The management of dental waste in dental offices and clinics in Shiraz, Southern Iran.

BACKGROUND: Dental waste can be hazardous to humans and the environment. OBJECTIVE: To determine the current status of dental waste management in private and public dental clinics and private dental offices in Shiraz, southern Iran. METHODS: This cross-sectional study was conducted at the Shiraz University of Medical Sciences from February through June 2013. A stratified random sampling method was used to study 86 private offices, 14 private clinics and 10 public clinics. Types of waste studied included mercury and amalgam, lead foil packets, sharps, infectious tissues and fluids, pharmaceuticals and domestic waste materials. Compliance with established standards by the monitored dental offices and clinics and public clinics were compared. RESULTS: 89.1% of dental offices and clinics disposed their infectious waste with domestic waste. Only 60% of centers used standard method for sharps disposal. None of the dental centers disposed their pharmaceutical waste and x-ray fixer waste by standard methods. Less than 10% of centers recycled the amalgam and lead foil pockets waste to the manufacture. CONCLUSION: Government agencies should establish monitoring programs for all dental offices and clinics to identify noncompliant activity and enforce recommended regulations.

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.

Infectious diseases in Iran: a bird's eye view.

Thanks to improved health standards in Iran over the past three decades, we have witnessed a shift in the causes of death in Iran from infectious causes to non-communicable diseases-mainly cardiovascular disorders, cancers, and road traffic injuries. The incidence and prevalence of many infectious diseases, such as many parasitic infections, have fallen significantly; there have been no reported cases of dracunculiasis in Iran since the mid-1970s. Great strides have also been made towards the elimination of schistosomiasis in Iran. However, we still have some problems with cutaneous leishmaniasis, hepatitis C, human immunodeficiency virus, tuberculosis, infections among immunocompromised hosts, hospital-acquired infections, and antibiotic-resistant bacterial strains. We need to emphasize improvements in sanitation, good clinical practice, and education about the rational administration of antibiotics.

Second Generation of HIV Surveillance System: A Pattern for Iran.

BACKGROUND: 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. METHODS: 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. RESULTS: The model was approved obtaining the final score of 36.3 out of 44, viz 82.5%. CONCLUSION: 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.

Vancomycin-Resistant Entrococci colonization in chronic hemodialysis patients and its risk factors in southern Iran (2005-2006).

BACKGROUND: Vancomycin-resistant enterococci (VRE) recently have emerged as a nosocomial pathogen among dialysis patients. This study aims to appraise the prevalence, incidence density and risk factors for VRE colonization among these patients. METHODS: In this prospective study, 782 stool or rectal swab specimens were collected from 250 chronic hemodialysis patients with an interval of at least one month. To identify the risk factors of VRE colonization, demographic and health data of VRE+ and VRE- patients were compared. RESULTS: VRE colonization was detected in 55 (22%) patients during study. Incidence density of one case per 79.6 patient-month of follow up was estimated.The only significant difference between the data collected from VRE+ and VRE- patients was observed in antibiotic consumption (P<0.001). CONCLUSION: VRE colonization is relatively high and rapidly spreading among chronic dialysis patients. It is strongly associated with recently antibiotic consumption.

Facilitators for influenza vaccination uptake in nurses at the Shiraz University of Medical Sciences.

OBJECTIVE: Influenza is an important cause of morbidity and mortality. The aim of this study was to identify facilitators for vaccination in nursing staff at the Shiraz University of Medical Sciences. DESIGN: Cross-sectional study. METHOD: A self-administered questionnaire was distributed among nurses between November 2005 and February 2006. RESULTS: The response rate was 100%. Sixty-one percent (89/145) of nurses reported that they had continued working while sick with an influenza-like illness, and 21% (35/166) of nurses had been vaccinated for the current season. The most common reasons given for uptake of the current influenza vaccine were the belief that they were at risk of influenza due to the nature of their work (80%, 28/35), and concern about transmitting influenza to their patients (31%, 11/35). Vaccinated nurses were 3.4 times more likely [95% confidence interval (CI) 1.0-11.7; P = 0.05] to have the intention to be vaccinated next season than unvaccinated nurses. Respondents who intended to be vaccinated next season were 10.3 times more likely (95% CI 4.4-23.2; P = 0.000) to recommend the vaccine to their family and coworkers, and 4.6 times more likely (95% CI 1.9-11.0; P = 0.001) to recommend vaccination to their patients. CONCLUSION: Free of charge and widely available vaccination programmes, and the belief that nurses are at risk of influenza due to the nature of their work improve vaccination uptake among nurses, and thereby reduce the risk of healthcare-associated infection in susceptible patient populations.

Quality of life and toxicity in breast cancer patients using adjuvant TAC (docetaxel, doxorubicin, cyclophosphamide), in comparison with FAC (doxorubicin, cyclophosphamide, 5-fluorouracil).

OBJECTIVES: The aim of this study was to compare two regimens of chemotherapy in patients with breast cancer, including FAC (doxorubicin, cyclophosphamide, and 5-fluorouracil) and TAC (docetaxel, doxorubicin and cyclophosphamide); and analyze the toxicity of these treatments and observe patient's health-related quality of life. METHODS: Health-related quality of life was assessed for up to 4 months (from the beginning to the end of chemotherapy cycles), using European organization and cancer treatment quality of life questionnaire (EORTC) QLQ-C30. A group of 100 patients, with node-positive breast cancer were studied in order to compare the toxicity of adjuvant therapy TAC with FAC and the subsequent effects on the patient's quality of life. RESULTS: After a 4-month follow-up of patients, our findings showed that despite having the same mean score of QOL at the start of adjuvant chemotherapy, the QOL in TAC arm was decreased more as a result of the higher range of toxicity in TAC regimen. CONCLUSION: In spite of increase in disease-free patients who received TAC regimen and increase their survival rate, there is significant toxicity and decrease in QOL in TAC protocol compare to FAC protocol. Using prophylactic granulocyte colony stimulating factor (G-CSF) along with increased education aimed at improving patient's knowledge and also the provision of a supportive group involving psychiatrics and patients that have successfully experienced the same treatment may be helpful.

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.

Economic burden of inappropriate antibiotic use for prophylactic purpose in shiraz, iran.

BACKGROUND: 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. METHODS: 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. RESULTS: 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 €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 €3,845.20) were spent for cefazoline alone. CONCLUSION: 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.

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.

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

Healthcare-associated infection in Shiraz, Iran 2004-2005.

Healthcare-associated infection (HCAI) is an important cause of morbidity and mortality. About 10% of hospitalised patients develop an HCAI. We present first point prevalence study of HCAI in Iran, examining three common HCAIs: urinary tract infection (UTI), surgical site infection (SSI) and bloodstream infection (BSI). On one day in each of the following months, May 2004, September 2004, November 2004 and March 2005, all patients hospitalised in eight participating hospitals were studied. Data collected included age, sex, ward, clinical characteristics and laboratory results using the Centers for Disease Control and Prevention (CDC) National Nosocomial Infection Surveillance (NNIS) system criteria. A total of 2667 patients was investigated. The prevalence rate of HCAI varied significantly between clinical units, ranging from 3.9% to 34.0%. The lowest rates were observed in obstetrics and gynaecology wards and the highest rates in burns wards and intensive care units. The HCAI prevalence rates found in the hospitals in Shiraz were higher than HCAI rates reported in studies from Latvia, Slovenia, France and Italy, but lower than those reported from Greece, Brazil, Saudi Arabia and other developing countries. Our findings highlight that HCAIs are of concern in Iran and that further study is needed to identify risk factors and preventive interventions.

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.

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

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

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 nonteaching hospitals as were vaccination rates among staff (hepatitis B and tetanus/diphtheria) with physicians scoring highest. Measures are needed to improve health workers' compliance.

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

Knowledge, practice and attitude towards standard isolation precautions in Iranian medical students.

Medical students are at high risk of being exposed to blood-borne pathogens. The aim of this study was to identify the levels of knowledge, attitude and practice of medical students regarding standard isolation precautions in Iran. A questionnaire was filled out by 468 medical students in their fifth to seventh year of study. Their mean knowledge, attitude and practice levels of standard isolation precautions were 6.1+/-1.5 (maximum possible score 9), 32.3+/-3.5 (out of 45), and 2.3+/-1.6 (out of 9), respectively. Statistically significant positive correlations were observed between knowledge and attitude, knowledge and practice, and practice and attitude. Ninety percent of medical students in Shiraz had received no education of standard isolation precautions, and 75% of respondents wanted more education on standard isolation precautions. Education on infection control issues should not only be focused on healthcare workers, but should also include medical students.

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.