A survey on occupational injuries and related factors among emergency patients of Mashhad teaching hospitals over a year.

BACKGROUND: Occupational injuries (OI) are a - significant source of social and economic costs. They can cause prolonged absences from work, loss of limb, and worker disability, among other negative consequences. In light of this, the present study aimed to evaluate the factors associated with OI in trauma centers affiliated with Mashhad University of Medical Sciences. METHODS: This cross-sectional study was carried out among patients admitted to the trauma ward of four teaching hospitals in Mashhad during 2019-2020. Patients' data was collected in a checklist and trauma severity was assessed based on injury severity score. The Epworth questionnaire was completed for patients. Data was analyzed by SPSS 20.0. RESULTS: Out of a total of 13660 patients who were referred to the emergency department of four hospitals of Mashhad University of Medical Sciences, 683 (5.15%) individuals suffered occupational trauma and entered the study. The mean (±SD) age and work experience of the participants were 34 (±10) and 10 (±9) respectively. Most of the participants were in the age group of 20-40 years. the most common mechanism of trauma was falling (p=0.00) and the most injury frequency was among manual working (p=0.01). There was not a significant association between trauma severity and demographic characteristics. Those who had falling or electric accidents had more severe trauma compared to other injured patients. (p=0.00) CONCLUSIONS: In general, the most burden of occupational accidents and in fact, the most serious injuries were related to men and manual workers. Also, most of the injuries happened through falls and cuts. The results of this study showed the need for serious policies to reduce occupational injuries.

Diagnostic Accuracy of Suprasternal Versus Subxiphoid Ultrasonography for Endotracheal Intubation.

Background: Airway management is an important skill for emergency physicians, and confirmation of correct endotracheal tube (ETT) placement is a crucial component of airway management. Objectives: Due to the occurrence of incorrect ETT positioning in emergency departments, the present study aimed to compare the diagnostic sensitivity of ultrasound using suprasternal and subxiphoid methods for confirming the correct placement of ETT compared to capnography. Methods: This cross-sectional study was conducted by examining patients requiring intubation. Ultrasound was performed by two independent emergency medical assistants using two suprasternal and subxiphoid methods to confirm correct ETT placement; the results were then interpreted. To observe the tube passage through the vocal cords, capnography and lung auscultation were applied as the gold standards, and the results of two ultrasound methods were compared. Results: A total of 66 patients, who were intubated in the emergency department, participated in this study. The positive and negative predictive values, sensitivity, and specificity of supernatural ultrasound were 96.72%, 80%, 98.33%, and 66.67%, respectively. Also, positive and negative predictive values, sensitivity, and specificity of subxiphoid ultrasound were 97.95%, 29.41%, 80%, and 83.33%, respectively. The diagnostic odds ratios of suprasternal and subxiphoid ultrasounds were 1.026 and 1.024 compared to capnography, respectively. Conclusions: Ultrasonography using the suprasternal method was feasible. Considering the high sensitivity and specificity of this method in confirming correct ETT placement, it produced reliable results. Overall, this modality can be used as one of the main methods to verify correct ETT placement in emergency departments.

Relationship between workplace violence and work stress in the emergency department.

BACKGROUND: Work place violence (WPV) is one of the workplace factors that can affect many aspects of the emergency staff's life. In this study, we are investigating the relationship between WPV and occupational stress. METHODS: We surveyed emergency department (ED) staff in a cross-sectional study design in three Mashhad Hospitals between 2017 and 2018. World Health Organization WPV and occupational stress questionnaire was used and 171 out of 200 collected data were analyzed. To investigate the relationship between different variables, t-test and logistic regression were implemented. RESULTS: In general, 58 (34.5%) participants had reported a physical assault, 116 (71.6%) verbal abuse, and 76 (44.4%) bullying/harassment within the past year. Males reported more experience of physical assault (P less than 0.001), verbal abuse (P less than 0.04) and bullying/harassment (P less than 0.01). The educational level and time shifts were associated with the frequency of physical violence and bullying/harassment (P less than 0.03), respectively. We noticed an association between the job stress scales and some types of work place violence including physical assault (P=0.02), bullying/harassment (P=0.006) and demands scale in recent cited violence (P=0.07). CONCLUSIONS: We presented considerable prevalence of WPV among ED staff. Improving workplace condition and reducing occupational stress could be decrease WPV frequency.

The knowledge of hand hygiene among the healthcare workers of two teaching hospitals in Mashhad.

INTRODUCTION: Healthcare-associated infections (HAIs) affect millions of patients worldwide annually. Hand hygiene (HH) has been identified as the single most important factor preventing HAIs. The aim of this study was to determine the knowledge regarding hand hygiene practices amongst health care workers, and identifying the areas of gaps in their knowledge. METHODS: This cross-sectional analytic study was conducted in two university hospitals in Mashhad, Iran between May 2014 and September 2015. Data was collected using a translated version of the World Health Organization (WHO) Hand Hygiene Knowledge Questionnaire (revised 2009). The questionnaire contained questions on the participants' age, gender, profession, year of the course, formal training in HH and 27 multiple choice and "yes" or "no" questions to assess HH knowledge. Data were entered into IBM SPSS Statistics, Version 16. Descriptive statistical methods and also analytical statistical methods include ANOVA and Independent-samples t-test were used in data analyzing. RESULTS: In total, 161 respondents including 32 residents, 92 nurses and 37 nursing assistants enrolled in this study. All study groups had a moderate knowledge of HH. The score of 21% was ≤ 50% (poor) and only 10.6% had a good knowledge score (i.e. the score ≥75%). There was no significant difference in the knowledge level of the participants who had received formal training in HH and those who had not (p=0.68). Also, the mean knowledge score was not associated with age (p=0.12), gender (p=0.84), department (p=0.96) or profession (p=0.43). CONCLUSION: This study highlights the importance of applying the multimodal training program addressing providers' knowledge regarding hand hygiene, as well as strategies for cognitive, emotional and behavioral methods such as patient engagement in hand-hygiene interventions.

Diagnostic Value of Leukocyte Esterase Test Strip Reagents for Rapid Clinical Diagnosis of Spontaneous Bacterial Peritonitis in Patients Admitted to Hospital Emergency Departments in Iran.

BACKGROUND: Spontaneous bacterial peritonitis (SBP) is a common and important clinical problem and is life-threatening in decompensated liver disease. Ascites fluid test by leukocyte esterase test strip has been recently proposed as an effective and rapid method to diagnose SBP in patients with cirrhosis. OBJECTIVES: This study aimed to evaluate sensitivity and specificity of leukocyte esterase test strip in the diagnosis of SBP. PATIENTS AND METHODS: The population of this research was all patients with cirrhosis and ascites admitted to the emergency room at Imam Reza (AS) hospital, Mashhad. A written consent was taken for inclusion in the study. 50 mL ascites sample was taken from all patients for use in a urine test strip (LER) (Urine Test Strips Convergys®Urine Matrix 11). The patient's ascites samples were evaluated for cell counting. Positive dipstick test for LER in this study considered as grade 3 +. The values of WBC > 500 cell/mm(3) or PMN > 250 cell/mm(3) considered as positive result of the gold standard method for the diagnosis of SBP. RESULTS: In this study, 100 patients with ascites due to cirrhosis, with an average age of 38.9 ± 6.54 years were evaluated. Twenty cases had positive results, of whom 17 cases were also detected based on the standard diagnostic criteria and other three cases were healthy individuals. Thus, sensitivity, specificity, positive and negative predictive values, and accuracy of the method were 95%, 96.3%, 85%, 97.5% and 95%, respectively. CONCLUSIONS: The use of leukocyte esterase urine dipstick test can be a quick and easy method in early diagnosis of SBP to start the treatment until preparation of SBP-cell count results.

A study on respiratory problems and pulmonary function indexes among cement industry workers in Mashhad, Iran.

BACKGROUND: The respiratory system is the most vulnerable system in the cement industry. This study was conducted to determine the effects of occupational exposure to cement dust on the respiratory system more thoroughly. MATERIAL AND METHODS: In this cross sectional study an interviewer-administered questionnaire on socio-demographic characteristics and respiratory symptoms was completed and pulmonary function tests were carried out on 100 exposed and 120 non-exposed workers at the cement factory in Mashhad, Iran. The data was statistically analyzed by SPSS 16. RESULTS: The mean of age and work duration in the exposed group was 37.5±6.3 and 10.7±5.4 years compared with the non-exposed group that was 36.1±7.1 and 10.1±5.7 years, respectively. Levels of exposure to inhalable cement dust in the exposed group were 23.13 mg/m3 (higher than national occupational exposure limits for such particles). Among the exposed group, respiratory symptoms as cough (6% vs. 0.8% of the non-exposed) and sputum (7% vs. 0.8% of the nonexposed) were significantly more prevalent (p<0.05). Forced expiratory flow 25-75% (FEF25-75%) was significantly lower in the exposed workers compared with non-exposed ones (p<0.05). Also forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) and FEF25-75% had a reverse correlation with the length of employment (p=0.000 and p=0.003, respectively). CONCLUSIONS: The findings of this study showed that occupational exposure to cement dust could be a significant factor of respiratory system dysfunction. Strict implementation of a respiratory protection program is recommended in cement industries.

The Accuracy of Pain Measurement in Diagnosis of Scaphoid Bone Fractures in Patients with Magnetic Resonance Imaging: Report of 175 Cases.

INTRODUCTION: Scaphoid fracture is the most common fracture among the bones of the wrist. Plain radiography has a sensitivity of 59 to 79 percent for the diagnosis of scaphoid fracture after injury. Casting is done to avoid complications in patients with suspected fractures with normal radiography. Magnetic resonance imaging (MRI) has a sensitivity of 100% and a specificity of 99%. To avoid unnecessary casting and high costs, we decided to offer a way more efficient than radiography and less costly than MRI. MATERIAL AND METHODS: In the present study, 175 patients with suspected scaphoid fracture along with snuff box tenderness and normal radiography were enrolled in the study. On arrival, patients' pain score were determined using visual analog scale method with anatomical snuffbox tenderness and then MRI was performed on the patients' wrist and the results were recorded for patient in the check list. The data was then aggregated and analyzed. RESULTS: The result of MRI for fracture was negative for 90.9% and positive for 9.1%. The mean pain score was 7.3 in negative MRI group and 8.75 in positive MRI group, considering a significant difference. ROC curve graph showed that the sensitivity and specificity will be 87% and 57%, respectively for scores 7.5 and higher and 75% and 72%, respectively for scores 8.5 and higher. CONCLUSION: It seems that although this method, beside other criteria in the diagnosis of fractures, can be useful in future studies, it would not be helpful in fracture detection.