questionnaire based cross-sectional study among 400 nurses and paramedical staff of hospitals affiliated to SUMS using a random-proportional [quota] sampling method. Data collection was performed using four standard questionnaires. SPSS software was used for data analysis and SmartPLS software for modeling variables

Results: Mean scores of work-family conflict and desertion intention were 2.6 and 2.77, respectively. There was a significant relationship between gender and family-work conflict [P=0.02]. Family-work conflict was significantly higher in married participants [P=0.001]. Based on the findings of this study, there was a significant positive relationship between work-family and family-work conflict [P=0.001]. Also, work-family conflict had a significant inverse relationship with organizational commitment [P=0.001]. An inverse relationship was seen between organizational commitment and turnover intentions [P=0.001]

Conclusion: Thus, regarding the prominent and preventative role of organizational commitment in employees' desertion intentions, in order to prevent negative effects of staff desertion in health sector, attempts to make policies to increase people's organizational commitment must be considered by health system managers more than ever

Iranian healthcare workers' perspective on hand hygiene: a qualitative study

Hand hygiene [HH] has been identified as one of the simplest, but most important, methods to prevent cross-infection in healthcare facilities. In spite of this fact, the HH compliance rate remains low among healthcare workers [HCWs]. Several factors may affect HH behavior. In this study, we aimed to assess various aspects of HH from the perspective of HCWs. This qualitative study was conducted in two hospital settings in Shiraz, Iran. Eight focus group discussions [FGDs] and six in-depth interview sessions were held with ICU and surgical ward nurses, attending physicians, medical and nursing students and supporting staff. Each FGD and interview was transcribed verbatim, open codes were extracted, and thematic analysis was conducted. Three themes emerged from the thematic analysis including: "the relationship between personal factors and HH compliance," "the relationship between environmental factors and HH compliance" and "the impact of the health system on HH adherence, including the role of adequate health systems, administrative obligations and the effect of surveillance systems." Several factors played a significant role in improving HCWs HH compliance, such as the regular adherence to health system tenets. HH compliance may be improved through application of realistic policies and better supervision. In addition, appropriate education may positively affect HH behavior and attitudes

Adherence to facility management and safety standards in Shiraz hospitals, Iran

Background: Evaluate the adherence to facility management and safety standards among governmental and non-governmental hospitals in Shiraz, Iran

Methods: In this cross sectional study, 22 hospitals of the 33 hospitals in Shiraz, Iran including 13 governmental and 9 non-governmental facilities were surveyed. A 74-item self-administered questionnaire was used. Collected data were entered to SPSS Version 15.0 software. The level for statistical significance was set at 0.05

Results: Adherence to facility management and safety standards was 65.17% in governmental and 72.79% in non-governmental hospitals. Compliance by governmental hospital in the areas of leadership and planning, safety and security, emergency management, medical equipment, utility system and staff education ranged from 60% to 86%. However, hazardous materials and fire safety adherence was below 50%. For non-governmental hospitals standard compliance for all areas ranged from 60% to 86%. Compliance rates between governmental and non-governmental hospitals in the areas of hazardous materials and staff education standards were statistically significantly different [p=0.02 and p=0.05 respectively]

Conclusions: To achieve more effective functional health care services, additional studies must be undertaken to assess the nature and extent of problem areas that exist in planning, implementing and monitoring of facility management and safety programs

Shiraz medical students' perceptions of their colleagues' professional behavior

Introduction: Today, development of professionalism is a critical aim of medical schools. Studies have demonstrated that medical students' perceived level of professionalism is inadequate worldwide. This study aimed to investigate the medical students' perceptions of their colleagues' professional behavior

Methods: This study is a cross-sectional study with 280 medical students at Shiraz University of Medical Sciences in their fifth to seventh year of study as the sample. The study was performed during one month in 2013, using stratified random sampling method. The instrument of the study was the Persian version of the questionnaire of the American Board of Internal Medicine [ABIM].The questionnaire includes demographic information, questions about the meaning of the professionalism, history of medical ethics education programs and 12 behavioral questions. The data were analyzed using student t-test and Pearson correlation test. The significance level was set as 0.05

Results: Forty percent of respondents did not know the meaning of professionalism. The mean +/- SD score of behavioral questions was 5.9 1 +/- 1.2 on a scale from 0 to 10. The mean +/- SD score of excellence questions was 4.94 +/- 1.7. It was 7.05 +/- 1.9 for 'honor/integrity', and 6.07 +/- 2.1 for 'altruism/respect' questions. There was a significant association between gender and excellence score [p=0.007]

Conclusion: Medical students assessed their colleagues' professional behavior as poor. They did not have proper information about professionalism. Medical students are future general practitioners and respecting medical ethics by them is very important in a perfect health system. Universities should emphasize the importance of teaching professionalism to medical students and faculty members, using innovative education methods

The geographical clusters of gastrointestinal tract cancer in Fars province, southern Iran

Background: Gastrointestinal tract cancer [GI.C] is one of the common cancers in world-wide. The incidence rate of it is different in various geographical regions. This study was performed to assess spatial clusters of the occurrence of GI.C in Fars Province

Methods: In this cross sectional study, the new cases were 4569 cases from 2001 to 2009. The crude incidence rates were standardized based on world population for both sexes. The spatial analysis was conducted using the geographical information systems. We used the local Indicators of spatial association measure, in order to identify local spatial clusters

Results: From a total of the new cases, 62.8% cases were male. The most common GI.Cs were stomach and colorectal cancer in men and women respectively. The significant cluster patterns were discovered from 2002 to 2007. The common type of spatial clustering was a high-high cluster, that to indicate from North-west to South-east of Fars Province

Conclusions: Analysis of the geographical distribution of GI.C will provide opportunities for policymakers for applying preventive measures. Furthermore, it could be helpful for researchers for future epidemiological studies for investigation of etiological agents in regions with significant spatial clustering of high incidence of cancer

Spatial prevalence of intellectual disability and related socio-demographic factors in Iran, using GWR: case study [2006]

Although intellectual disability [ID] is a common disability in Iran, there is no investigation on the spatial distribution pattern of these patients in national level and the spatial maps for recognition the areas with higher prevalence of IDs and local neighborhoods of these regions or effect of socio-demographic factor on this scattering is not still available. This proposition motivated us to assess the population with ID in our country. In a cross-sectional study, we applied Moran's Index [Moran's I] which includes information about the strength of the neighboring association between counties, as global univariate distribution assessment. A geographically weighted regression was used to explore relation between ID patient's prevalence and some socio-demographic factors [migration and illiteracy rate, physician number [PN]/10,000 people and health-care centers [HCCs]/10,000 people]. We found that spatial clusters of ID patients exist among Iran counties [Moran's I = 0.36, P < 0.01] and in a rural area population groups [Moran's I = 0.20,P < 0.01]. Further, we detected spatial associations between ID patients and all of our investigated socio-demographic factors in national scale. In rural areas, illiteracy has high association with ID especially in the south region of Iran. Urban area has random pattern of ID patients both within and between the Iran counties [Moran's I = 0.01, P > 0.3]. According to the results, our Initial hypothesis about the existence of spatial clusters in distribution of people with ID in Iran was proven. Spatial autocorrelation between migration and illiteracy rate and prevalence of patients with ID was shown and was in agreement with our hypothesis. However, our supposition that the prevalence should have inverse relationship with PN and HCC was rejected

qualitative study of the causes of improper segregation of infectious waste at Nemazee hospital, Shiraz, Iran

Medical waste management is a major concern for healthcare facilities. One important element is the segregation of infectious waste from domestic, non-infectious waste. The aim of this qualitative study was to identify factors that negatively affect proper segregation at Nemazee Hospital, which is affiliated with Shiraz University of Medical Sciences. Study data came from focus groups involving hospital workers. Participants expressed their opinions regarding barriers to proper segregation of medical wastes. The participants gave their permission to have their comments recorded. Data analyses were based on a grounded theory approach. The results indicated that managerial weakness was an important factor in suboptimal disposal of medical waste. It appears that hospital authorities should pay better attention to educational planning, organizational resources and supervision. Together, these considerations should help reduce waste-management errors. The results also suggest that healthcare worker training needs improvement. In general, patients and their companions, as well as the local population, did not appear to have sufficient knowledge concerning disposal of infectious medical waste. Hospital authorities should conduct a broad review of medical waste management, including improved employee training. This step should have a positive effect on local health, as well as the environment. Improvement is also needed in the infection prevention performance of hospital healthcare workers. This approach should reduce additional production of infectious waste and costs associated with healthcare

Medical students' knowledge of indications for imaging modalities and cost analysis of incorrect requests, Shiraz, Iran 2011-2012

Medical imaging has a remarkable role in the practice of clinical medicine. This study intends to evaluate the knowledge of indications of five common medical imaging modalities and estimation of the imposed cost of their non-indicated requests among medical students who attend Shiraz University of Medical Sciences, Shiraz, Iran. We conducted across-sectional survey using a self-administered questionnaire to assess the knowledge of indications of a number of medical imaging modalities among 270 medical students during their externship or internship periods. Knowledge scoring was performed according to a descriptive international grade conversion [fail to excellent] using Iranian academic grading [0 to 20]. In addition, we estimated the cost for incorrect selection of those modalities according to public and private tariffs in US dollars. The participation and response rate was 200/270 [74%]. The mean knowledge score was fair for all modalities. Similar scores were excellent for X-ray, acceptable for Doppler ultrasonography, and fair for ultrasonography, CT scan and MRI. The total cost for non-indicated requests of those modalities equaled [dollar sign]104303 [public tariff] and [dollar sign]205581 [private tariff]. Medical students at Shiraz University of Medical Sciences lacked favorable knowledge about indications for common medical imaging modalities. The results of this study have shown a significant cost for non-indicated requests of medical imaging. Of note, the present radiology curriculum is in need of a major revision with regards to evidence-based radiology and health economy concerns

Cost-utility analysis of neonatal screening program, shiraz university of medical sciences, shiraz, Iran, 2010

The most important cause of infant mortality during the first month of life is related to congenital abnormalities. Nevertheless, timely diagnosis of these diseases can reduce the severity of their effects. The present study aimed to investigate the cost-effectiveness of the neonatal screening program in Pars Province, Iran. In this study, costs of executing the screening programs, treatment of the diagnosed cases, treatment of affected, non-screened individuals, quality of life, and incremental cost-effectiveness ratios were measured in two study groups. Performing the screening programs for phenylketonuria, congenital hypothyroidism, galactosemia, and favism resulted in respectively $3386, $13078, $19641, and $1088 saving per patient. Overall, the study results revealed the cost-effectiveness of execution of the neonatal screening program. Neonatal screening program is one of the health interventions which lead to long-term beneficial outcome for the patients, financial saving for the society, and improvement of the patients' quantity as well as quality of life

Incidence of nosocomial infections in a big university affiliated hospital in Shiraz, Iran: a six-month experience

Nosocomial infections [NIs] are one of the most important health issues, particularly in developing countries, because these infections cause high mortality and morbidity, and economic and human resource loss as a consequence. To date, most surveillance studies have been conducted in developed countries, and only a few have been performed in Iran. All of the few Iranian studies have been performed using paper-based collection forms, and none was conducted with the aid of an electronic patient data retrieving and collecting tool. The aim of this study is to determine the incidence of NIs in a big university hospital of Shiraz, with the help of specifically programmed surveillance software merging electronically the available patient data and the infection results input manually. The study was conducted prospectively through 6 months from 21[st] March up to 22[nd] September 2006, in a 374-bedded educational hospital. All patients admitted during this period were included in the study and examined everyday for detecting four types of NIs: surgical site infection [SSI], urinary tract infection [UTI], pneumonia [PNEU], and blood stream infection [BSI]. Centres for Disease Control and Prevention National Nosocomial Infection Surveillance system criteria were applied. 4013 patients were admitted in the hospital. The overall infection rate was 4.14, and UTI, SSI, BSI, and PNEU rates were 1.82, 1.22, 0.5, and 0.5, respectively, per 1000 patient days of admission. The results of this study showed that the frequency of NI in the investigated hospital was not higher than in many other reported surveillance results from other countries. This, however, might be a bias as the administration of antibiotics was very high in this study and the quality of microbiological investigation might have influenced significantly, resulting in more false-negative results than expected. Overall, the use of the Iranian National Nosocomial Infection Surveillance System Software proved to be useful and allowed both rapid data collection and detailed data analysis

Knowledge, attitudes, and practices regarding pandemic H1N1 influenza among medical and dental residents and fellowships in Shiraz, Iran

Influenza disease is one of the oldest medical problems that can cause severe illness and high mortality rates, worldwide. In flu pandemics, medical and dental students' knowledge, attitudes, and practices [KAP] is critical to save patientslife.The aim of this study was to determine the score of KAP toward the Pandemic H1N1 and their predictor factors among the medical and dental residents and fellowships of Shiraz University of Medical Sciences, Iran. In 2009, 125 participants were recruited in a convenient sampling cross-sectional survey. Self-reported questionnaire were used and results were analyzed applying appropriate statistical tests. The mean score of participants' knowledge, attitude and practice were 22.6, 21.1 and 26.5 respectively. Participants practice had significant linear positive correlation with knowledge and attitude. Also, their age was significantly and directly correlated to knowledge and practice. The educational major, age, and sex were significant predictors of responder's knowledge score and age was the only significant predictor of both attitude and practice scores. High knowledge is not sufficient lonely for improve attitude and practices. It seems that traditional educational models are not efficient and governments should emphasize to advanced and motivational education methods including health belief model and motivational interview at postgraduate levels. Perhaps younger students, dentists and males have less motivation to change their attitude and behavior, so we can focuses our interventions in these groups

Are the pPredictors of hookah smoking different from those of cigarette smoking? report of a population-based study in Shiraz, Iran, 2010

The aim of this study was to determine the prevalence of tobacco use and effect of lifestyle factors on cigarette and hookah use among adult re sidents of Shiraz, Iran. In 2010, 1,000 participants were recruited in a multistage, random sampling cross-sectional population-based survey. Response rate was 98%. Prevalence of cigarette smoking was 9.7%. Among cigarette users, 12.6% reported smoking <1 year; 13.4% smoked 1-2 years and 73.9% smoked>2 years. Almost half of those surveyed [48.9%] smoked <10 cigarettes per day [cpd]; 28.4% smoked 10-15 cpd; 14.8% smoked 16-19 cpd, and 8%>20 cpd. Almost a quarter [20.4%] of the cigarette smokers tried to quit in the past year. Being male, married, aged 37-54, having higher perceived levels of stress, a non-manual occupation, and sedentary lifestyle were positively associated with cigarette smoking. Manual labor occupations, housewife/jobless status, and going frequently to restaurants were positive predictors of hookah smoking. Compared to cigarettes, hookah smoking was more prevalent among Iranian adults. Prevalence of hookah smoking in women approximated that of men, whereas cigarette use was 31 times more common in men. Cigarette and hookah smoking were associated with less healthy lifestyle habits in both men and women

spatial distribution of cancer incidence in Fars province: a GIS-based analysis of cancer registry data

Cancer is a major health problem in the developing countries. Variations of its incidence rate among geographical areas are due to various contributing factors. This study was performed to assess the spatial patterns of cancer incidence in the Fars Province, based on cancer registry data and to determine geographical clusters. In this cross sectional study, the new cases of cancer were recorded from 2001 to 2009. Crude incidence rate was estimated based on age groups and sex in the counties of the Fars Province. Age standardized incidence rates [ASR] per 100,000 was calculated in each year. Spatial autocorrelation analysis was performed in measuring the geographic patterns and clusters using geographic information system [GIS]. Also, comparisons were made between ASRs in each county. A total of 28, 411 new cases were diagnosed with cancer during 2001-2009 in the Fars Province, 55.5% of which were men. The average age was 61.6 +/- 0.5 years. The highest ASR was observed in Shiraz, which is the largest county in Fars. The Moran's Index of cancer was significantly clustered in 2004, 2005, and 2006 in total, men, and women. The type of spatial clustering was high-high cluster, that to indicate from north-west to south-east of Fars Province. Analysis of the spatial distribution of cancer shows significant differences from year to year and between different areas. However, a clear spatial autocorrelation is observed, which can be of great interest and importance to researchers for future epidemiological studies, and to policymakers for applying preventive measures

Comparing tobacco use knowledge, attitudes and practices between engineering students at a public and islamic Azad university in Shiraz, Iran 2011

To compare the level of knowledge, the attitudes, and practices with regards to tobacco use between Iranian students at a public [PBU] and Islamic Azad [IAU] university. A cross-sectional design was used in this study. As the number of students at the IAU were three times greater than that of the PBU, we selected 150 students from the PBU and 450 students from the IAU using simple random sampling. A 57-item survey instrument was utilized for this study. The collected data were recorded by SPSS version 15 software and then it underwent statistical analysis using descriptive statistics and ANOVA to compare the difference between means of knowledge, attitude and practice scores. Logistic regression analysis was conducted to identify variables that have an independent association with students smoking and to describe possible variations in these relationships. The P value level for statistical significance was set at 0.05. From participants, 46.8% were females, 10% of 327 students reported being daily smokers; of these, 84% were from the IAU. Totally, among the 107 smokers, 61 [57%] and 29 [27.1%] were water pipe and cigarettes smokers, respectively. Ninety three IAU students [21.7%] and 30 PBU students [20.7%] reported smoking during the past 30 days. The mean of the knowledge items between the students of IAU was lower than PBU students. Female gender, smoking in the home, and allowing visitors to smoke in the home were significant predictors of smoking in the past 30 days in PBU, respectively. In IAU, female gender, smoking by friends, and health status were predictors for smoking in the past 30 days. Future studies should assess the factors affecting smoking initiation, as well as effective techniques for the prevention of smoking initiation and substance abuse in Iranian adolescents and young adults

Knowledge and practice of medical students on healthy lifestyle: a cross-sectional study in Shiraz

Background: Physicians are one of the most important groups directly associated with public health and their health related lifestyle has a significant impact on their patient's behaviors. Several studies showed that the majority of medical students did not have appropriate and healthy behaviors. The aim of this study was to determine the prevalence of risky lifestyle knowledge and behaviors among Shiraz medical students

Methods: This cross-sectional survey was conducted in 2011. Using a stratified random sampling method, 400 medical students were selected to fill in the questionnaires. The questionnaire contained 33 questions including demographic data, healthy lifestyle knowledge and behavior [including physical activity, fruit and vegetable consumption, water drinking, etc], perception of stress and student's health information resource. The association between demographic factors and participants' knowledge, practice and stress score was determined. The correlation between the participants' knowledge and behavior scores was calculated

Results: The mean knowledge and attitude scores were 2.8 and 3.6, respectively. In 40% of knowledge and 80% of practice questions, the percentage of the correct answer was below 50%. There was a significant correlation between the participants' knowledge and behavior scores [P<0.05]

Conclusion: This study raises the voice of concern with medical students' knowledge and behavior on healthy lifestyle measures. There is a need for re-thinking, planning and reviewing these concepts of pure reason which is essential in their future professional career. Health considerations, health surveillance and care systems which are based on evidence, reasonability and rationality still have to be paramount

Study of antibiotics self-medication at primary Health Care Centers in Shiraz, Southern Iran

Background: Nowadays, self-medication of therapeutic agents is of global concern particularly in developing and underdeveloped countries. Some studies conducted in Iran showed that the frequency of self-medication was significant

Objective: This research was conducted to estimate the prevalence of arbitrary use of antibiotics in Shiraz community with special interest in its determinant factors

Methods: This cross-sectional study was conducted in Shiraz, in 2009. Approximately 710 out of all patients referred to all health care centers in Shiraz were selected to fill out a questionnaire containing 23 questions divided into two parts. The frequency of self-medication according to demographic factors was described and the association between independent variables and self-medication was analyzed

Results: The frequency of self-medication in this study was 44.5% and the request to prescribe antibiotics by the patients was 53.5%. Amoxicillin was the most widely used drug by the participants. There was a significant association between age and gender with self-medication. The frequent cause for self-medication was common cold. Approximately, 74.4% of the participants reported their previous experience as the main reason for self-medication

Conclusion: The results of this survey demonstrated the high frequency of self-medication in Shiraz. Socio-cultural determinants are the etiologic factors for self-medication. Policy makers are recommended to provide community-wide educational programs to make people aware about the adverse effects of self-medication. There was a significant association between age, gender and education with self-medication and governments could pay more attention to these factors for designing the interventional programs

Irrational antibiotic use among secondary school teachers and university faculty members in Shiraz, Iran

The main aim of this study was to assess knowledge, attitude, and practice of university faculty members and high school teachers regarding irrational antibiotic use and self-medication. In this cross-sectional survey, 320 university teaching staff and 150 high school teachers received a questionnaire that assessed their knowledge, attitude, and practice regarding the use of antibiotics and self-medication. The reliability of the questionnaire was assessed with Cronbach's alpha internal consistency coefficient and the results were analyzed with the Mann-Whitney U test. Spearman's correlation coefficient was used to determine the correlation between knowledge, attitude, and practice. The questionnaires were completed by 134 university faculty members and 308 high school teachers, among whom 35.8% and 47.1%, respectively, reported self-medication with antibiotics during the previous year, mostly to relieve sore throat. High school teachers were significantly better than university teaching staff in their knowledge about the effects of antibiotics and in their usage practices. In both the groups, a weak direct linear relationship was detected between attitude and practice [r=0.243, r=0.238, P<0.01] and a weak inverse linear relationship was seen between knowledge and practice [P=0.22] in the high school teacher group. Our results showed that self-medication and the irrational use of antibiotics were common among highly educated people in a community population sample in Shiraz, Iran. The rational use of antibiotics may be favored by improving knowledge about these drugs

Point prevalence and risk factors of hospital acquired infections in a cluster of university-affiliated hospitals in Shiraz, Iran

Hospital-acquired infections [HAIs] are critical and mostly preventable complications that occur in hospitalized patients and lead to major health and economic burdens. Most of the information on HAI risk factors and the recommended preventive measures is based on data acquired from only a few countries. The aim of this point prevalence HAI study conducted in Shiraz, Iran, was to study the local epidemiology of HAIs and the major risk factors for acquiring HAIs in a Middle-Eastern region. The study employed four identical point prevalence surveys in eight university hospitals, each consisting of 60-700 beds. The study was conducted during all four season of 2008-2009. All of the patients admitted for >/= 48 h were studied, although the patients admitted to emergency wards were excluded. A standardized data collection form that included name, age, gender, presence or absence of HAI, administration of any antibiotics, insertion of a central line, use of an endotracheal tube, mechanical ventilation, and use of an urinary catheter was completed for each patient. The HAI definitions used in this study were based on the US National Nosocomial Infection Surveillance [NNIS] guidelines. Data from 3450 patients were prospectively collected and analyzed. The overall HAI prevalence was 9.4%. The most common HAIs were blood stream infections [2.5%], surgical site infections [2.4%], urinary tract infections [1.4%], and pneumonia [1.3%]. A logistic regression analysis showed that the odds ratio OR for males rather than females acquiring infections was 1.56 [95% confidence interval [CI] 1.21-2.02]. Other HAI risk factors included using a central intravascular catheter, adjusted OR of 3.86 [95% CI 2.38-6.26], and using an urinary catheter, adjusted OR of 3.06 [95% CI 2.19-4.28]. Being admitted to an ICU was not an independent HAI risk factor. For all HAIs, the OR of acquiring infection was 3.24 [95% CI 2.34-4.47] in the patients with hospital stays longer than eight days. A high discrepancy between HAIs and antibiotic use was observed. Antibiotics were administered to 71% of the patients, but only 9.4% of the patients also had at least one documented infection. This point prevalence study showed that HAIs are frequent in Shiraz university hospitals, and that the proportion of patients receiving antibiotics is high. The results imply that more primary prevention efforts are necessary to address HAIs associated with using indwelling devices and to prevent surgical site infections