Iran University of Medical SciencesInternational Journal of Hospital Research2251-89405120160301Awareness towards Occupation Exposure among Health Care Workers of a Tertiary Care Hospital: A KAP Survey1617277ENBineeta KashyapDepartment of Microbiology, Maulana Azad Medical College & َAssociated Lok Nayak Hospital, New Delhi, India0000-0003-2471-4078Shilpi GuptaDepartment of Microbiology, Maulana Azad Medical College & َAssociated Lok Nayak Hospital, New Delhi, IndiaJournal Article20160809<strong>Background and Objectives: </strong>Health care workers are under constant exposure to the risk of ooccupational blood-borne infection, which most of the time can be avoided by observing standard precautions. The aim of this study was to assess the knowledge, attitude and practices of health care workers of a sample tertiary care hospital towards occupational exposure to blood-borne pathogens.<br /> <br /><strong>Methods: </strong>A cross sectional study was carried out among health care workers of a 2500 bedded tertiary care hospital. The study instrument was structured and pretested questionnaire designed to measure the knowledge, attitude and practices of the participants towards occupational exposure.<br /> <strong>Findings: </strong>Among the 380 respondents 22.63% gave history of sustaining NSI in the preceding 1 year. The commonest clinical activity to cause NSI among doctors was blood sampling (37.5%) followed by re-capping of needles (31.3%). Although 70.5% of the participants were aware of the immediate step to be followed after NSI, only 47.36% gave partial correct answer to the questions regarding the number of diseases transmitted by NSI, and 44.2% had the correct knowledge about the Post Exposure Prophylaxis (PEP) facilities available in the hospital.<br /> <br /><strong>Conclusions: </strong>The prevention of transmission of blood-borne pathogens among health care workers requires an education-centric approach and a comprehensive infection control protocol along with strict compliance with the practices within the health care delivery system.Iran University of Medical SciencesInternational Journal of Hospital Research2251-89405120160301Safety Considerations on MRI Systems for Firefighters and Paramedics71217278ENGeorg SchmidtAlfred Nobel Open Business School, AustriaJournal Article20160809<strong>Background and Objectives:</strong> The use of Magnetic Resonance Imaging (MRI) systems is on the rise and the number of installed systems is constantly increasing all over the world. This raises the possibility for emergency personnel to get in contact with these systems. However, the clothing and working material of paramedics and firefighters is not designed for the use on magnets. More research is needed to gain a deeper understanding of the risks for emergency personnel, working on MRI systems. Therefore, this study examined the effects of magnetic force on selected working materials and clothes of firefighters and paramedics. <br /><strong>Methods:</strong> This study was conducted as a field study, utilising a 1.5 tesla MRI system. Selected items were examined on their behavior in the magnetic field and the following parameters were measured: (i) the force of attraction and (ii) the distance to the magnet when a force of attraction is recognisable. Manual force meter and a wooden distance meter were used to measure the parameters. <br /><strong>Findings:</strong> The highest force of attraction can be researched in helmets (30 newton), boots (90 newton) and gloves (17 newton). The measured force is high enough to pull these items into the magnet. Jackets and pants did not receive a high force of attraction. Working material can be influenced by eddy currents, according to the composition. The movement of the item can then be restricted. <br /><strong>Conclusions:</strong> Considering the results of this study, most of the clothing and working materials can be considered as MRI safe. However, the force of attraction of boots and helmets might be high enough to cause serious distraction for emergency personnel. There might be a high risk for emergency personnel to forget small items in their pockets which subsequently can act as dangerous projectiles. Additional tests might display the need for an independent MRI system. There is a high risk to damage the system (e.g. to break the cover by attracted objects) and hospitals might not be willing to take the risk in the future. Iran University of Medical SciencesInternational Journal of Hospital Research2251-89405120160301Compliance of General Health Clinics to National Licensure Standards: A Survey in Northwestern Iran131617544ENJafar Sadegh TabriziHealth Services Management Research Center, School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, IranFarid GharibiIranian Center of Excellence in Health Management (IceHM), School of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, IranMaryam EbrahimnejadSchool of Management and Medical Informatics, Tabriz University of Medical Sciences, Tabriz, IranJournal Article20160815<strong>Background and Objectives: </strong>Monitoring of health organizations by the regulatory bodies is crucial to ensure high performance of health system. Although Iranian health settings are monitored by the MOHME in various ways, periodic evaluation of their continuous commitment to the national licensure standards in health domain is rare. The aim of the present study was to highlight the important of such evaluations by auditing the general health clinics of Tabriz (a metropolitan city in Northwestern Iran) based on national licensure standards.<br /> <br /><strong>Methods: </strong>This across-sectional study surveyed all general health settings in Tabriz city. The data were collected using a validated researcher-made checklist. The collected data were summarized using descriptive statistical methods. The mean values were compared by t-test and ANOVA.<br /> <strong>Findings: </strong>The score of compliance to national licensure standards averaged at 70.5%. The highest level of compliance was observed for <em>medical and non-medical devices</em> dimension (78.2%) whereas the loest compliance was recorded for <em>hygiene</em> dimension (58.4%). Public clinics showed a significantly higher compliance to standards compared to the private settings (P < 0.05). Also a significant difference in total compliance score was identified between clinics with >and <br /><strong>Conclusions: </strong>The level of current compliance of the surveyed clinical settings shows room for considerable improvement. Private health settings and the <em>hygiene</em> domain are the primary targets of focus for monitoring and intervention. Our results encourage further national-wide studies to gain a comprehensive view of the compliance of Iranian clinics to the licensure standards.Iran University of Medical SciencesInternational Journal of Hospital Research2251-89405120160301A Risk for Nosocomial Infections: Contamination of Hospital Air Cooling Systems by Acantamoeba spp.172117279ENMahdi MosayebiDepartment of Parasitology, School of Medicine, Arak University of Medical Sciences, Arak, IranReza HajihosseinDepartment of Parasitology, School of Medicine, Arak University of Medical Sciences, Arak, IranBehzad GhorbanzadehDepartment of Parasitology, School of Medical Sciences, Tarbiat Modarres University, Tehran, IranSaba KalantariDepartment of Occupational Health Engineering, School of Public Health, Tehran University of Medical Sciences, Tehran, IranJournal Article20160809<strong>Background and Objectives: </strong>In the most Iranian hospitals the internal air is cooled by a system comprising centrifugal blower fan and excelsior filters. Because amoeba can be present in air and dust it may enter into filters of cooling systems. It has been suggested that diffusion of amoebae cyst through air canals may contribute to various types of nosocomial infections. This study thus aimed to examine the possible contamination of filters of the conventional hospital cooling systems with free-living amoebae.<br /> <br /><strong>Methods:</strong> Eighty four cooling systems from four hospitals in Arak City (Central Iran) were sampled. Samples were cultured in defined medium and were tested from presence of <em>Acanthamoeba </em>spp.<br /> <strong>Findings:</strong> Ten out of the 18 hospital wards/sites and 23 out of 84 cooling systems surveyed (27.3%) were found to be contaminated by amoebae.<br /> <br /><strong>Conclusions: </strong>Our results indicate a significant level of amoebae cysts contamination of cooling systems with excelsior filters in various hospital wards. Given the potential contribution of cyst to nosocomial infection, a prompt addressing of the problem is warranted. This may partly be accomplished by using non-aqueous or closed circulation cooling systems. Our study also highlights the need for similar investigations in other health settings and in larger scales to gain insight into the extent of the problem and the associated risks.Iran University of Medical SciencesInternational Journal of Hospital Research2251-89405120160301The Efficacy of Therapeutic Angiogenesis Using basic Fibroblast Growth Factor in Patients with Coronary Artery Disease: A Double-Blind, Placebo-Controlled Study222817282ENHossein AhmadiDepartment of Cardiac Surgery, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, IranArmita MahdaviClinical Research Center, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, IranMorteza DaliriDepartment of Animal and Marine Biotechnology, National Institute of Genetic Engineering and Biotechnology, Tehran, IranMohammad ImaniIran Polymer and Petrochemical Institute, Tehran, IranAbbasali Karimi KarimiDepartment of Cardiac Surgery, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, IranAbbas Salehi OmranDepartment of Cardiac Surgery, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, IranMehdi NajafiDepartment of Anesthesiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, IranMohsen AhmadiClinical Research Center, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, IranFarhad FathiClinical Research Center, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, IranPegah BikdeliClinical Research Center, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, IranPayam MohammadinejadClinical Research Center, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, IranJournal Article20160809<strong>Background and Objectives:</strong> Complete revascularization is not possible in up to 37% of patients with coronary artery disease (CAD). Therapeutic angiogenesis may be considered as an option in the management of these patients. The aim of the present study was to evaluate the effectiveness and safety of therapeutic angiogenesis using basic fibroblast growth factor in patients with CAD.<br /> <br /> <br /><strong>Methods:</strong> In this double-blind, placebo-controlled study, eighteen patients with a severe diffuse atherosclerotic disease along the left anterior descending (LAD) artery who were a CABG candidate with at least one graftable coronary artery and the presence of ischemia and viable areas along the LAD were enrolled. The patients were randomized into two groups to either undergo CABG and simultaneous FGF-2 therapy (bFGF group) or CABG without FGF-2 therapy (control group). During the CABG procedure in bFGF group, FGF-2/alginate-heparin-sepharose microcapsules, each contains 100 mcg FGF-2, were implanted in the subepicardial layer of the diffusely defective LAD territory via 2-3 mm stab incisions. Seven patients in each group were followed up for a period of 24 months. <br /> <br /> <strong>Findings:</strong> The result of left ventricular evaluation with echocardiography and perfusion scans showed significant improvement in FGF-2-receiving group with no significant change in controls, 3 and 6 months after the intervention. New Yor; Heart Association (NYHA) class was significantly lower in the intervention group (1.43±0.535 vs. 2.57±.535, P = 0.002), In addition, intervention group remained free of angina 24 months after the intervention while three patients in the control group were hospitalized due to the acute chest pain.<br /> <br /> <br /><strong>Conclusions:</strong> Our study revealed that FGF-2 can improve the outcomes of patients with CAD undergoing CABG, without serious adverse effects. Considering other advantages associated with protein therapy our finding may help open novel avenues to safe and cost-effective therapy of the target patients.Iran University of Medical SciencesInternational Journal of Hospital Research2251-89405120160301High Ergonomic Risk of Computer Work Postures Among Iranian Hospital Staff: Evidence From a Cross-Sectional Study293442443ENMohammad KhandanOccupational Health Department, Health Faculty, Qom University of Medical Sciences, Qom, IranZahra ArabDepartment of Ergonomics, University of Social Welfare and Rehabilitation Sciences, Tehran, IranAlireza KoohpaeiOccupational Health Department, Health Faculty, Qom University of Medical Sciences, Qom, IranJournal Article20170130<strong>Background and objectives</strong>: Non-ergonomic computer work has emerged as a significant cause of musculoskeletal disorders among employees of health care organizations. Given the negative impact of such disorders on quality of work life, safety, and performance of hospital staff, there is a need to evaluate the exposure of this staff to the ergonomic risks associated with the computer-based jobs.
<strong>Methods</strong>: A sample of 150 computer user employees from two hospitals in Qom (Central Iran) was surveyed. Musculoskeletal disorder data was collected by standardized Nordic Musculoskeletal Questionnaire (NMQ). The postural states of the participants were assessed using Novel Ergonomic Postural Assessment Method (NERPA) and Rapid Office Strain Assessment (ROSA). Data were summarized by descriptive statistical methods. The correlation between categorical variables was examined by Chi-square test.
<strong>Findings</strong>: Among the total sample, 76.7% had administrative tasks, 20% were nurse and the rest were secretary of wards. Almost all participants (94%) reported work-related pain at least in one of their body limbs in the past year. Pain in neck was the most frequent (70%) musculoskeletal symptom, followed by pain in lower (62%) and upper back (55.3%), respectively. While most postures as assessed by NERPA were at medium level of ergonomic risk (left-hand, 74.7% and right hand, 69.3%), significant fraction of postures were highly risky (left-hand, 24% and right hand, 29.3%). Also ROSA recorded undesirable ergonomic score for 87.3% of the participants. Postures related to seat showed the higher frequency of undesirable scores (86.7%), followed postures associated with the use of peripherals (44%) and mouse/keyboard (26.7%), respectively. The highest frequency of inappropriate ergonomic postures as identified by both methods was observed among administrative staff. Statistical test found significant correlation between risky ergonomic postures and musculoskeletal problems (P < 0.05).
<strong>Conclusions</strong>: Our study revealed the significant ergonomic risk associated with postural states of hospital employees working in computer workstations. Our results highlight the need for further large-scale studies to identify the extent of this occupational hazard throughout the country. Given the negative impact of musculoskeletal disorders on performance of hospital personnel and thereby patient safety, possible confirmation of widespread computer-related non-ergonomic postures will require urgent intervention.Iran University of Medical SciencesInternational Journal of Hospital Research2251-89405120160301Identification of Determinant Factors of Health-Related Quality of Life in Iranian Urban Population354042444ENSajad VahediHealth Management and Economics Research Center, Iran University of Medical sciences, Tehran, IranAziz RezapourSchool of Health Management and Information Sciences, Iran University of Medical sciences, Tehran, IranMasoud ArefnezhadDepartment of Healthcare Management, Zabol University of Medical Sciences, Zabol, IranSajad LakDepartment of Health Care Management, School of Medicine, Science and Research Branch, Islamic Azad University, Tehran, IranFatemeh BastamiDepartment of Health Education and Promotion, Faculty of Health, Isfahan University of Medical Sciences, Isfahan, IranJournal Article20170130Iran University of Medical SciencesInternational Journal of Hospital Research2251-89405120160301Designing a Public-Private Partnership Model for Public Hospitals in Iran414517283ENMehdi BarzegarHealth Services Management Department, Islamic Azad University, Science and Research Branch, Tehran, IranSeyed Jamaledin TabibiDepartment of Health Services Administration, Science and Research Branch, Islamic Azad University, Tehran, IranMohammad Reza MalekiSchool of Management and Medical Information, Iran University of Medical Sciences, Tehran, IranAmir Ashkan NasiripourHealth Services Management Department, Islamic Azad University, Science and Research Branch, Tehran, IranJournal Article20160809<strong>Background and Objectives</strong>: Public-Private Partnership (PPP) is a well-established model to alleviate the risk of investment in health domain. While the model is widely applied in the developed countries, the adoption of the model in many developing countries is hampered partly by the lack of knowledge on dimensions and requirements of its local implementation. The present study, thus, aimed to identify the key aspects of PPP for hospital building in an Iranian context.<br /> <br /><strong>Methods: </strong>A comparative study of PPP implementation in seven pioneer countries revealed 53 elements potentially influencing development of PPP. Using rigorous expert opinion seeking, these elements were refined and adapted with respect to the Iranian context. Based on this information a 38-item questionnaire was designed. The questionnaire was distributed among 220 experts from different health domains, including clinicians of public and private hospitals and policy makers, executives, and authorized advisors from MOHME and various medical universities. The collected data were analyzed using exploratory factors analysis in order to identify factors influencing PPP development. The robustness of the identified factors was further explored by confirmatory factor analysis.<br /> <strong>Findings: </strong>Legislation, policy making, finance, capacity building, and social orientation were identified as the five key dimensions of hospital-building PPP implementation in the Iranian context.<br /> <br /><strong>Conclusions:</strong> Identification of the major dimensions of hospital PPP implementation may help policy-makers to develop effective strategies for promotion of PPP in the Iranian health system.