Development of accreditation modules based on hospital types in Iran: Protocol for a mixed methods study.

BACKGROUND: Among different tools, accreditation is widely used worldwide to improve the quality and safety of hospital services. In Iran, as in many other countries, the same accreditation standards apply to all hospitals, regardless of their size and type of activity. This has given rise to many problems for hospitals. MATERIALS AND METHODS: We will conduct this study in three phases: In the first phase, relevant individuals are interviewed to identify challenges caused to hospitals by applying the same standards for all types of hospitals and clarify issues that could be removed or changed in small hospitals. In the second phase, a scoping review is conducted on the literature about accreditation models worldwide. The first and second phases are conducted simultaneously, and a new accreditation model for Iran hospitals is derived by combining their results. In the final phase, using the Delphi technique, the obtained model and accreditation modules are verified during Delphi rounds. DISCUSSION: A more appropriate accreditation model that matches the characteristics of the target hospitals could be the output of this study. It is expected that the model could improve the process of evaluating the quality of hospital services through the accreditation tool.

Training needs assessment of hospital CEOs in a developing country: the example of Iran.

BACKGROUND: It is essential to identify the necessary competencies of hospital CEOs in order to improve the quality and efficiency of services they provide. Expert leadership skills and competencies can have a significant impact on the success of an organization, benefiting both patients and staff. This study aimed to assess the competencies and training needs of hospital CEOs in Iran public hospitals. METHODS: We conducted this cross-sectional analytical study through a self-assessment questionnaire, which was a web-based platform developed by the WHO country office in Iran, between July 2018 and September 2018. The questionnaire was completed by 180 hospital CEOs and included a core set of 81 items based on Assessing the Competency of Hospital CEO. These items were categorized into five superordinate categories: leadership, personality and quality of individual behavior, knowledge and business skills, social responsibility, and healthcare environment. In addition, we conducted focus groups with 30 hospital CEOs, supervisor assessments with 10 hospital managers, and interviews with 10 supervisors. RESULTS: Of the 180 questionnaires distributed, 78% were returned, and most respondents were medical specialists. The need for leadership competencies such as individual behavior skills and change management received the highest priority. Most respondents required training in management skills, including financial management, governance, strategic thinking, quality improvement, and disaster management. CONCLUSION: Providing needs-based education is crucial, especially in developing countries. In this study, leadership and strategic thinking were found to be the most needed competencies among hospital CEOs in Iran. These findings serve as reference points for developing countries with similar backgrounds and healthcare environments as Iran.

How Do Hospitals Organize Diabetes Services? A Comparative Study.

Most patients with diabetes will present to hospital for a reason not directly related to their diabetes. When a person with diabetes is not cared for properly, hospitalization can become complicated and lead to worse consequences for the patient. In fact, it is important to know how to manage a diabetic patient while in hospital. Therefore, a special organization is needed in hospitals for adaptation to chronic diseases such as diabetes. This study intends to help hospital adaptation to the special needs of diabetic patients by identifying patterns of care delivery in selected countries. This comparative study was performed in 2021. The data collection was conducted by searching in PubMed, Web of Knowledge, Scopus, Science Direct, Springer, Proquest, and also the websites of the selected countries hospitals. Based on the sampling method, three countries, Turkey, United Kingdom, and the United States, were selected from the countries with eligibility. However, during the study, according to the good practices about special diabetic care of countries such as Australia and Denmark, they were also examined. In this review study, we organized and compared the effective measures taken in selected countries in relation to the management of these patients in the hospital, focusing on the dimensions of service package, human resource, process, structure, equipment/technology, and information system required by diabetic patients.

A comparative study on specialized services in pre-hospital emergencies in Iran and selected countries.

The quality of emergency services is one of the indicators describing the health status of countries. Moreover, the specialization of services and targeted response to any accident or disease has been the priority of pre-hospital emergency operations in some leading countries. This study aimed to compare the special services provided in the emergency department of several selected countries. This was a comparative study that was done in Isfahan in 2022. Data were collected by reviewing the literature provided by libraries and emergency websites of selected countries. We selected countries based on the accessibility of information in two groups of developed countries and countries with the same income and population as Iran including Germany, France, The United States, Australia, Britain, Malaysia, and Turkey. Data were classified and compared based on staff, vehicles, and specialized services. Emergency staffs in most countries were of different skill and training levels. Ambulances varied in equipment types in various land, air, and sea forms and dimensions. Developed countries had more modern ambulances and equipment. France and Germany were operating more especially. Specialized teams are dispatched only in the United States and Germany. Existing studies have shown the adequacy and effectiveness of these teams in reducing complications and mortality and improving the prognosis of patients. The use of specialized teams appropriate to each emergency based on the specific and targeted response is effective in improving the prognosis of patients. The results of this study are suggested to beneficiaries to improve the quality of emergency care and reduce complications and potential causalities.

Documenting the managerial experiences of Isfahan Khorshid educational and medical center in dealing with the coronavirus crisis.

BACKGROUND: One of the crises facing human beings is coronavirus disease. This disease was identified in December 2019 in Wuhan, China. With the death of two patients with respiratory complications in Qom Hospital on February 20, 1998, and the confirmation of their positive test, the arrival of COVID-19 disease in Iran was officially confirmed and Khorshid Medical Center as the main reception the Medical Center for patients with COVID-19 from August 3, 2010. The purpose of this study is to document the experiences of Khorshid Training Center in coronavirus crisis management to improve crisis management knowledge. MATERIALS AND METHODS: This research was conducted qualitatively with grounded theory method in the period from March 1998 to the end of May 1999. The study population was Khorshid Educational and Medical Center. Sampling was done purposefully among medical staff, support, and hospital officials. The number of samples with the mentioned conditions reached 44 people. Data were collected using a semi-structured questionnaire and analyzed in the style of grounded theory in the style of Strauss and Corbin. RESULTS: Data collected after sorting, analysis, conceptual analysis; they were coded and categorized into four groups of challenges, weaknesses, strengths, and actions based on the specific objectives of the research in 5 natures, reorganization, accident control system, medical equipment and supplies, human resources, and clinical approaches. CONCLUSION: According to the points classified in the challenges and weaknesses, it was found that the hospital has faced several problems in corona crisis management. The management team, taking advantage of strengths in various areas, has taken effective measures to improve corona crisis management. It has led to the provision of appropriate services to the patients of the Medical Center.

Development and psychometric evaluation of the emergency nurses' professional resilience tool.

BACKGROUND: There is no specific tool for measuring the professional resilience of emergency nurses. Therefore, the present study aimed to design and psychometrically evaluate a new tool named the emergency nurses' professional resilience tool. METHOD: This mixed-method sequential exploratory study was conducted in two phases: (1) item generation using literature review and evaluation of the results of a qualitative study and (2) psychometric evaluation of the developed scale. The face, content, and construct validity (exploratory and confirmatory factor analysis), reliability (internal consistency, relative, and absolute), and accountability were assessed in the population of Iranian nurses (N = 465) during March 2019-June 2020. RESULTS: The tool designed for assessing the professional resilience of Iranian nurses included 37 items. The average scale content validity index (S-CVI/Ave) was equal to 0.94. The exploratory factor analysis revealed five factors, including professional competencies, emotional-cognitive characteristics, external support, in addition to behavioral and cognitive strategies, and explained 75.59% of the whole variance. Cronbach's alpha and intraclass correlation were 0.915 and 0.888, respectively. Construct validity for five factors was established with acceptable model fit indices [Chi-square/df = 1336.56/619, p < .001]; [Comparative Fit Index [CFI] = 0.96]; [Non-Normed Fit Index [NNFI] = 0.96]; [Root Mean Square Error of Approximation (RMSEA) = 0.074 and 90 Percent Confidence Interval = (0.069; 0.080)]; and [SRMR = 0.095]. CONCLUSIONS: According to the findings of the current study, the emergency nurses' professional resilience tool can be used by healthcare managers as a valid and reliable scale to evaluate the professional resilience of nurses to designate them as nurses working in emergency and disaster situations.

A roadmap for implementing general policies of resistance economy in the Isfahan Universities of Medical Sciences.

CONTEXT AND AIMS: The country development can be promoted through applying policies of the resistance economy in the health system and universities. Therefore, this paper aimed to provide a scientific analysis of resistance economy policies and providing a roadmap for their implementation in the field of health care of Isfahan University of Medical Sciences. MATERIALS AND METHODS: This is a qualitative study. The basis, general purposes, and strategies of the resistance economy were extracted from the review of the policy of the resistance economy with a political research approach. Then, effective programs and indicators to achieve the goals of the resistance economy were proposed by holding 10 sessions of a centralized group discussion. Finally, the implementation of the resistance economy in the deputies of the University of Medical Sciences was approved by these programs and indicators along with other components and Delphi questionnaire to 30 experts. Framework analysis and descriptive statistics were used to analyze the data from the group discussion and the Delphi stage, respectively. RESULTS: Implementation of general policies of resistance economy in the field of health and treatment of Isfahan University of Medical Sciences with eight thematic bases, 39 goals, 54 strategies, and 98 programs and indicators were approved by experts. The eight areas of people-centered, economic growth, economic justice, support for internal services, economic flexibility, economic stability, economic influence, and economic health were identified as the thematic bases of communicative policies of the resistance economy in the field of health. CONCLUSION: The implementation of resistance economy policies entails planning in the long run, culture-building, appreciating the resistance economy in health issues, cooperation, and synergy among different institutions, restructuring the education system at different levels of the health system, and entrepreneurship training.

Risk Management in Executive Levels of Healthcare Organizations: Insights from a Scoping Review (2018).

BACKGROUND: This study attempted to present a framework and appropriate techniques for implementing risk management (RM) in executive levels of healthcare organizations (HCOs) and grasping new future research opportunities in this field. METHODS: A scoping review was conducted of all English language studies, from January 2000 to October 2018 in the main bibliographic databases. Review selection and characterization were performed by two independent reviewers using pretested forms. RESULTS: Following a keyword search and an assessment of fit for this review, 37 studies were analyzed. Based on the findings and considering the ISO31000 model, a comprehensive yet simple framework of risk management is developed for the executive levels of HCOs. It includes five main phases: establishing the context, risk assessment, risk treatment, monitoring and review, and communication and consultation. A set of tools and techniques were also suggested for use at each phase. Also, the status of risk management in the executive levels of HCOs was determined based on the proposed framework. CONCLUSION: The framework can be used as a training tool to guide in effective risk assessment as well as a tool to assess non-clinical risks of healthcare organizations. Managers of healthcare organizations who seek to ensure high quality should use a range of risk management methods and tools in their organizations, based on their need, and not assume that each tool is comprehensive.

A Successful implementation of an idea to a nationally approved plan: Analyzing Iran's National Health Roadmap using the Kingdon model of policymaking.

Introduction: Hospital beds, human resources, and medical equipment are the costliest elements in the health system and play an essential role at the time of treatment. In this paper, different phases of the NEDA 2026 project and its methodological approach were presented and its formulation process was analysed using the Kingdon model of policymaking. Methods: Iran Health Roadmap (NEDA 2026) project started in March 2016 and ended in March 2017. The main components of this project were hospital beds, clinical human resources, specialist personnel, capital medical equipment, laboratory facilities, emergency services, and service delivery model. Kingdon model of policymaking was used to evaluate NEDA 2026 development and implementation. In this study, all activities to accomplish each step in the Kingdon model was described. Results: The followings were done to accomplish the goals of each step: collecting experts' viewpoint (problem identification and definition), systematic review of the literature, analysis of previous experiences, stakeholder analysis, economic analysis, and feasibility study (solution appropriateness analysis), three-round Delphi survey (policy survey and scrutinization), and intersectoral and interasectoral agreement (policy legislation). Conclusion: In the provision of an efficient health service, various components affect each other and the desired outcome, so they need to be considered as parts of an integrated system in developing a roadmap for the health system. Thus, this study demonstrated the cooperation process at different levels of Iran's health system to formulate a roadmap to provide the necessary resources for the health sector for the next 10 years and to ensure its feasibility using the Kingdon policy framework.

Revised Risk Priority Number in Failure Mode and Effects Analysis Model from the Perspective of Healthcare System.

BACKGROUND: Methodology of Failure Mode and Effects Analysis (FMEA) is known as an important risk assessment tool and accreditation requirement by many organizations. For prioritizing failures, the index of "risk priority number (RPN)" is used, especially for its ease and subjective evaluations of occurrence, the severity and the detectability of each failure. In this study, we have tried to apply FMEA model more compatible with health-care systems by redefining RPN index to be closer to reality. METHODS: We used a quantitative and qualitative approach in this research. In the qualitative domain, focused groups discussion was used to collect data. A quantitative approach was used to calculate RPN score. RESULTS: We have studied patient's journey in surgery ward from holding area to the operating room. The highest priority failures determined based on (1) defining inclusion criteria as severity of incident (clinical effect, claim consequence, waste of time and financial loss), occurrence of incident (time - unit occurrence and degree of exposure to risk) and preventability (degree of preventability and defensive barriers) then, (2) risks priority criteria quantified by using RPN index (361 for the highest rate failure). The ability of improved RPN scores reassessed by root cause analysis showed some variations. CONCLUSIONS: We concluded that standard criteria should be developed inconsistent with clinical linguistic and special scientific fields. Therefore, cooperation and partnership of technical and clinical groups are necessary to modify these models.

Strategies for reducing expenditures in Iran's health transformation plan: A qualitative study.

Background: Iranian health system underwent a series of reforms entitled Health Transformation Plan (HTP) in 2014. The plan started with packages that have imposed financial burden and increased expenditure in the health system. This study aimed to identify strategies and solutions to reduce expenditures in HTP in Iran. Methods: To conduct this qualitative study, the researchers held 15 semi-structured interviews with prominent experts in the research arena in 2018. Content analysis was used to analyze the data using MAXQDA 10 software. Results: Data collection yielded 9 main topics, including purchase and provision medicine, prescription, purchase and use of equipment, diagnostic medical services, referral system, human resources, physical space, payment system, and modifying and increasing base salaries. Conclusion: In Iran's health system, some aspects of HTP wasted resources, eg, the waste of resources in the service delivery system; thus, policymakers should consider proper strategies to control the costs based on the nature of their implementation.

Implementing clinical governance in Isfahan hospitals: Barriers and solutions, 2014.

INTRODUCTION: In the new approach, all health care providers have been obligated to maintain and improve the quality and have been accountable for it. One of the ways is the implementation of clinical governance (CG). More accurate understanding of its challenges can help to improve its performance. AIMS: In this study, barriers of CG implementation are investigated from the perspective of the hospitals involved. Besides, some solutions are suggested based on stakeholders' opinions. MATERIALS AND METHODS: This study used combined method (qualitative content analysis and questionnaire) in hospitals affiliated to Isfahan University of Medical Sciences in 2014. First, experts, and stakeholders talked about CG implementation obstacles in a semi-structured interview. Interviews were confirmed by the interviewee (double check). After analyzing the interviews using reduction coding the questionnaire was drawn up. The questionnaire "validity was confirmed by Cronbach's alpha (0/891)" and its reliability was obtained using experts confirmation. Data analyzing was performed using SPSS (18) software. RESULTS: According to results staffing and management factors were the main obstacles. After them, were factors related to organizational culture, infrastructure elements, information, sociocultural and then process factors. The learning barriers were in final rank. Thirty-four solutions was proposed by experts and divided into subset of eight major barriers. Most solutions were offered on modifying processes and minimal solutions about modifying of organizational culture, sociocultural, and educational factors. CONCLUSION: Removing the obstacles, especially management and human resource factors can be effective by facilitating and accelerating CG. Furthermore, use of experts and stakeholders opinions can help to remove CG barriers.

The impact of top management turnover on quality management implementation.

INTRODUCTION: The purpose of this study was to investigate the impact of top management turnover on Strategic Collaborative Quality Management (SCQM) implementation in healthcare organizations. The role of top management turnover in the process and impact of the SCQM model was investigated using a case study of a public hospital. METHODS: Both qualitative and quantitative methods were used for data collection. RESULTS AND DISCUSSION: Top management turnover is a major threat to the long-term success of the SCQM intervention and makes it very difficult to sustain its benefits. Successful quality management implementation needs supportive and committed leadership and management. Top management stability encourages long-term planning and commitment to pursuing long-term objectives. CONCLUSION: This paper has highlighted the critical role of top management stability during the course of quality management implementation.

Stakeholders' analysis of the medical tourism industry: development strategies in Isfahan.

INTRODUCTION: Policy makers and decision makers must identify the stakeholders in medical tourism, who will be affected by and/or affect this industry, and determine their status for partnership. The aim of this study was to identify the main stakeholders in Isfahan's medical tourism, analyze them, and provide strategies for developing this industry. MATERIALS AND METHODS: A qualitative study was conducted in 2011. At first, the key stakeholders in medical tourism were identified in accordance with the experts' idea and literature review. Then we interviewed the key stakeholders. Data analysis was conducted using the stakeholders' analyses, which helped in developing strategies. RESULTS: The result showed that the key stakeholders were made up of nine groups. They included the provincial governance of Isfahan, the Cultural Heritage and Tourism Organization of Isfahan, the Chamber of Commerce, the Medical Council, the Isfahan University of Medical Sciences, health service providers, tourism services providers, investors, and the Tosea Saderat Bank. The rate of knowledge of the Cultural Heritage and Tourism Organization of Isfahan, clinic and international relationship of Isfahan University of Medical Sciences from government policy about medical tourism were very much. Private Hospitals, the Medical Council, investors, and the University of Medical Sciences had great power. Private hospitals, clinics, the Cultural Heritage and Tourism Organization of Isfahan, and the University of Medical Sciences were in the supporter position. The effected strategies were the included strategies, focused on increasing power; increasing support, and on maintaining the position. CONCLUSION: There are different stakeholders in the medical tourism industry. Thus, policy makers can plan, make a policy and decision, and use effective strategies to develop medical tourism by designing a medical tourism stakeholders' network, a medical tourism provincial council, and clarify the roles and responsibilities of stakeholders.

Leadership, job satisfaction and organizational commitment in healthcare sector: proposing and testing a model.

CONFLICT OF INTEREST: none declared. INTRODUCTION: Employees' job satisfaction and commitment depends upon the leadership style of managers. This study clarifies further the relationships between leadership behaviors of managers and two employees' work-related attitudes-job satisfaction and organizational at public hospitals in Iran. A better understanding of these issues and their relationships can pinpoint better strategies for recruiting, promotion, and training of future hospital managers and employees, particularly in Iran but perhaps in other societies as well. METHODS: This cross-sectional study was conducted using self-administered questionnaires distributed among 814 hospital employees and managers through a stratified random sampling. RESULTS AND DISCUSSION: The dominant leadership style of hospital managers was participative style. Hospital employees were moderately satisfied with their jobs and committed to their organization. Salaries, benefits, promotion, contingent rewards, interpersonal relationships and working conditions were the best predictors of job satisfaction among hospitals employees. Leadership, job satisfaction and commitment were closely interrelated. The leadership behavior of managers explained 28% and 20% of the variations in job satisfaction and organizational commitment respectively. CONCLUSION: This study clarifies the causal relations of job satisfaction and commitment, and highlights the crucial role of leadership in employees' job satisfaction and commitment. Nevertheless, participative management is not always a good leadership style. Managers should select the best leadership style according to the organizational culture and employees' organizational maturity.

Evaluation of outsourcing in nursing services: a case study of kashani hospital, isfahan in 2011.

BACKGROUND: Hospitals need to focus on their core activities, thus outsourcing of services may be effective in some instances. However, monitoring and supervision is a vital mechanism to preserving and enhancing the quality of outsourced services, and to identify the benefits and losses occurred. The purpose of this study is evaluation of nursing services outsourced in a general hospital from different point of views. METHODS: This is a descriptive and applied study done by case study (before and after) method. Outsourcing nursing services of clinical wards (ENT and Neurosurgery) of Kashani Hospital in 2011 has been studied. We extracted data from a handmade questionnaire about internal customer's satisfaction and semi-structured interviews with officials, and also survey of financial and administrative documents and records related to the topic. RESULTS: The findings indicate an increased number of graduated nurses per bed to fulfill the main objective of outsourcing in this case. But achieving this objective is accompanied with remarkable increased costs per bed after outsourcing. Besides, we noticed minor changes in internal customer satisfaction rate. CONCLUSION: While outsourcing should bring about staff and patients' satisfaction and increase the efficiency and effectiveness, outsourcing nursing workforce singly, leaded to a loss of efficiency. Therefore, the applied outsourcing has not met the productivity for the hospital.

Incineration or autoclave? A comparative study in isfahan hospitals waste management system (2010).

INTRODUCTION: Medical wastes are among hazardous wastes and their disposal requires special methods prior to landfilling. Medical wastes are divided into infected and non-infected wastes and the infected wastes require treatment. Incineration is one of the oldest methods for treatment of medical wastes, but their usage have faced wide objections due to emission of hazardous gases such as CO2 and CO as well as Carcinogenic gases such as Dioxins and Furans which are generated as a result of incomplete combustion of compositions like PVCs. Autoclave is one the newest methods of medical wastes treatment which works based on wet disinfection. METHODS: The statistical population in this descriptive, comparative study includes hospitals located in Isfahan city and the sample hospitals were selected randomly. To environmentally evaluate the Autoclave method, TST (time, steam, temperature) and Spore tests were used. Also, samples were made from incinerator's stack gases and their analyses results were compared with WHO standards. FINDINGS: TST and spore tests results were negative in all cases indicating the success of treatment process. The comparison of incinerator's stack gases with WHO standards showed the high concentration of CO in some samples indicating the incomplete combustion. Also, the incineration efficiency in some cases was less than 99.5 percent, which is the efficiency criterion according to the administrative regulations of wastes management law of Iran. No needle stick was observed in Autoclave method during the compaction of bags containing wastes, and the handlers were facing no danger in this respect. The comparison of costs indicated that despite higher capital investment for purchasing autoclave, its current costs (e.g. maintenance, etc) are much less than the incineration method. DISCUSSION: Totally, due to inappropriate operation of incinerators and lack of air pollution control devices, the use of incinerators doesn't seem rational anymore. Yet, despite the inefficiency of autoclaves in treatment of bulky wastes such as Anatomical wastes, their usage seems logic considering the very low amounts of such wastes. Also, considering the amount of generated wastes in Isfahan hospitals, a combination of centralized and non-centralized autoclaves is recommended for treatment of infected wastes. Mobile autoclaves may also be considered according to technical and economical conditions. It must not be forgotten that the priority must be given to the establishment of waste management systems particularly to personnel training to produce less wastes and to well separate them.

Do electronic health records standards help implementing patient bill of rights in hospitals?

INTRODUCTION: Patient bill of rights (PBR) calls for equal rights to access health services for all patients. It makes a foundation for preserving good relationships between patients, doctors and other healthcare staffs. Third Edition of national PBR was published in Iran in 2009. On the other hand, developing national wide Electronic Health Records (EHR) is now one of the strategic goals of Iran Ministry of Health and Medical Education. EHR as a basic repository for all related information provides access to the necessary data to organize, store and manage them. It also makes an additional support to the legal aspects of healthcare services, increases staff information about patient rights, and raises them to respect these rights. This article reviews how EHR standards can help to institutionalize the PBR. METHODS: To do that, we have collected some important topics of PBR in Iran. Then we used some valid references on Electronic health record standards like ASTM, ISO, HL7 and CEN to review existing standards. The Main issues regarding patient rights derived from these standards were: privacy, confidentiality, and secrecy, access levels to patient information, medical care in emergency situations, patient autonomy and authentication (electronic signature). In each topic, the most relevant standard phrases are marked. RESULTS: Developing EHR creates an opportunity to establish patient rights in its structure. To internalize them, there are some reliable EHR standards like ASTM and ISO 13606-1 that implementing them could be very fruitful.

Certain hospital waste management practices in isfahan, iran.

OBJECTIVES: Infected hospital wastes are among hazardous wastes, and special treatment methods are needed for their disposal. Having information about present status of medical waste management systems is of great importance in finding weak, and for future planning. Such studies have not been done for most of the hospitals in Iran. METHODS: This paper reports the results of a study on the present status of medical waste management in Isfahan hospitals. A ten page researcher made questionnaire was used to collect data in terms of collection, transportation, segregation, treatment and disposal. For assessment of autoclaves, standard tests including TST (Time, Steam, and Temperature) strip test and spore tests were used. Samples were made of stack gases of incinerators. Quantity and composition of hospital wastes in Isfahan were also measured manually. RESULTS: Of all wastes in selected hospitals, 40% were infected wastes (1.59 kg/day/bed), which is 15 to 20% higher than World Health Organization (WHO) standards. TST and Spore test results were negative in all samples. Stack gases analysis showed high concentration of CO in some samples. Besides, the combustion efficiency in some samples is less than 99.5%, which is the standard criterion in Iran. CONCLUSIONS: This study may create awareness regarding the magnitude of the problem of waste management in hospitals of Isfahan and may stimulate interests for systematic control efforts for hospital waste disposal. Hospital waste management cannot succeed without documented plans, certain equipment, defined staff trainings, and periodic evaluations.