Hospital challenges and managerial approaches to combat COVID-19 outbreak: a qualitative study in southeastern Iran.

BACKGROUND: During the covid-19 pandemic, hospitals have faced several challenges, so they need to identify and address effective management strategies to cope with these challenges that enhance their current knowledge to deal with similar challenges in the future. This study aimed to identify managerial strategies for dealing with Covid-19 pandemic challenges at a hospital in southeastern Iran. METHODS: This qualitative content analysis study used purposive sampling to select eight managers, three nurses, and one worker from Shahid Bahonar Hospital. In this study, semi-structured interviews were used to collect data and Lundman and Graneheim's approach was used to analyze them. RESULTS: Three hundred fifty codes remained after constant comparison, compression, and merging. The results demonstrated one theme "Managerial reengineering in the healthcare system during the Covid-19 crisis", two main categories, seven subcategories and, 19 sub- subcategories. The first main category was "The difficulty of managing challenges," including "Insufficient resources and physical space", "Socio-organizational challenges" and, "Incompetence and unpreparedness of managers." The second main category was "Reforming the management duties." This category included "Planning and decision-making," "Organization," "Leadership and motivation," and "Monitoring and control." CONCLUSIONS: Hospitals and managers were less prepared to cope with the Covid-19 crisis challenges due to health system organizations' less attention to biological crises. Healthcare organizations can carefully evaluate these challenges, and the strategies managers adopt to deal with these problems. They also can identify the strategies' strengths and weaknesses and propose more effective strategies. As a result, healthcare organizations will be better prepared for similar crises.

Barriers to hand hygiene compliance in intensive care units during the COVID-19 pandemic: A qualitative study.

Background: The practice of hand washing is an effective way to prevent contamination and disease transmission. Following the COVID-19 pandemic, hand washing has become increasingly important. Therefore, this qualitative study aimed to understand barriers to hand hygiene compliance among healthcare workers during the COVID-19 pandemic. Materials and methods: Twenty-five healthcare workers from intensive care units were sampled using purposive sampling in a qualitative content analysis study. Data were collected through a semi-structured interview and field notes. Based on the Lundman and Graneheim approach, the data were analyzed. COREQ checklist was used to report the research. Results: According to the findings, there are three main categories of barriers to hand hygiene practice: barriers related to individuals (including two subcategories of lack of knowledge of healthcare workers and healthcare workers' improper attitude), barriers related to management (including two subcategories of wrong behavioral patterns and unsuitable training and planning), and barriers related to organizations (including four subcategories of heavy workloads, improperly designed wards, a lack of equipment, and lack of quality equipment). Conclusions: This research indicates that hand washing practice increased during the COVID-19 pandemic. Nevertheless, some barriers persist, resulting in a decline in hand washing compliance among health care workers. This finding can help managers and policymakers remove barriers to hand washing compliance and improve healthcare workers' adherence to hand washing.

The Impact of COVID-19 Outbreak on Nosocomial Infection Rate: A Case of Iran.

BACKGROUND: Coronavirus disease-19 (COVID-19) is a new type of coronavirus that has caused a global pandemic. The disease is highly contagious, and all people are susceptible to the disease. Therefore, extensive measures were taken to prevent the spread of the disease at the community and hospitals. This study aimed to investigate the impact of COVID-19 outbreak on nosocomial infection rate. METHODS: This cross-sectional study was conducted in an educational hospital, southeast Iran. The nosocomial infection rates of critical/intensive care units (CCU/ICUs) and medical-surgical units were assessed during and before the COVID-19 outbreak. RESULTS: There was a 19.75-point decrease in the total rate of nosocomial infection during the COVID-19 outbreak (P = 0.02). In addition, there was a 39.12-point decrease in the total rate of CCU/ICUs' nosocomial infection during the COVID-19 outbreak (P < 0.001). A 19.23-point decrease was also observed in the total rate of medical-surgical units' nosocomial infection during the COVID-19 outbreak (P = 0.13). All kinds of CCU/ICUs' nosocomial infections had between 31.22- and 100-point decreases during the COVID-19 outbreak. Among medical-surgical units, 33.33- and 30.70-point decreases were observed only in UTI and SSI, respectively, during the COVID-19 outbreak, while BSI had a 40-point increase during the COVID-19 outbreak. CONCLUSIONS: Proper implementation of infection control protocols during the COVID-19 pandemic seems to reduce nosocomial infections.

Protection of renal damage by HMG-CoA inhibitors: A comparative study between atorvastatin and rosuvastatin.

OBJECTIVES: Hypercholesterolemia is a common metabolic disorder in developing and developed countries and is associated with the increased rates of chronic kidney disease (CKD). Statin therapy could reduce cholesterol synthesis as well as progression of CKD. Diversity between statins causes variety in pharmacokinetics and pharmacodynamics and also their pleiotropic effects. In the present investigation we aimed to evaluate the protective potentials of both atorvastatin (Ator) (as lipid-soluble statin) and rosuvastatin (Ros) (as water-soluble statin) against renal histopathological damages in the high cholesterol diet induced hypercholesterolemic rats (HCDIHR). MATERIALS AND METHODS: Serum lipid profile, oxidized low density lipoprotein (OX-LDL), malondialdehyde (MDA), urea and creatinine levels, as well as renal histopathology were evaluated. RESULTS: While Ros acted better than Ator to reduce serum low density lipoprotein cholesterol (LDL-C) (P<0.01), atherogenic index (AI) (P<0.01), MDA (P<0.01), and OX-LDL (P<0.01); no significant differences were noted in their cholesterol (P=0.72), triglyceride (TG) (P=0.79), and very low density lipoprotein cholesterol lowering (VLDL-C) (P=0.79) and high density lipoprotein cholesterol elevating effects (HDL-C) (P=0.72). Ator was more effective to reduce renal histopathologic indices compared to Ros, including accumulation of lipid droplet, glomerular foam cells, mesangial cell proliferation, renal hemorrhage, and tubulointerstitial damages in the kidneys of diet induced hypercholesterolemic rats. CONCLUSION: The findings underline that the lipophilic Ator may performs better than Ros in attenuating renal damages in HCDIHR.

The impact of dyslipidemia and oxidative stress on vasoactive mediators in patients with renal dysfunction.

Hyperlipidemia and oxidative stress are indispensable features of chronic kidney disease (CKD) that favor the development of atherogenic plaques and cardiovascular disease (CVD). A number of vasoactive mediators including proprotein convertase subtilisin-kexin type 9 (PCSK9), endothelin-1, nitric oxide, and angiotensin II have fundamental roles in the pathophysiology of atherosclerotic events; moreover, their levels are affected by dyslipidemia and oxidative stress due to renal dysfunction. Therefore, therapeutic measures aimed at correcting dyslipidemia and alleviating oxidative stress could potentially protect against CVD in CKD patients. In this review, we discuss the relation between dyslipidemia, oxidative stress, and vasoactive mediators as well as the available treatment options against these disturbances in CKD patients.

The effect of oral melatonin on renal ischemia-reperfusion injury in transplant patients: A double-blind, randomized controlled trial.

BACKGROUND: One of the important factors in the occurrence of acute kidney injury (AKI) among renal transplant patients (RTPs) is ischemia reperfusion injury (IRI). The current study aimed at determining the anti-inflammatory and anti-oxidative effects of melatonin on the complications of IRI and the level of Klotho expression in these patients. METHODS: A total of 40 renal transplant candidates were randomly assigned into placebo or melatonin group receiving the same dose of 3 mg/day. In order to measure serum melatonin levels, inflammatory and oxidative stress factors, renal function biomarkers, and Klotho gene/protein expression, venous blood samples were taken from patients over two different time points, i e, 24 h before the transplantation and at discharge from hospital. RESULTS: Melatonin was associated with improvement in renal transplantation, since the serum level of neutrophil gelatinase-associated lipocalin, as a renal functional marker, significantly decreased (P < .001). The effect of melatonin as a suppressor of inflammation and oxidative stress was also evident in the melatonin group due to a significant reduction in the serum levels of MDA, CP, 8-OHdG, and TNF-α markers (P < .001). CONCLUSIONS: Reduction in serum levels of renal function and oxidative stress/inflammatory markers in the melatonin group indicates that melatonin can inhibit IRI outcomes in RTPs through its anti-oxidant and anti-inflammatory properties. However, these properties do not appear as a result of influence on the level of Klotho gene/protein expression.