Systematic review and meta-analysis of hospital acquired infections rate in a middle east country (1995-2020).

Background: Hospital-acquired infections (HAIs) are a global problem in hospitals and significant causes of mortality and morbidity regardless of advances in supportive care, antimicrobial therapy and prevention. The study aimed to determine a comprehensive estimate of the HAIs prevalence, influential factors, and types of these infections in Iran. Methods: A systematic literature review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines using the online databases; Medline, EMBASE, Scopus, Cochrane, SID, Magiran, and Medlib from January 1995 to September 2020 using a combination of medical subject heading terms ('Nosocomial infection [Mesh] OR '' Hospital infection [Mesh] OR Hospital Acquired Infection[Mesh] OR Healthcare-associated infection ''AND ('Iran' [Mesh]) among observational and interventional studies. SPSS version 25 and STATA version 11 were used for data analysis. Results: A total of 66 (cross-sectional, cohort, and case-control) observational studies were identified. More of the studies had been done before 2014(43 papers or 65%). Based on the random-effects model, the overall prevalence of HAIs in Iran was 0.111 [95% CI: 0.105 - 0.116] with a high, statistically significant heterogeneity (I2= 99.9%). The infection rate was 0.157 and 0.089 before and after the Iranian Health Transformation Plan (HTP), respectively. HAIs rates reported more in the South and West of Iran rather than other regions (0.231 and 0.164) (p= 0.001). Escherichia coli and klebsiella infections were reported in 53 and 52 papers (0.239 and 0.180, respectively). In addition, respiratory and urinary infections were reported 0.296 and 0.286 in 51 and 38 papers, respectively. Conclusion: The prevalence of HAIs in Iran is relatively high. Preventing and decreasing hospital nosocomial infections can considerably affect reducing mortality and health-related costs. This should be taken into consideration by health policymakers for pathology and revision of some previous programs and standards as well as the development of appropriate and evidence-based control and education programs to reduce this health problem.

A Systematic Review and Meta-analysis of the Medical Error Rate in Iran: 2005-2019.

BACKGROUND AND OBJECTIVES: Medical errors (MEs) are one of the main factors affecting the quality of hospital services and reducing patient safety in health care systems, especially in developing countries. The aim of this study was to determine the rate of ME in Iran. METHODS: This is a systematic literature review and meta-analysis of extracted data. The databases MEDLINE, EMBASE, Scopus, Cochrane, SID, Magiran, and Medlib were searched in Persian and English, using a combination of medical subject heading terms ("Medical Error" [Mesh] OR "Medication error" [Mesh] OR "Hospital Error" AND ("Iran" [Mesh]) for observational and interventional studies that reported ME rate in Iran from January 1995 to April 2019. We followed the STROBE checklist for the purpose of this review. RESULTS: The search yielded a total of 435 records, of which 74 articles were included in the systematic review. The rate of MEs in Iran was determined as 0.35%. The rates of errors among physicians and nurses were 31% and 37%, respectively. The error rates during the medication process, including prescription, recording, and administration, were 31%, 27%, and 35%, respectively. Also, incidence of MEs in night shifts was higher than in any other shift (odds ratio [OR] = 38%; 95% confidence interval [CI]: 31%-45%). Moreover, newer nurses were responsible for more errors within hospitals than other nurses (OR = 57%; 95% CI: 41%-80%). The rate of reported error after the Health Transformation Plan was higher than before the Health Transformation Plan (OR = 40%; CI: 33%-49% vs OR = 30%; CI: 25%-35%). CONCLUSION: This systematic review has demonstrated the high ME rate in Iranian hospitals. Based on the error rate attributed solely to night shifts, more attention to the holistic treatment process is required. Errors can be decreased through a variety of strategies, such as training clinical and support staff regarding safe practices and updating and adapting systems and technologies.

The economic burden of tuberculosis in Sistan: a high-risk region in Iran.

INTRODUCTION: To estimate the economic burden of tuberculosis treatment in Sistan, the region with the highest number of tuberculosis cases in Iran. METHODS: All patients with smear-positive pulmonary tuberculosis who had contracted tuberculosis in 2018 and successfully completed their treatment were interviewed. RESULTS: Ninety patients with a mean age of 57 ± 18 years were interviewed. Most of them were women (58%), housewives (57%) and resided in rural areas (84%). The mean cost of treatment for tuberculosis was estimated as 6800 USD per patient. Direct costs were 87% of the total cost. Twenty-two patients lost an average income of 530 USD (8514590 rials) during treatment. The results showed the significant correlation of direct and indirect costs with sex, age, place of residence and education (P < 0.05). CONCLUSION: It appears essential to improve social protection and implement interventions to promote knowledge in rural areas.

Sources of news as a necessity for improving community health literacy about COVID-19.

Background: In the 21st century, the world has become a global village and a disease outbreak in one part of the world can spread rapidly to other countries far away. Methods: The emergence of the new Coronavirus (COVID-19) in China in January 2020 and its growing level of spread and severity between and within other countries as well as different continents has become a global emergency. Moreover, low health literacy results in more problems and continuation of the outbreak. Consequently, COVID-19 pandemic may produce new debates, discussions, and disturbing developments every day. In the meantime, cyberspace plays an important role in this case. Results: Improving people's health literacy can lead to increased potential of patients to make informed decisions, reduce health risks, increase disease prevention, and improve quality of life. Conclusion: The experience during COVID-19 pandemic has shown that health literacy plays an important role in preventing and controlling diseases and pandemic.

Economic cost of diabetes in the Eastern Mediterranean region countries: A meta-analysis.

BACKGROUND AND AIMS: Non communicable diseases including diabetes imposes substantial financial burden on households, societies and nations in both developed and developing countries. However, there is no information on the extent of diabetes expenditure in the Eastern Mediterranean Region (EMRO). Therefore, this study aimed to identify the treatment costs of diabetes in this area. To our knowledge, this is the first systematic review on treatment expenditures of diabetes in EMRO countries. METHODS: A comprehensive literature search was conducted in PUBMED, MEDLINE, EMBASE, SCOPUS and WEB OF SCIENCES databases to find out published manuscripts on treatment cost of diabetes. Information was extracted using data extraction sheets and then the data were imported into STATA software version.11. Mean annual treatment cost of diabetes per patient, annual treatment costs of diabetes per patient by Diabetes Mellitus (DM) complications and finally, cost of chronic diabetes complications per patient were pooled and reported. RESULTS: After reviewing title, abstract and the full text of identified articles; a total of seven studies were reported appropriate data for this meta-analysis. The pooled annual treatment cost per diabetes patient for EMRO countries was 1150 US$ (95% CI: 595-2221) which was 3358 US$ (95% CI: 2200-5124) in EMRO countries except of Iran compared to 255 US$ (92-708) in Iran. The treatment cost of diabetes was higher in males, insulin-used and in the patient with family history of diabetes. The cost of diabetes was significantly increased with the duration of diabetes (P = 0.001) as well. According to the results, the largest share of costs is related to medication costs. Finally, the pooled average annual treatment cost per patient by diabetes mellitus complications was varied from 2828 US$ in the patients that have cerebrovascular disease complication to 7261 US$ in the patients with Stroke complication. CONCLUSIONS: This study demonstrated that the annual treatment cost of diabetes is varied within EMRO countries. Qatar and Iran have spent the highest and lowest cost for diabetes, respectively. This may be due to the large socioeconomic differences between countries and special conditions of them such as currency value in the region.

Household financial contribution to the health system after Iran's Health Transformation Plan.

INTRODUCTION: Iran's Health Transformation Plan (HTP) was implemented in 2014 to decrease household expenditures. The present study seeks to measure the household financial contribution to healthcare expenditures in Sistan-Baluchistan Province after the implementation of HTP. METHODS: A household survey was conducted in 2017 in Sistan-Baluchistan Province. The province is the most remote and poorest in the country and this poverty has extended to most of its main health indicators as well. About 2400 households were selected as the study samples using multistage sampling. Data were collected using the World Health Survey questionnaire. The questionnaire was designed by WHO in 2003 for assessing health system performance. Two main indicators of equity in health were measured: the percentage of households facing catastrophic health expenditure (CHE) and the Fair Financial Contribution Index (FFCI). The multiple adjusted logistic regression model was used to study the likelihood of facing CHE and to calculate the adjusted odds ratios (OR) using the model coefficients. Data were then analyzed the Statistical Package for the Social Sciences. RESULTS: The results showed that 484 (20.2%) of the households faced CHE after implementation of the HTP. The FFCI was approximately 0.7 across the province. Statistically significant relationships were observed between the chances of facing CHE and variables including place of residence (p=0.010), having members aged more than 65 years (p=0.005) and having members with disabilities and in need of care (p=0.001). There were statistically significant relationships between the chance of facing CHE and variables related to the use of health services, including the use of dental (OR=5.212), rehabilitation (OR=2.471), diagnostic and laboratory (OR=3.637), and inpatient (OR=2.511) services. CONCLUSION: Despite the implementation of HTP, a high percentage of the households faced CHE. The authorities should pay more attention to low-income and remote regions of the country; in addition, the HTP should financially cover outpatient healthcare services in an adequate manner.

Factors affecting mortality in burn patients in the poorest region of Iran; a case control study.

BACKGROUND: Burns is one of the most important health issues as well as the most expensive injuries that take place at all ages. It also considers a disaster for society, family, and person. The aim of the study was to examining fatal burns and associated factors' in burn unit patients in Iran. METHODS: a case-control study was carried out in the poorest region of Iran. The research population consisted of all patients in a burn unit in Zahedan public hospital during 2013-2018. Using systematic random sampling method, 430 persons (215 dead persons, 215 released persons) were entered into the study. The data form and SPSS software were used for data gathering and the data analyzing, respectively. RESULTS: about 41.4% of dead patients were at the age of 25-44 and 60.5% of dead patients were women. Also, 96.3% of expired patients were on level 3 burns. The cause of the burns in 46% of death was flame, oil, and gasoline. Moreover, there is a significant relationship between burns and the age, gender, residence place, history of the previous disease, the cause of burns, burns percentage and the burn level in both case and control group. CONCLUSION: in the poorest region of Iran, younger (as the labor force) and women were at high risk of death due to burn. Developing gas infrastructures in this region could decrease the incidence and severity of burns.

A Comparison of Mothers' Quality of Life after Normal Vaginal, Cesarean, and Water Birth Deliveries.

BACKGROUND: Assessment of quality of life (QOL) is of paramount importance for improving postpartum QOL which will in turn enhance QOL of mothers, children, individuals, and the community. The present study aimed to evaluate and compare postpartum QOL after Cesarean Section (CS), Normal Vaginal Delivery (NVD), and water birth delivery. METHODS: This descriptive analytical, cross-sectional study was conducted on postpartum women referred to urban health centers and two public hospitals in 2012-13 in Shiraz, Iran. Overall, 59 women with NVD, 39 with CS, and 39 with water birth, all at 2 months postpartum, were recruited into the study through multi-stage sampling. Postpartum QOL was measured using Short Form Health Survey (SF-36) which hadbeen adapted previously in Iran. Then, the data were analyzed using descriptive statistics and one-way analysis of variance (ANOVA) in SPSS, version 18. RESULTS: The results showed that the NVD group had the highest mean score in physical health domains; the women with water birth had the highest mean score in mental health domains and total QOL. Regarding postpartum QOL the results of one-way ANOVA showed no statistically significant differences between the three modes of delivery. CONCLUSION: Women with water birth and NVD had the highest and second highest total QOL mean scores, respectively; women with NVD and water birth experienced better physical health. Thus, providing more information to pregnant women to encourage them to use NVD and water birth is suggested.

Barriers to implementation of evidence based practice in zahedan teaching hospitals, iran, 2014.

This study aimed to determine the barriers to implementation of EBP among nurses. This cross-sectional study was conducted in Zahedan City, South East of Iran, in 2014. The questionnaire of barriers to implementation of EBP consists of 27 statements which was distributed among 280 nurses. More than half of the participants agreed that 56% and 57% of barriers to implementation of evidence based practice are related to organizational and individual aspects, respectively. Participants identified barriers at organizational level included the lack of human resources (78.3%), lack of internet access at work (72.2%), and heavy workload (70.0%). Barrier at individual level included lack of time to read literature (83.7%), lack of ability to work with computer (68.8%), and insufficient proficiency in English language (62.0%). Age, educational level, job experience, and employment status were associated with organizational barriers to implementation of EBP. At the individual level only education was associated with barriers to implementation of EBP. Barriers to implementation of EBP occur at both individual and organizational levels. The indicator of quality in nursing practice is EBP. Hence, familiarity with EBP is recommended for Iranian nurses. In addition, knowledge of barriers will help health care system and policy makers to provide a culture of EBP.

Medical Errors and Barriers to Reporting in Ten Hospitals in Southern Iran.

BACKGROUND: International research shows that medical errors (MEs) are a major threat to patient safety. The present study aimed to describe MEs and barriers to reporting them in Shiraz public hospitals, Iran. METHODS: A cross-sectional, retrospective study was conducted in 10 Shiraz public hospitals in the south of Iran, 2013. Using the standardised checklist of Shiraz University of Medical Sciences (referred to the Clinical Governance Department and recorded documentations) and Uribe questionnaire, we gathered the data in the hospitals. RESULTS: A total of 4379 MEs were recorded in 10 hospitals. The highest frequency (27.1%) was related to systematic errors. Besides, most of the errors had occurred in the largest hospital (54.9%), internal wards (36.3%), and morning shifts (55.0%). The results revealed a significant association between the MEs and wards and hospitals (p < 0.001). Moreover, individual and organisational factors were the barriers to reporting ME in the studied hospitals. Also, a significant correlation was observed between the ME reporting barriers and the participants' job experiences (p < 0.001). CONCLUSION: The medical errors were highly frequent in the studied hospitals especially in the larger hospitals, morning shift and in the nursing practice. Moreover, individual and organisational factors were considered as the barriers to reporting MEs.

Prescribing errors in two ICU wards in a large teaching hospital in Iran.

BACKGROUND: Despite efforts to improve the patients' safety, medical errors especially prescription errors can lead to morbidity and mortality in patients. The present study was conducted to assess the prescription errors in the intensive care units (ICU) in Shiraz, Southwest of Iran. METHODS: We reviewed the all recorded orders in the two ICU wards of the Shiraz largest hospital in the south of Iran. Data were collected from the two wards and hospital archive using a structured checklist. Descriptive statistics, Chi-square and logistic regression tests were used to analyze the data. RESULTS: Among the 2230 recorded prescriptions for 40 hospitalized patients, 387 prescribed orders (251 in the General ICU and 136 in the Central ICU) had at least one error which occurred in the three months of the study. The study revealed that illegible orders have the highest error frequency in the two wards. The mean prescription error in the two ICU wards was 17.3 (0.19 errors in the General and 0.14 errors in The Central ICU, respectively). Lack of drug dosage was more than that in the larger wards (P = 0.037); moreover, illegible order and mistaken dosage were more in smaller wards (OR 1.84, CI = 1.18-2.86 and OR 2.55, CI = 1.08-6.00, P = 0.007 and P = 0.031, respectively). CONCLUSION: The rate of prescription errors in ICU wards was high and it was higher in crowded wards. Illegible orders were the majority of important errors in prescriptions. In the majority of orders, physicians did not write the drug form and drug dose which could be potentially harmful to patients. It is recommended that a computerized physician order should be used because it can decrease prescription errors.