Effect of a Smoking Cessation Program on Inpatients in the Largest Hospital in Southern Iran.

BACKGROUND: There is evidence that cessation programs can be effective for hospital inpatients. Hence, the aim of this study was to investigate the effects of such programs and factors that may affect success. METHODS: This study was carried out on in-patient users of tobacco in Shiraz Hospital, Iran in 2015. After implementing the inclusion criteria, a study population was selected using a convenience sampling method. Participants were contacted monthly by study personnel concerning certain aspects of their tobacco cessation program. The study lasted 6 months. Data analyses involved survival analysis using Kaplan-Meier analysis, log-rank test, and multivariate Cox regression modeling. RESULTS: The study included 425 in-patient smokers of which 328 (77.2%) were male. Median follow-up time was 96 days (interquartile range: 20-150). Cessation survival rates were 76% at 1 month, 63% at 2 months, and 61% at 3 months. From the 4th month onward rates remained unchanged at 60%. Univariate analyses with variables such as time since last smoking, consumption type, interval between wake-up and consumption, the severity of dependence and interest in smoking cessation were statistically significant as to cessation survival rate (P < 0.05). After adjusting the confounding variables based on multivariable analyses, results indicated that consumption type, the severity of dependence and interest in smoking cessation were the most important predictors of cessation survival rates among in-patient smokers. CONCLUSIONS: Findings indicated that application of the cessation program among our group of inpatients appears to have been an effective intervention that produced an extended period of no smoking.

Social Determinants of Health and Attempt to Change Unhealthy Lifestyle: A Population-based Study.

BACKGROUND: A healthy lifestyle is important because of its long-term benefits; however, there is a paucity of information concerning health choices among Iranians. We evaluated personal health behaviors, attempts to change unhealthy behaviors, and factors affecting attempts at change. METHODS: The design of this cross-sectional study was to assemble a representative cadre of >18-year-old adults in Shiraz, Iran, using a multistage cluster sampling technique. Validated questionnaires collected participant's demographic information, such as weight, height, cigarette smoking history, physical activity, and attempts at lifestyle changes during the previous year. To determine predictors of attempts to change unhealthy lifestyle and to identify confounders, we applied single and multivariable logistic regression methods, respectively. A confidence interval of 95% was calculated for each odds ratio. RESULTS: The prevalence of attempts to change unhealthy lifestyle was 42%, 64.8%, and 27.8%, respectively, for losing weight, being more physically active, and smoking cessation. Unemployment, low levels of education, and decreased socioeconomic status have important roles in attempts to change lifestyle conditions. Low socioeconomic status was a risk factor for quitting smoking. Occupation (unemployed/homemaker) and low level of education were two significant factors for being more physically active. CONCLUSIONS: The prevalence of inadequate physical activity and being overweight or obese was considerable in Shiraz, Iran. Attempts to change unhealthy lifestyle were less than ideal. Social determinants of health factors including unemployment and low levels of education and socioeconomic status play important roles in attempts to change current lifestyles.

Evaluation of a Web-based Error Reporting Surveillance System in a Large Iranian Hospital.

BACKGROUND: Proper reporting of medical errors helps healthcare providers learn from adverse incidents and improve patient safety. A well-designed and functioning confidential reporting system is an essential component to this process. There are many error reporting methods; however, web-based systems are often preferred because they can provide; comprehensive and more easily analyzed information. This study addresses the use of a web-based error reporting system. METHODS: This interventional study involved the application of an in-house designed "voluntary web-based medical error reporting system." The system has been used since July 2014 in Nemazee Hospital, Shiraz University of Medical Sciences. The rate and severity of errors reported during the year prior and a year after system launch were compared. RESULTS: The slope of the error report trend line was steep during the first 12 months (B = 105.727, P = 0.00). However, it slowed following launch of the web-based reporting system and was no longer statistically significant (B = 15.27, P = 0.81) by the end of the second year. Most recorded errors were no-harm laboratory types and were due to inattention. Usually, they were reported by nurses and other permanent employees. Most reported errors occurred during morning shifts. DISCUSSION: Using a standardized web-based error reporting system can be beneficial. This study reports on the performance of an in-house designed reporting system, which appeared to properly detect and analyze medical errors. The system also generated follow-up reports in a timely and accurate manner. Detection of near-miss errors could play a significant role in identifying areas of system defects.

Awareness and Observance of Patient Rights from the Perspective of Iranian Patients: A Systematic Review and Meta-Analysis.

BACKGROUND: Recipients of healthcare services have rights, which must be acknowledged and protected. Such rights include observance of acceptable patient physical, mental, spiritual, and social needs guided by commonly accepted rules and regulations. The objective of this study was to conduct a systematic review and meta-analysis of awareness rates and observance of patient rights in Iran from the perspective of the patient. METHODS: In this study, various references such as Medline (PubMed), Scopus, Scientific Information Database (SID), Google scholar, Magiran, and IranMedex were searched (from August to December 2015). Heterogeneity was assessed using the Q statistic. English and Persian search keywords and combinations included terms such as "patient bill of rights, patient rights, Iranian patient bill of rights, and Persian patient rights." A meta-analysis of the primary search sources was accomplished using STATA (version 11.0). RESULTS: Initial review included 20 articles of which 12 assessed observance rates of patient rights and three described service awareness rates of recipients concerning their personal rights. Five articles covered both topics and had an estimated 54.2% coverage based on the results of meta-analysis and the random-effects model with the heterogeneity. CONCLUSION: An Observance rate of patient bills of rights was considered somewhat adequate. However, contradictions in findings noted in this study suggest deficiencies do exist and need to be resolved. There appears a need to better describe and increase awareness rates of healthcare services by patients concerning their own bill of rights.

Comparing knowledge and self-reported hand hygiene practices with direct observation among Iranian hospital nurses.

We compared knowledge and self-reported hand hygiene practices with direct observations among Shiraz Nemazee Hospital nurses. Overall hand hygiene compliance was low (39.6%). Use and appreciation for alcohol-based handrubs were suboptimal. Some reluctance was due to religious concerns. Most nurses self-reported performing proper hand hygiene more than 75% of the time, whereas direct observation indicated much lower levels of compliance. It appears that additional training and improved monitoring are needed.

Knowledge, attitudes, and practices of health care personnel concerning hand hygiene in Shiraz University of Medical Sciences hospitals, 2013-2014.

This study evaluated knowledge and self-reported attitudes and practices concerning hand hygiene among hospital workers in Shiraz, Iran, using a 68-question survey divided into 4 sections: demographics, knowledge, attitudes, and practices. Work experience had a correlation with practices and knowledge (P < .05), and knowledge and practices scores were positively correlated (P < .05). Participants appear to have sufficient knowledge and proper attitudes regarding hand hygiene; however, compliance practices were suboptimal.

Improving infection prevention methods in hemodialysis units: a multicenter survey.

The aim of this cross-sectional study was to investigate the implementation of and compliance with international infection control standards by patients and staff in dialysis centers in Shiraz, Iran. The results indicate negligence in various aspects of infection control. Providing staff education and training programs, establishing effective surveillance systems, and enforcing regulations in the hospitals should help improve infection prevention.

Assessment of injection practice in primary health care facilities of Shiraz, Iran.

BACKGROUND: Occupational risk for several bloodborne viruses is attributable to unsafe injection practices. To understand injection frequency and safety, we surveyed injection rates and factors influencing injection prescription in primary health care facilities and associated health clinics in Shiraz, Iran. METHODS: We used both quantitative and qualitative approaches to study the frequency and safety of injections delivered in 27 primary health care facilities. We used observations and 3 data collecting tools. Patterns of 600 general practice physicians' (GPs) prescriptions were also reviewed. In-depth interviews to elicit the factors contributing to injection prescriptions were conducted. RESULTS: The annual per capita injection rate was 3.12. Corticosteroids were prescribed more frequently than antibiotics (P < .001). Knowledge of participants concerning transmission risks for 3 of the most common bloodborne infections (BBIs) was less than 75%. Factors affecting use of injections by GPs included strong patient preference for injections over oral medications and financial benefit for GPs, especially those in private practice settings. CONCLUSION: Frequency of therapeutic injections in the participating facilities in Shiraz was high. Sociocultural factors in the patient community and their beliefs in the effectiveness of injections exerted influence on GP prescribing practices. Programs for appropriate and safe injection practices should target GP and injection providers, as well as patients, informing them about alternative treatments and possible complications of unnecessary and unsafe injections.

Transportation behaviors in Shiraz, Iran.

OBJECTIVE: Motor vehicle accidents can occur as a result of improper driver behavior. There needs to be a comprehensive collection of information concerning driver behavior and its predisposing factors. METHODS: Study participants (500 males and 500 females ≥18 years old) living in Shiraz, Iran, were selected using a multistage sampling methodology. Data came from questionnaires completed using a face-to-face interview process. Independent variables such as age, gender, marital status, occupation, educational level, socioeconomic status (SES), and history of smoking and stress levels were compared to the dependent variables using a private automobile, public transportation, or motorcycle, wearing a seat belts, wearing safety helmets, and obeying the speed limit. Statistical significance was set at a P value of .05 or less. RESULTS: In general, female, better educated persons, and those with higher SES reported better driving behaviors. Better drivers also did not use tobacco or hookah. Compliance with driving safety factors was disappointing 49.8 percent always wore a seat belt, 22.4 percent always wore a safety helmet (29.4% never wore a helmet), and 49.4 percent always observed the speed limit. CONCLUSIONS: There is a need to improve driver safety compliance in Shiraz, Iran. One factor that can be addressed concerns regulation of male drivers, especially among lower SES groups.

The effect of long-term disinfection on clinical contact surfaces.

BACKGROUND: The author measured the effect long-term disinfection had on common types of dental office environmental surfaces. METHODS: The author tested nine common dental surfaces and six spray disinfectants, as well as a tap water control. The author used the "spray-wipe-spray" method with paper towels to disinfect the surfaces. Each surface was disinfected 1,920 times, which was an estimate of the number of cleanings per year. After every 100 disinfections, the author conducted blood removal testing of the surface, which monitored residual blood and disinfectant cleaning ability. RESULTS: The surface that was most difficult to clean was textured vinyl, followed by smooth vinyl, enameled metal, service line rubber hosing and brushed aluminum. Diluted bleach affected surfaces the most, which resulted in higher blood removal scores. CONCLUSIONS: When compared with the control, Birex SE had equal or better cleaning scores across time, which might indicate that its use caused little change in the integrity of the surfaces. The results for the other disinfectants varied. CLINICAL IMPLICATIONS: Disinfectants should have good antimicrobial activity and minimal negative impact on the integrity of the surfaces being disinfected. Effective disinfection is highly dependent on efficient cleaning (removal of the bioburden present).

Clinical laboratory waste management in Shiraz, Iran.

Clinical laboratories are significant generators of infectious waste, including microbiological materials, contaminated sharps, and pathologic wastes such as blood specimens and blood products. Most waste produced in laboratories can be disposed of in the general solid waste stream. However, improper management of infectious waste, including mixing general wastes with infectious wastes and improper handling or storage, could lead to disease transmission. The aim of this study was to assess waste management processes used at clinical laboratories in Shiraz, Iran. One hundred and nine clinical laboratories participated In this cross sectional study, Data collection was by questionnaire and direct observation. Of the total amount of waste generated, 52% (by weight) was noninfectious domestic waste, 43% was non-sharps infectious waste and 5% consisted of sharps. There was no significant relationship between laboratory staff or manager education and the score for quality of waste collection and disposal at clinical laboratories. Improvements in infectious waste management processes should involve clearer, more uniformly accepted definitions of infectious waste and increased staff training.

Disinfection of bacterially contaminated hydrophilic PVS impression materials.

PURPOSE: This study evaluated disinfection of bacterially contaminated hydrophilic polyvinylsiloxane (PVS) and polyether impressions. MATERIALS AND METHODS: Four light-bodied PVS (Examix, Genie, Take 1, Aquasil) and one polyether (Impregum) impression materials were evaluated using three disinfectants (EcoTru [EnviroSystems], ProSpray [Certol], and bleach [diluted 1:9]) as spray and immersion disinfections for 10-minute exposures. Pseudomonas aeruginosa ATCC 15442, Salmonella choleraesius ATCC 10708, and Staphylococcus aureus ATCC 6538 was the microbial challenge. Test specimens were prepared using aluminum molds with ten tapered cones. Mucin covered each cone, followed by 0.01 mL of each bacterium. Impressions were made using low viscosity impression material that was injected over the cones and filled custom trays. One-half of the impressions were spray disinfected, while the others underwent immersion disinfection. Trays that were contaminated but not disinfected served as positive controls, while those not bacterially contaminated or disinfected served as negative controls. The impressions were poured with Silky Rock Die Stone, and after setting, two cones were placed within a sterile capsule and triturated into powder. Four milliliters of TRIS buffer (0.05 M, pH 7.0) containing sodium thiosulfate (0.0055% w/v) were poured in each tube. After mixing, the solution was serially diluted and spread-plated onto selective agars. After incubation, colony counting occurred. RESULTS: No viable bacteria transferred to casts from either spray- or immersion-disinfected impressions. Negative controls produced no microbial colonies. Positive controls produced on average 3.35 × 10(5) bacterial cells. CONCLUSION: Results suggest the methods used could disinfect contaminated impression materials. Microbial transfer from nondisinfected impressions to cones approached 33.5%.

Controlling bacterial contamination of dental impression guns.

BACKGROUND: Dental impression material handgun cartridge dispensers are contaminated easily during clinical use. The authors attempted to quantify contamination by bacteria, including methicillin-resistant Staphylococcus aureus (MRSA), of impression guns used in an academic dental clinic after five infection-prevention protocols were followed. METHODS: The authors obtained samples from four commercially available impression guns at four specific sites (button, handle, latch, trigger) after routine clinical use, disinfection, steam sterilization (also known as autoclaving), steam sterilization followed by use of plastic impression gun covers and steam sterilization followed by use of plastic impression gun covers and disinfection. RESULTS: The authors found that after routine clinical use, bacteria-including MRSA-heavily contaminated the impression guns. After the impression guns underwent disinfection, there was a 6 percent decrease in bacterial counts. The use of steam sterilization achieved sterility without harming the impression guns. Use of steam-sterilized impression guns with plastic impression gun covers decreased bacterial isolates by approximately 60 percent. Use of steam-sterilized impression guns plus covers and disinfection resulted in an approximately 95 percent reduction in contamination. CONCLUSIONS: The use of common infection-prevention methods appears to reduce the bacterial counts, including those of MRSA. Bacterial contamination was lowest after steam sterilization, followed by the use of plastic impression gun covers and disinfection. CLINICAL IMPLICATIONS: Use of contaminated impression guns on successive patients could increase the risk of causing cross-transmission of disease. The use of sterilization, plus plastic impression gun covers and disinfection, for impression guns after each use could be an effective and practical infection-control method for dental practices.

Effect of surgical safety checklists on postoperative morbidity and mortality rates, Shiraz, Faghihy Hospital, a 1-year study.

OBJECTIVE: The study intent was to (1) encourage the use of surgical safety checklists and (2) measure the effect checklists have in reducing surgical complications. DESIGN: An interventional study designed to improve postsurgical outcomes was performed. SETTING: The study site was a 374-bed referral educational hospital in Shiraz, Iran, with 6 operating rooms. The study lasted 6 months. PARTICIPANTS: Patient selection involved a convenient sampling method with all eligible patients entering. INTERVENTION: Our checklist covered 3 surgical stages--before anesthesia, immediately before an incision, and before moving the patient to a recovery room. Persons included were operating room team members. MAIN OUTCOME MEASURES: Rates of postsurgical complication before and after application of the surgical safety checklist underwent comparison. RESULTS: Incidence of any complication before and after intervention was 22.9% and 10% (P = .03). Five checklist items were in total compliance. The most common complication was surgical site infection. Implementation of the checklist, responsibility in 2 stages, such as time out and sign out, were significant (P < .05). In most cases, these items reflected the performance of surgeons and anesthesia professionals as compared with the World Health Organization Surgical Safety Checklist. CONCLUSION: Complications decreased by 57% after intervention. Both high patient information detection and elevated levels of cooperation by surgical personnel were observed. Compliance likely helped prevent some adverse effects associated with surgery.

Microbial contamination and the sterilization/disinfection of surgical guides used in the placement of endosteal implants.

PURPOSE: The purpose of this study was twofold: (1) to estimate the level of microbial contamination found on commercial guides (CG) and in-house laboratory guides (LG) prior to use, and (2) to evaluate the antimicrobial potential of disinfectants commonly used in dentistry to decontaminate heat-sensitive surgical guides. Ethylene oxide gas was used as the positive control; sterile water served as a negative control. MATERIALS AND METHODS: Evaluation of CGs and LGs for bacterial contamination occurred soon after their arrival in the laboratory. Some guides went directly into tubes of trypticase soy broth solution, vortexed and equally divided into two tubes. One tube went into an 80°C bath for 19 minutes, while the other stayed at room temperature. After plating, half of the samples underwent anaerobic incubation. All incubation was for 48 hours at 37°C. Other guides underwent water rinsing or disinfection by various methods for 5 or 15 minutes or ethylene oxide gas sterilization prior to sampling. RESULTS: Untreated CG specimens showed modest levels of bacterial contamination, with most colonies coming from liquid specimens not exposed to 80°C. LG specimens had more bacteria from both heat-treated and non-heat-treated aliquots. Chlorhexidine gluconate, diluted bleach, and water rinsing were not able to completely eliminate microorganisms on the specimens, but no viable microorganisms were present on specimens treated with gas sterilization or 70% ethanol for 15 minutes. CONCLUSION: CGs and LGs, on average, had different levels of bacterial contamination prior to disinfection. Water, chlorhexidine gluconate, and diluted bleach were not totally successful in decontaminating the surgical guides, but no growth was found after 15 minutes of immersion in 70% ethanol. Preferably, surgical guides should be submerged in 70% alcohol for a minimum of 15 minutes or undergo sterilization using ethylene oxide gas.