Iranian Healthcare Workers Research Articles

Iranian healthcare workers' perspective on hand hygiene: a qualitative study.

Hand hygiene (HH) has been identified as one of the simplest, but most important, methods to prevent cross-infection in healthcare facilities. In spite of this fact, the HH compliance rate remains low among healthcare workers (HCWs). Several factors may affect HH behavior. In this study, we aimed to assess various aspects of HH from the perspective of HCWs. This qualitative study was conducted in two hospital settings in Shiraz, Iran. Eight focus group discussions (FGDs) and six in-depth interview sessions were held with ICU and surgical ward nurses, attending physicians, medical and nursing students and supporting staff. Each FGD and interview was transcribed verbatim, open codes were extracted, and thematic analysis was conducted. Three themes emerged from the thematic analysis including: "the relationship between personal factors and HH compliance," "the relationship between environmental factors and HH compliance" and "the impact of the health system on HH adherence, including the role of adequate health systems, administrative obligations and the effect of surveillance systems." Several factors played a significant role in improving HCWs HH compliance, such as the regular adherence to health system tenets. HH compliance may be improved through application of realistic policies and better supervision. In addition, appropriate education may positively affect HH behavior and attitudes.

Determining the Latent Tuberculosis Infection by IFN - γ Elispot Assay in Healthcare Workers From University Hospitals of Shiraz, South West of Iran

BackgroundClassical screening methods are incapable to properly detect LTBI (Latent TB Infection) and HCWs (Healthcare Workers) are at the high risk of exposure. Only few reports estimated the prevalence of LTBI among Iranian HCWs and they mostly used the TST (Tuberculin Skin Test), rather than assessing the response against TB-specific antigens.ObjectivesThe current study aimed to determine the frequency of IFN - γ producing blood cells of microbiology and radiology ward technicians by an in-house IFN - γ ELISPOT assay in the University hospitals of Shiraz University of Medical Sciences (SUMS) against recombinant ESAT - 6 and PPD antigens.Materials and Methods89 HCWs from medical laboratory and radiology departments of Shiraz University of Medical Sciences’ hospitals, South of Iran, were screened for LTBI. To achieve the goal, an in-house IFN - γ (Interferon - gamma) ELISPOT (Enzyme Linked ImmunoSpot) assay was used to detect the reactivity against ESAT - 6 (Early Secreted Antigen Target protein - 6) and the PPD (Purified Protein Derivate).ResultsAlmost 8% of the personnel showed positive TST (over 10 mm) reaction while 29% of them had considerable T - cell reactivity against PPD in ELISPOT assays. However, the ESAT - 6 reactivity was found only in one case of HCWs. No correlation was found between the patterns of the reactions and the age or the duration of the employment or previous vaccination history of the participants. The ELISPOT results were not correlated with the TST results.ConclusionsConsidering the hindrance of TST, the IFN - γ ESAT - 6 ELISPOT assay, even in forms of in-house tests, could replace traditional methods to properly spot the LTBI among the high risk groups from Iran’s health system.

Hepatitis B Immunization in Health Care Workers: Needs and Opportunities

Hepatitis B Immunization in Health Care Workers: Needs and Opportunities

Predicting hand hygiene among Iranian health care workers using the theory of planned behavior

This study was conducted to identify significant predictors of handwashing associated with hospital elective (clean) and hospital inherent (dirty) contacts. This cross-sectional survey of 1,700 health care workers was based on the theory of planned behavior. Data were aggregated into components according to the theory and tested for predictors of hospital elective and hospital inherent handwashing using multiple logistic regression analysis. The α value was set at 0.05, and odds ratios (ORs) for significant predictors were adjusted by interquartile range. All wards studied were in private and government hospitals associated with the University of Medical Sciences, Shiraz, Iran between April and September 2008. Of the 1,200 healthcare workers surveyed 1,077 (90%), of whom 83% were nurses, returned a completed survey. Hospital elective handwashing practice was positively influenced by community elective practice (adjusted OR [aOR], 2.1; P < .000), hospital inherent practice (aOR, 1.6; P < .000), perception that handwashing required little effort (aOR, 1.1; P = .039), and subjective norms (nursing peers) (aOR, 1.1; P = .025) and negatively influenced by poor attitudes regarding handwashing (aOR, 0.91; P = .01). Hospital inherent handwashing practice was positively influenced by hospital elective practice (aOR 2.5; P < .000), community inherent practice (aOR, 1.5; P = .001), subjective norms (infection control practitioners) (aOR, 1.4; P = .001, and attitudes (aOR, 1.1; P = .001) and negatively influenced by poor subjective norms (nurses) (aOR, 0.74; P < .000). Community-based handwashing practices exerted a strong influence on handwashing compliance in the hospital. Given this interdependence between community and hospital handwashing, a campaign to improve awareness of the benefit of community handwashing may improve clinicians' compliance.

Using the theory of planned behavior to identify predictors of handwashing among Iranian healthcare workers

The incidence of healthcare associated infections in a surgical ward in Shiraz has been established as 18% with associated costs of approx US150,000. Healthcare workers (HCWs) had acceptable levels of knowledge and attitude about hand hygiene but poor self-reported practices. We used the Theory of Planned Behavior (TPB) to identify predictors of handwashing to underpin a theory-driven intervention.

Comparing the performance of QuantiFERON-TB Gold and Mantoux test in detecting latent tuberculosis infection among Iranian health care workers

The risk of transmission of Mycobacterium tuberculosis from patients with tuberculosis to health care workers (HCWs) has been well documented but little is known about the prevalence of latent tuberculosis infection (LTBI) in Iranian HCWs. The aim of this study was to determine the prevalence of LTBI among HCWs by using IFNgamma-release assay and compare the results with those of tuberculin skin test (TST). Two hundred HCWs were evaluated with both TST and QuantiFERON-TB Gold In Tube test (QFT-GIT). The obtained data were analyzed by SPSS v.16 Software. The participants were 73 males and 127 females with the mean age of 34.36±8.26 years. TST was positive in 105 cases (52.5%) and the QFT results were positive in 17 cases (8.5%). There was poor agreement between the two tests (53%, κ = 0.115). Induration diameter of TST ≥ 10 mm and working duration ≥ 10 years were independent predictors for positive QFT (p = 0.004). Due to the fact that BCG vaccination has been administered routinely to all HCWs in Iran, specific tests should be introduced for high risk groups. QFT thus seems to be more effective for LTBI diagnosis than TST among HCWs with BCG immunization history.

Influenza immunization rates, knowledge, attitudes and practices of health care workers in Iran

This study aimed to determine influenza vaccine coverage and evaluate the knowledge, attitudes and practice about influenza and vaccine of health care workers in Tehran, Iran. This cross-sectional survey involved 144 health care workers (HCWs) at the Tehran University of Medical Science between October 2008 and February 2009. Participants received a self-administered questionnaire directed at 35 items of knowledge and every correct response was scored one point. Influenza vaccination coverage for the 2008-2009 season was 66.9 % (range, 45% to 62%). Most HCWs (80.6%) had received an influenza vaccination in the past, and 65.4% intended to receive vaccination in the coming year. The main reason given for being immunized was the effectiveness of the influenza vaccine (51.4%). The main reason given for not being immunized was concern about adverse effects (23.1%). The knowledge score for the 35 items ranged from 0 to 34 (mean 17.37). Mean knowledge scores differed between educational levels. There was no significant difference in mean knowledge scores between females and males (P > 0.05). Independent variables (age, sex, marital status, having children aged ≤ 16 years, educational level) were not significant predictors of taking influenza immunization. Despite the high coverage rate of influenza vaccination in our study, we would expect a higher rate because of free vaccine availability. The results indicate the need for on-going education of influenza disease among HCWs to increase vaccination rates.

Influenza vaccine: Immunization rates, knowledge, attitudes and practice of health care workers in Iran in 2008/09

Influenza vaccine: Immunization rates, knowledge, attitudes and practice of health care workers in Iran in 2008/09

Adverse Events of Trivalent Influenza Vaccine among Health Care Workers in Iran

Adverse Events of Trivalent Influenza Vaccine among Health Care Workers in Iran

Knowledge and attitude toward Crimean–Congo haemorrhagic fever in occupationally at-risk Iranian healthcare workers

We assessed the knowledge and attitude (K&A) toward Crimean-Congo haemorrhagic fever (CCHF) of occupationally at-risk healthcare workers (HCWs). A cross-sectional survey was performed in three referral hospitals in the Systan-Baluchestan and Isfahan provinces of Iran where CCHF is highly endemic. In all, 191/209 eligible HCWs were enrolled (response rate: 93%). All but 11 (5.8%) had heard of CCHF. The mean K&A scores of the respondents were 50.34% and 79.25%, respectively. The correlation between K&A was significant (correlation coefficient: 0.542; P<0.001). Being a physician, working in Isfahan (versus the relatively deprived Systan-Baluchestan) and relying on academic material rather than local media were independent factors significantly associated with more knowledge; higher education and laboratory staff with better attitude were also significant factors. Although HCWs showed the best K&A for preventive measures, only 44% wore gloves and masks for contact with CCHF patients and 22% failed to observe any safety measure. Those with a history of percutaneous contact (6.3%) had significantly lower knowledge scores (P=0.047). There is a need to establish professional education campaigns in highly endemic deprived areas in order to improve physicians' attitudes, encourage nurses' use of academic materials and increase the knowledge of less-educated HCWs.

R2240 Study of epidemiological determinants of occupational exposure to HIV, HBV, HCV in healthcare workers in Iran

R2240 Study of epidemiological determinants of occupational exposure to HIV, HBV, HCV in healthcare workers in Iran

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.