Mehrdad Askarian

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.

The prevalence of needle stick injuries in medical, dental, nursing and midwifery students at the university teaching hospitals of Shiraz, Iran

BACKGROUND Medical, dental, nursing and midwifery students are at high risk for occupational exposure to blood-borne pathogens (BBPs) via sharp injuries such as needle stick injuries (NSIs). AIMS The aim of this study was to determine the frequency of NSIs and the knowledge, attitude and practices of these students regarding their prevention. SETTINGS AND DESIGN The clinical students at Shiraz University of Medical Sciences, Iran, were eligible to participate in a survey conducted by a self-administered questionnaire in 2004, asking them about NSIs during their clinical training undergraduate years. MATERIALS AND METHODS A cross-sectional study evaluated NSIs and practices regarding protective strategies against BBPs in medical, dental, nursing and midwifery students at Shiraz University, Iran, in 2004. These students completed a self-administered questionnaire. STATISTICAL ANALYSIS The data were entered into a personal computer using Epi-Info (version 2000). Chi-square and Fishers exact tests for categorical variables and student t-test for continuous variables were performed, where appropriate, using SPSS version 10. Alpha was set at the 5% level. RESULTS The questionnaire was completed by 688 (53%) students. 71.1% (489/688) of the students had NSIs that most commonly (43.6%) occurred in patient rooms. 82% (401/489) of NSIs were not reported. 87.8% (604/688) of the students received information about standard isolation precautions and 86.2% of them had been vaccinated against hepatitis B. CONCLUSION NSIs and non-reporting of NSIs were highly prevalent in these students. Education about the transmission of blood-borne infections, standard precautions and increasing availability of protection strategies must be provided.

Knowledge, attitudes, and practices of food service staff regarding food hygiene in Shiraz, Iran.

BACKGROUND The practice of safety measures by the food service staff in hospitals is necessary for the prevention of food-borne outbreaks. Hospitalized patients are more vulnerable to potential hazards, and neglecting these principles can lead to increased morbidity and mortality. METHODS We assessed the knowledge, attitudes, and practices of food service staff regarding food hygiene in government and private hospitals in Shiraz, Iran. Two questionnaires were designed, one for food service staff and the other for supervisors. Thirty-one hospitals were approached, and the response rate was 99.5%. Four models were developed regarding knowledge, attitudes, and practices, and a multiple logistic regression analysis was performed. Comparison among the government and private hospitals was done. RESULTS This study showed that personnel had little knowledge regarding the pathogens that cause food-borne diseases and the correct temperature for the storage of hot or cold ready-to-eat foods. Older personnel had better attitudes and practices. Females practiced safety measures less often than did males. Personnel working in hospitals with fewer than 300 beds also had better practices. Most of the personnel had positive attitudes, but disparity between attitude and practice was noted. CONCLUSION There is a dire need for education and increased awareness among food service staff regarding safe food handling practices.

National nosocomial infection surveillance system–based study in Iran: Additional hospital stay attributable to nosocomial infections

BACKGROUND Nosocomial infection is a serious health and financial problem. The purpose of this study was to determine the extra hospital stay attributable to nosocomial infections for patients undergoing surgery. METHOD All patients undergoing surgery admitted from March 1, 1999, to February 28, 2000, to the 38-bed general surgery ward within a university hospital in Shiraz, Iran, were included in this study. The study was planned as a pairwise-matched case-control study nested in cohort design. A case was defined as any patient with 1 of 4 of the following nosocomial infections: urinary tract infection; surgical site infection; bloodstream infection; or pneumonia, whereby definitions for the nosocomial infections were on the basis of National Nosocomial Infection Surveillance system definitions. For each patient, an appropriate match was selected, which resulted in 69 pairs of study patients. RESULTS The total incidence of nosocomial infection during the study period was 17.59%. The mean extra length of hospitalization as a result of all major kinds of nosocomial infections was 6.62 days total, which was obtained using 4.4, 5.33, 8.73, and 9.2 extra days for urinary tract infection, pneumonia, surgical site infection, and bloodstream infection, respectively. CONCLUSION Nosocomial infections add considerable costs to the health care system in Iran. Therefore, the development of strategies and concepts to reduce the incidence of nosocomial infections is cost-effective and warranted, and an appropriate surveillance system on the basis of international criteria is the cornerstone for this task.

Epidemiology of burns presenting to an emergency department in Shiraz, South Iran

A retrospective study of 1493 burn patients attending the Ghotbeddin emergency burn center in Shiraz, South Iran during the 1 year period 2001-2002 was undertaken in order to describe the epidemiological features of burns in Shiraz. The following results were obtained: the mean age of attendees was 21.84+/-19.05 with an overall male to female ratio of 1.12. 41.2% of patients were children under 15 years with a M/F ratio of 1.36. The main causes of burns were scalds (53%) followed by flame (25%). The frequency of scalds was much higher among children (70%). The majority of accidents (81%) occurred at home, 5.2% occurred in workplace and domestic accidents were more frequent among women. The mean total body surface area (TBSA) burned was 7.4+/-14.3%. Extensive TBSA had a significant association with flame burns and sex, showing that female patients have higher risk for more extensive burns. Finally, there was a significant seasonal variation for burns, with most burns occurring in winter months.

A total quality management approach to healthcare waste management in Namazi Hospital, Iran.

BACKGROUND Healthcare waste comprises all wastes generated at healthcare facilities, medical research centers and laboratories. Although 75-90% of these wastes are classified as household waste posing no potential risk, 10-25% are deemed to be hazardous, representing a potential threat to healthcare workers, patients, the environment and even the general population, if not disposed of appropriately. If hazardous and non-hazardous waste is mixed and not segregated prior to disposal, costs will increase substantially. Medical waste management is a worldwide issue. In Iran, the majority of problems are associated with an exponential growth in the healthcare sector together with low- or non-compliance with guidelines and recommendations. The aim of this study was to reduce the amounts of infectious waste by clear definition and segregation of waste at the production site in Namazi Hospital in Shiraz, Iran. MATERIALS AND METHODS Namazi Hospital was selected as a study site with an aim to achieving a significant decrease in infectious waste and implementing a total quality management (TQM) method. Infectious and non-infectious waste was weighed at 29 admission wards over a 1-month period. RESULTS Before the introduction of the new guidelines and the new waste management concept, weight of total waste was 6.67 kg per occupied bed per day (kg/occupied bed/day), of which 73% was infectious and 27% non-infectious waste. After intervention, total waste was reduced to 5.92 kg/occupied bed/day, of which infectious waste represented 61% and non-infectious waste 30%. The implementation of a new waste management concept achieved a 26% reduction in infectious waste. CONCLUSION A structured waste management concept together with clear definitions and staff training will result in waste reduction, consequently leading to decreased expenditure in healthcare settings.

Knowledge, attitude, and practices related to standard precautions of surgeons and physicians in university-affiliated hospitals of Shiraz, Iran

Summary Objective To measure levels of knowledge, attitudes, and practice toward standard precautions (SP) in medical practitioners of Shiraz University of Medical Sciences affiliated hospitals in Iran. Method In this cross-sectional study, knowledge, attitude, and practice related to SP among four medical staff groups – surgeons, surgical residents, physicians and medical residents – were assessed using a questionnaire. Results Across the four medical staffing groups the median levels of knowledge ranged from 6 to 7 (maximum score 9), median attitude scores were high ranging from 35 to 36 (maximum score 45), while median practice scores were low, ranging from 2 to 3 (maximum score 9). A moderate relationship between knowledge and attitudes was found in surgical residents and medical residents (r =0.397, p =0.030 and r =0.554, p =0.006, respectively). No significant correlation was found between knowledge and practice between the groups. A significant but poor (r =0.399, p =0.029) relationship between attitude and practice was found in surgical residents. Conclusion Specific training programs may have to target newly graduated medical practitioners to establish acceptance of appropriate practices that will enable them to adopt and adhere to SP while their older counterparts may require more intense continuous assistance.

Knowledge, practice, and attitude among Iranian nurses, midwives, and students regarding standard isolation precautions.

Our goal was to assess the knowledge, attitudes, and practices regarding infection control and standard precautions among a group of nursing and midwifery instructors and students in Iran. A survey questionnaire was completed by 273 nursing and midwifery instructors and students at Shiraz University Medical Sciences during the period from May to November 2002. Two hundred thirty-one (90.9%) of the participants reported that they needed additional infection control education, especially on standard isolation precautions. There was a linear positive correlation between knowledge, practice, and attitude scores for the group of nursing, auxiliary nursing, and midwifery instructors, as well as their students (P<.05). Our study shows that there is an urgent need for evaluating education on infection control practices and standard precautions in general, as well as for structured infection control programs among nursing and midwifery staff.

The use of artificial neural networks and multiple linear regression to predict rate of medical waste generation

Prediction of the amount of hospital waste production will be helpful in the storage, transportation and disposal of hospital waste management. Based on this fact, two predictor models including artificial neural networks (ANNs) and multiple linear regression (MLR) were applied to predict the rate of medical waste generation totally and in different types of sharp, infectious and general. In this study, a 5-fold cross-validation procedure on a database containing total of 50 hospitals of Fars province (Iran) were used to verify the performance of the models. Three performance measures including MAR, RMSE and R(2) were used to evaluate performance of models. The MLR as a conventional model obtained poor prediction performance measure values. However, MLR distinguished hospital capacity and bed occupancy as more significant parameters. On the other hand, ANNs as a more powerful model, which has not been introduced in predicting rate of medical waste generation, showed high performance measure values, especially 0.99 value of R(2) confirming the good fit of the data. Such satisfactory results could be attributed to the non-linear nature of ANNs in problem solving which provides the opportunity for relating independent variables to dependent ones non-linearly. In conclusion, the obtained results showed that our ANN-based model approach is very promising and may play a useful role in developing a better cost-effective strategy for waste management in future.

Assessment of knowledge, attitudes, and practices regarding isolation precautions among Iranian healthcare workers

We conducted a survey of 1,048 healthcare workers (HCWs) at 8 Iranian hospitals regarding knowledge, attitudes, and practices related to isolation precautions. We found 75% below acceptable safety levels. Routine handwashing before and after glove use was reported by fewer than half of the HCWs.