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.

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%.

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.

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.

The in vivo contamination of air-driven low-speed handpieces with prophylaxis angles.

BACKGROUND: The authors conducted an in vivo study to determine if low-speed handpiece motors can become contaminated with oral flora when used with prophylaxis angles. METHODS: This crossover study involved 20 subjects, two types of handpieces and three prophylaxis angles. The authors used each handpiece/prophylaxis angle system to polish teeth. They then collected samples, spiral-plated the specimens and incubated them at 37 degrees C anaerobically and aerobically (with 5 percent carbon dioxide). After incubation, the authors examined the plates for the presence of bacterial colonies. RESULTS: At least 75 percent of the handpiece/prophylaxis angle systems used on the 20 subjects had bacterial contamination for at least one cultured area. Of the 420 specimens, 258 (61.4 percent) produced bacterial growth. Contamination varied from zero to 6,300 colony-forming units per milliliter. CONCLUSIONS: These data suggest that the internal surfaces of low-speed handpieces can become microbially contaminated during use with prophylaxis angles. CLINICAL IMPLICATIONS: Unless low-speed handpieces are sterilized properly after each use, they pose a risk for crossinfection.

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.

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, attitude, and practice toward contact isolation precautions among medical students in Shiraz, Iran.

BACKGROUND: Proper behavior regarding infection control may be learned during clinical training for medical students. METHODS: Different groups of medical students at the Shiraz Medical School were asked to complete a questionnaire. The survey had 2 components: demographic inquiries and questions designed to assess the knowledge, attitude, and practices regarding contact isolation precautions used in Iranian hospitals. RESULTS: A total of 468 (of 622) useable surveys were analyzed. Responses to knowledge and attitude questions concerning isolation precautions in general were acceptable as being in accordance with the CDC guidelines (Mean scores approximate 66.3% and 63.4% of the total possible scores, respectively). However, self-reporting behaviors indicated an overall lack of compliance with expected practices (approximately 19.1% of a total possible perfect score). CONCLUSION: This study suggests that knowledge of transmission routes and a positive attitude toward infection control measures alone are not sufficient to induce acceptable compliance (behavior) with current recommendations.

Internal contamination of air-driven low-speed handpieces and attached prophy angles.

BACKGROUND: In an in vitro crossover study, the authors investigated whether the interior of low-speed handpiece/prophy-angle systems becomes contaminated during operation and submersion into Geobacillus stearothermophilus. METHODS: This study involved two types of handpieces attached to eight brands of prophy angles. The researchers operated angles attached to sterile handpieces for 60 seconds. They then analyzed the inside surfaces of the angle, nosecone and motor. They tested each prophy angle and handpiece 10 times. RESULTS: In the 160 tests of handpieces contaminated at the prophy cup end, the spores traveled into the motor gears 32 times (20 percent). In the other 160 tests in which the motor gears were contaminated, the test bacterium traveled through the prophy cup in 75 instances (47 percent). CONCLUSIONS: The in vitro data suggest that low-speed handpiece motors can become contaminated internally during use with prophy angles. Also, internal contaminants appear to have been released from the handpiece. CLINICAL IMPLICATIONS: The results suggest that low-speed hand-pieces can become contaminated internally during use. Unless low-speed handpieces are sterilized properly between patients, they may become cross-contaminated.

Effects of delayed microbial analysis of dental unit water line specimens.

PURPOSE: Monitoring microbial concentrations in water emitted from dental unit water lines (DUWL) is an important safety procedure. Improper handling of test water specimens could give incorrect results. Thus, the objective of this study was to measure the effects delayed culturing might have on DUWL specimens. METHODS: First, 100 mL water specimens were obtained from 10 different handpiece service lines within the School. All units had independent water systems, used DI (deionized water) water and were routinely cleaned using an alkaline peroxide based product. Two specimens of 10 mL were removed from the bottles and placed into individual sterile conical tubes. One set of tubes was processed immediately. 0.05 mL of sterile 1.0% (w/v) sodium thiosulfate solution was added to undiluted and diluted (1:10 and 1:100 with sterile DI water) specimens. After mixing, specimens were spiral plated onto duplicate R2A plates and incubated at 21degrees C for 7 days. Colonies were then counted and the cfu/mL of each original specimen determined. Another set of tubes was placed into a shipping envelope and mailed out to the School. Upon receipt, the tubes were processed as described above. The remaining 80 mL of water in the collection bottles were divided equally into new sterile tubes. One tube was left at 21 degrees C, while the other was placed into a 37 degrees C incubator. Aliquots were processed immediately and then after 1, 3 and 7 days. Next, 30 mL water specimens were obtained from 15 handpiece service lines in three outside clinics. All units had independent water systems, used DI water and were routinely cleaned with an alkaline peroxide-based product. Specimens were then divided equally into three sterile conical tubes. One of the tubes was transported (at 4 degrees C) to the laboratory and immediately processed as described. At the collection site, the second tube was placed into a padded envelope and mailed back to the School. The third tube was returned by overnight delivery using a Cool Pack type container. Upon receipt, all the tubes were processed as described previously. RESULTS: The 10 handpiece waterline specimens processed immediately ranged from 0 to 1000 cfu/mL. Holding specimens at 21 degrees C produced radically higher bacterial counts (1540-866,000 cfu/mL) in water from 90% of the handpieces. Holding at 37 degrees C produced unacceptably high bacterial counts in only 50% of the handpiece specimens. Mailed specimens were cultured 5 days after collection and water of unacceptable quality water was noted in 70% of the specimens. In another experimental set, mailed specimens arrived after 72 hours and were an average of 20 degrees C. Express sent specimens came the next morning at an average temperature of 4.5 degrees C. Only one waterline specimen processed immediately contained more than 500 cfu/mL. In contrast, 80% of specimens returned by post at ambient temperature had unacceptably high bacterial counts (780-376,000 cfu/mL). Express sent specimens produced the same results as those processed immediately.

Environmental surface asepsis.

Environmental surface disinfection is easily accomplished with precleaning and disinfection techniques, and prepared surfaces or difficult-to-clean items can be covered with impermeable barriers. When carried out effectively, both practitioners and patients are protected from exposure to microorganisms that transmit disease and cause illness.

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.

The effect of distillation and line cleaning on the quality of water emitted from dental units.

PURPOSE: To monitor water emitted from dental units connected to centralized water distillation units fitted with reservoirs for dispensing chemicals designed to control biofilms. METHODS: Three private practice dental offices participated in the study. None of the office operatories had independent water reservoir (bottle) systems or any other type of water treatment equipment. Initially, 5.0 mL water specimens were obtained from the handpiece and three-way syringe service lines as well as from the sink faucets in three operatories in each office. Specimens were collected at the end of the workweek. Specimens were neutralized for residual chlorine, diluted and spiral plated onto R2A agar. Aerobic incubation was allowed for 7 days at 21 degrees C. Numbers of colonies were then determined and expressed as CFU/mL. If water specimens containing more than 200 CFU/mL were detected, the offices were equipped with water distillers with attached cleaning solution dispensers. The units allowed distilled water to move under normal pressure to all connected dental units. When cleaning, the distillers were inactivated, which allowed cleaning fluid to move under pressure from the dispensers through all unit waterlines. The waterline-cleaning scheme followed the manufacturer recommendations. The presence of no more than 200 CFU/mL in emitted water was then established and a regimen of weekly cleanings applied for 3 weeks. Water specimens were always collected on the last workday of the week. Then, cleaning was suspended and weekly monitoring performed. Cleaning was restored immediately after detection of more than 200 CFU/mL. RESULTS: Levels of microbial contamination prior to the initiation of cleaning indicated marked variability (720-332,000 CFU/mL) and that water containing less than 200 CFU/mL was not being emitted from any operatory water source. However, sought-after water was consistently obtained over a period of 3 weeks from all unit sources after line-cleaning processes were completed. Water containing less than 200 CFU/mL was obtained from all unit sources in the three offices after skipping of one weekly cleaning. In one office, cleaning was suspended for 3 weeks without affecting water quality. Resumption of weekly cleanings produced desirable water from all sources in the three offices within 2 weeks. Results indicate that dental units attached to centralized combined water distillation-cleaning solution distribution systems can produce water with less than 200 CFU/mL and that the missing of one weekly cleaning did not negatively affect water quality.