Prevalence of Vancomycin-Resistant Enterococci colonization and its risk factors in chronic hemodialysis patients in Shiraz, Iran

<p>Abstract</p> <p>Background</p> <p>Vancomycin-resistant entrococci (VRE) are increasing in prevalence at many institutions, and are often reported in dialysis patients. The aim of this cross-sectional prevalence study was to determine the prevalence and risk factors of VRE colonization in chronic hemodialysis patients in two hemodialysis centers in Shiraz, Iran.</p> <p>Methods</p> <p>Rectal swabs were obtained from all consenting patients and were streaked on the surface of Cephalexin-aztreonam-arabinose agar (CAA) and incubated at 37°C in air for 24 h. The vancomycin susceptibility of each isolate was confirmed by disk susceptibility testing. The MICs of vancomycin and teicoplanin were confirmed by the E test. To identify risk factors, a questionnaire was completed for all the studied patients and the data of VRE positive and negative groups were compared using Man-Withney U test for continues data and the Fisher exact test for categorical data.</p> <p>Results</p> <p>Of 146 patients investigated, 9 (6.2%) were positive for VRE. All VRE strains were genotypically distinguishable. Risk factors for a VRE-positive culture were "antimicrobial receipt within 2 months before culture" (P = 0.003) and "hospitalization during previous year" (P = 0.016).</p> <p>Conclusion</p> <p>VRE colonization is an under-recognized problem among chronic dialysis patients in Iran. VRE colonization is associated with antibiotic consumption and hospitalization.</p

Adherence to facility management and safety standards in Shiraz hospitals, Iran

Abstract   Background: Evaluate the adherence to facility management and safety standards among governmental and non-governmental hospitals in Shiraz, Iran.  Methods: In this cross sectional study, 22 hospitals of the 33 hospitals in Shiraz, Iran including 13 governmental and 9 non-governmental facilities were surveyed. A 74-item self-administered questionnaire was used. Collected data were entered to SPSS Version 15.0 software. The level for statistical significance was set at 0.05.  Results: Adherence to facility management and safety standards was 65.17% in governmental and 72.79% in non-governmental hospitals. Compliance by governmental hospital in the areas of leadership and planning, safety and security, emergency management, medical equipment, utility system and staff education ranged from 60% to 86%. However, hazardous materials and fire safety adherence was below 50%. For non-governmental hospitals standard compliance for all areas ranged from 60% to 86%. Compliance rates between governmental and non-governmental hospitals in the areas of hazardous materials and staff education standards were statistically significantly different (p=0.02 and p=0.05 respectively).  Conclusions: To achieve more effective functional health care services, additional studies must be undertaken to assess the nature and extent of problem areas that exist in planning, implementing and monitoring of facility management and safety programs

Prevalence of needle stick injuries among dental, nursing and midwifery students in Shiraz, Iran

Background: The risk of occupational exposure to blood borne pathogens (including hepatitis B, hepatitis C and HIV) via sharp injuries such as needle stick injuries (NSIs) among health care workers, especially dental, nursing and midwifery students is a challenging issue. Inadequate staff, lack of experience, insufficient training, duty overload and fatigue may lead to occupational sharp injuries. The aim of this prospective cross-sectional study was to evaluate the frequency of NSIs in Iranian dental, nursing, and midwifery students and their knowledge, attitude and practices regarding prevention of NSIs

The Spatial Distribution of Cancer Incidence in Fars Province: A GIS-Based Analysis of Cancer Registry Data

Background: Cancer is a major health problem in the developing countries. Variations of its incidence rate among geographical areas are due to various contributing factors. This study was performed to assess the spatial patterns of cancer incidence in the Fars Province, based on cancer registry data and to determine geographical clusters. Methods: In this cross sectional study, the new cases of cancer were recorded from 2001 to 2009. Crude incidence rate was estimated based on age groups and sex in the counties of the Fars Province. Age standardized incidence rates (ASR) per 100,000 was calculated in each year. Spatial autocorrelation analysis was performed in measuring the geographic patterns and clusters using geographic information system (GIS). Also, comparisons were made between ASRs in each county. Results: A total of 28,411 new cases were diagnosed with cancer during 2001 2009 in the Fars Province, 55.5% of which were men. The average age was 61.6 ± 0.5 years. The highest ASR was observed in Shiraz, which is the largest county in Fars. The Moran\u27s Index of cancer was significantly clustered in 2004, 2005, and 2006 in total, men, and women. The type of spatial clustering was high high cluster, that to indicate from north west to south east of Fars Province. Conclusions: Analysis of the spatial distribution of cancer shows significant differences from year to year and between different areas. However, a clear spatial autocorrelation is observed, which can be of great interest and importance to researchers for future epidemiological studies, and to policymakers for applying preventive measures

Readmission Risk Factors in Patients of General Surgery Wards in Shiraz Hospitals: Applying LACE Index as a Predictive Indicator

Background: Today, the effective use of limited health care resources is increasingly regarded. Reduction of&nbsp;the readmission is one of the key tools can improve health outcomes and considered as one of the control levers&nbsp;that reduces health costs. Identifying the causes of readmission to the hospital helps to utilize hospital beds and&nbsp;facilities a more efficiently.Methods: This case-control study had been conducted in general surgery (GS) wards in 2011-2012. Using chisquare test, t-test, and multiple regressions, we studied risk factors associated with readmission in both groups&nbsp;of case and control. Finally, the predictive power of the Length of stay, Acuity of illness, Co morbidity of the&nbsp;patient, Emergency (LACE) index was evaluated using receiver operating characteristic (ROC) curve.Results: About 20% of patients in GS wards were admitted within 30 days. There is a significant difference&nbsp;between the two groups in the following variables: age, sex, length of hospital stay, marital status, discharge&nbsp;season, congestive heart failure, diabetes and renal failure. The rate of readmission with LACE index which is&nbsp;compared with the ROC curve shows that it is significant (P &lt; 0.001 and Kappa = 0.22).Conclusions: Awareness of the prevalence and risk factors of readmission is effective in planning and decision&nbsp;making for using hospital facilities efficiently. Identifying patients at risk of readmission and erforming&nbsp;training plan, ischarging and following up medical programs can reduce the rate of readmission and costs of&nbsp;hospital. Predicting readmission can be very effective but identifying an effective index is very difficult

Prevalence of nasal carriage of methicillin-resistant Staphylococcus aureus and its antibiotic susceptibility pattern in healthcare workers at Namazi Hospital, Shiraz, Iran

SummaryObjectiveThe aim of this study was to determine the prevalence of nasal carriage of methicillin-resistant Staphylococcus aureus (MRSA) among healthcare workers (HCWs) at Namazi Hospital, Shiraz, Iran.MethodsThis cross-sectional study was conducted from July to November 2006. Nasal swabs were taken from 600 randomly selected HCWs. The isolates were identified as S. aureus based on morphology, Gram stain, catalase test, coagulase test, and mannitol salt agar fermentation. To analyze sensitivity patterns of MRSA strains more precisely, minimum inhibitory concentrations (MICs) of antibiotics were determined by the E-test method. All methicillin-resistant isolates were examined for the existence of the mecA gene by total DNA extraction and PCR.ResultsThe prevalence of nasal carriage of methicillin-sensitive S. aureus (MSSA) was 25.7% and of MRSA was 5.3%, with the highest nasal carriage of MRSA in surgical wards and the emergency department. There was no significant difference between the sexes (p=0.247), age (p=0.817), and years of healthcare service (p=0.15) with regard to the nasal carriage of MRSA and MSSA. In the univariate analysis, a statistically significant difference was only found for occupation (p=0.032) between the carriage of MSSA and MRSA. In the multivariate analysis, the occupation ‘nurse’ was independently associated with MRSA carriage (p=0.012, odds ratio 3.6, 95% confidence interval 1.3–9.7). The highest resistance rate for both gentamicin and clindamycin (69%) was noted among the MRSA strains. None of the MRSA strains were resistant to mupirocin, linezolid, fusidic acid, or vancomycin. The existence of the mecA gene in all 32 methicillin-resistant isolates was observed by PCR.ConclusionsThis study revealed the prevalence of nasal carriage of S. aureus strains among HCWs to be lower than that found in other studies from Iran. The antibiotic susceptibility patterns also differed, perhaps as a result of the excessive use of antibiotics at our hospital. Only the occupation of nurse was an independent risk factor for MRSA carriage

Adherence to informed consent standards in Shiraz hospitals: matrons’ perspective

Background: Informed consent is an important part of the patients’ rights and hospitals are assigned to obtain informed consent before any diagnostic or therapeutic procedures. Obtaining an informed consent enables patients to accept or reject their care or treatments and prevent future contentions among patients and medical staff. Methods: This survey was carried out during 2011-2. We assessed adherence of 33 Shiraz hospitals (governmental and non-governmental) to informed consent standards defined by Joint Commission International (JCI) Accreditation, USA. The questionnaire was designed using the Delphi method and then filled out by hospital matrons. We calculated valid percent frequency for each part of the questionnaire and compared these frequencies in governmental and non- governmental hospitals using analytical statistics. Results: Considering 63% of the hospitals that filled out the questionnaire, no statistically significant difference was observed between the governmental and non-governmental hospitals in adherence to informed consent standards. Conclusion: This study shows a relatively acceptable adherence to standards about informed consent in Shiraz hospitals but the implementation seems not to be as satisfactory

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

Medical error and under-reporting causes from the viewpoints of nursing managers : a qualitative study

Background: Patient safety as a goal can be achieved by reporting medical errors (ME); however, most errors are never reported. The aim of this study is to explore the causes of ME, and the obstacles in reporting them amongst nurses. Methods: We conducted semi-structural interviews, with 12 nursing managers in the biggest teaching hospital in southern Iran (2015-2016). The interview guide concentrated on the causes of ME and barriers in reporting them. All face-to-face interviews were recorded and transcribed verbatim and analysed using thematic analysis. Results: In this study 4 main themes were extracted for the causes of ME: personal/social characteristics, nonprofessional practice, hospital related factors/organization contextual factors, and poor management. Also, 5 main themes (such as; personal characteristics, fear from reporting, nonprofessional practices, cultural and social factors, and error surveillance system features) were obtained with regards to barriers in reporting. Conclusions: ME can be reduced by improving professional practice and better human resource management. Also, reporting errors can be increased by focusing on cultural and social factors