Teaching Hospitals In Isfahan Research Articles

Assessing the Isfahan Hospitals based on the World Health Organization's Age-Friendly Hospital Model: A Mixed Method Study

Objectives The rapid growth of the elderly population requires the design of age-friendly healthcare systems to respond to the complex needs of the elderly. This study aims to assess the hospitals in Isfahan, Iran based on the age-friendly primary health care centers criteria and identify challenges. Methods & Materials This cross-sequential study was conducted in two phases in 2020-2021. First, using the checklist of Ahmadi et al.’ study, the teaching hospitals in Isfahan were assessed based on the age-friendly primary health care centers criteria. The checklists were completed by observation and based on the opinions of the experts. Data analysis was done in SPSS software, version 26 using descriptive statistics and Pearson correlation test. Qualitative data were collected through a semi-structured interview and were analyzed using Conventional content analysis method. Results Most of the hospitals were in good conditions in terms of physical environment, sanitary facilities, and signboards. The lowest scores were related to the areas of admission and payment, appointments, accessibility, and inpatient services. The mean age-friendly score of hospitals was 51.7 out of 100. There was no significant relationship between the characteristics of hospitals (type of ownership, type of activity, specialty, number of beds, bed occupancy rate, degree of accreditation, and manager’s study field) and their age-friendly scores. We identified 9 themes and 27 sub-themes related to challenges of being age-friendly in the hospitals. Conclusion The hospitals in Isfahan have many shortcomings in being age-friendly. Promoting the expertise of geriatric medicine and geriatric nursing, designing a special queuing system for the elderly, considering a special administrator for the elderly in different departments, reducing the costs of treatment for the elderly, promoting consultation/examination/treatment/follow-up programs for the elderly with an emphasis on upstream documents and cooperation between different departments, empowering employees, upgrading physical infrastructure can help solve existing challenges.

Rapid detection and simultaneous identification of the Mycoplasma and Ureaplasma species by real-time PCR and melt curve analysis among fertile and infertile females.

Mycoplasma and Ureaplasma species threaten reproductive health and fertility worldwide. Due to the lack of sensitive, accurate, and affordable diagnostic tools, the simultaneous contributions of these agents in infertility have been overlooked. This study aims to detect and identify Mycoplasma and Ureaplasma species in the genital tracts of fertile and infertile females simultaneously. In a case-control study, cervicovaginal clinical samples were collected from patients referred to two teaching hospitals in Isfahan from July 2019 to February 2019. The initial screening was by using Real-time PCR and designed primer to evaluate the presence of Mycoplasma and Ureaplasma species including fertile and infertile women. The bacteria species were then detected and differentiated by using the melt curve and sequenced to confirm and identify. Finally, the standard curve was used to measure and compare the copy number of each species in each group. The isolates also were detected in clinical samples using the commercial PCR method. The frequencies of Mycoplasma genitalium and Mycoplasma hominis were (0.0, 10.0%) in the fertile group and (4.3%, 34.3%) in the infertile group, respectively. Ureaplasma parvum and Ureaplasma urealyticum species in the fertile group (7.1%, 5.7%) and in the infertile group (32.9%, 24.3) were determined, respectively. The comparison of the results obtained from PCR and Real-time PCR showed that the recent technique has the ability to track 101-103 copy numbers. The present method allows differential diagnosis and quantification of Mycoplasma and Ureaplasma species in a short time and simultaneously.

Exploring the barriers to pulmonary rehabilitation for patients with chronic obstructive pulmonary disease: a qualitative study

BackgroundThe complexity of chronic obstructive pulmonary disease (COPD) and its different physical, mental, familial, occupational, and social complications highlight the necessity of pulmonary rehabilitation (PR) for afflicted patients. However, PR for patients with COPD usually faces some barriers. The aim of this study was to explore the barriers to PR for patients with COPD.MethodsThis qualitative descriptive study was conducted in January 2019 to October 2020. Participants were 19 patients with COPD, 11 family caregivers of patients with COPD, and 12 healthcare providers, who all were recruited purposively from two teaching hospitals in Isfahan, Iran. Data were collected through semi-structured interviews and were analyzed through conventional content analysis.ResultsThe barriers to PR for patients with COPD fell into three main categories, namely barriers related to patients and their families, inefficiency of PR services, and inappropriate organizational context for PR. Each category had four subcategories, namely patients’ and families’ lack of knowledge, complexity and chronicity of COPD, heavy financial burden of COPD, patients’ frustration and discontinuation of PR, lack of patient-centeredness, lack of coordination in PR team, inadequate professional competence of PR staff, lack of a holistic approach to PR, limited access to PR services, inadequate insurance for PR services, ineffective PR planning, and discontinuity of care.ConclusionPR for patients with COPD is a complex process which faces different personal, familial, social, financial, organizational, and governmental barriers. Strategies for managing these barriers are needed in order to improve the effectiveness and the quality of PR services for patients with COPD.

Isolation and Host Range of Lytic Staphylophages on Clinical Isolates of Methicillin-Resistant Staphylococcus aureus

Background: Staphylococcus aureus (S. aureus) is a major cause of nosocomial infections in humans and animals. Because of the widespread resistance to antibiotics, microbiologists are trying to find other therapeutic interventions such as phage therapy for bacterial infections. Objectives: The present study aimed to isolate staphylophages with lytic effects on methicillin-resistant S. aureus (MRSA) clinical isolates as a potential alternative agent to antibiotic therapy. Methods: This experimental, descriptive study is performed in the Microbiology Laboratory of Shahrekord University (Iran) from September 2018 to March 2019. Two cocktails of staphylophages were isolated from Isfahan (Iran) urban sewage samples. The double-layer agar method was used to detect lytic phages. Morphology characteristic by transmission electron microscopy (TEM) images was used to identify staphylophages. One hundred and thirty three S. aureus were isolated from clinical samples of two teaching hospitals in Isfahan and Shiraz, Iran. Methicillin resistance and the presence of the mecA gene were determined by the disk diffusion method and polymerase chain reaction (PCR) assay, respectively. The phage susceptibility of mecA positive isolates was determined by plaque assay. Results: Two staphylophage cocktails were prepared, which had lytic effects on forty-four MRSA isolates. Cocktails 1 and 2 lysed 19 (14.2%) and 25 (18.7%) isolates, respectively. Of 133 S. aureus isolates, 88.7% carried the mecA gene. Conclusions: Different bacteriophages in two phage cocktails had relatively good lytic effects on S. aureus clinical isolates. Therefore, phage cocktails may be an appropriate alternative to antibiotics against S. aureus.

Nurses' Job Burnout: A Hybrid Concept Analysis.

Introduction: Job burnout can significantly affect nurses’ physical and mental health and the quality of the care services they provide. Yet, there is no clear definition for job burnout in nursing. This study aimed to analyze the concept of nurses’ occupational burnout.Methods: This concept analysis was conducted, using the three-phase hybrid model. In the theoretical phase, online databases, namely Iranmedex, Scientific Information Database (SID), Science Direct, MagIran, ProQuest, Web of Sciences, Scopus, and PubMed were searched to retrieve studies published from 2007 to 2018. In the fieldwork phase, twelve semi-structured interviews were conducted with nurses and head-nurses selected from teaching hospitals in Isfahan, Iran. The interviews were transcribed and analyzed through thematic analysis. In the final analytic phase, the findings of the first and the second phases were combined.Results: Based on the findings of the theoretical and the fieldwork phases, job burnout can be defined as, “a state of physical, mental, emotional, and social exhaustion resulting from the negative effects of unmanaged occupational stress and inadequate managerial and social support, which reduces interest in and motivation for work, affects care quality, and results in negative attitudes and behavior towards self, clients, and the work”. Conclusion: This study provides an in-depth understanding of the concept of job burnout in the nursing context of Iran. Managers need to develop strategies for job burnout prevention and management based on its contributing factors.

Molecular analysis of methicillin-resistant Staphylococcus aureus isolates from four teaching hospitals in Iran: the emergence of novel MRSA clones

BackgroundThe global spread of methicillin-resistant Staphylococcus aureus (MRSA) infections necessitates the use of validated methods for the identification and typing of this bacterium. This study aimed to determine the distribution of main molecular types of MRSA strain circulating among hospitalized patients in teaching hospitals in Isfahan and Kashan.MethodsA total of 146 Staphylococcus aureus strains were isolated from patients in four teaching hospitals in Isfahan and Kashan during June 2017 to September 2018. The antimicrobial resistance patterns of Staphylococcus aureus strains were performed by disc diffusion method. The MRSA strains were identified phenotypically and confirmed by PCR assay. The prevalence of microbial surface components recognizing adhesive matrix molecules (MSCRAMMs) genes among MRSA strains was evaluated by multiplex PCR. The genotypes of MRSA strains were determined by multilocus sequence typing and SCCmec typing.ResultsOf 146 Staphylococcus aureus isolates, 24 (16.4%) isolates were identified as MRSA strains. According to antimicrobial susceptibility testing the highest resistance rates were seen for tetracycline, erythromycin, ciprofloxacin and gentamicin. All of Staphylococcus aureus isolates were susceptible to vancomycin whereas 3 (2.1%) isolates were resistant to linezolid. Three different SCCmec types were obtained among MRSA strains including 16 (66.7%) SCCmec type V, 3 (12.5%) SCCmec type III and 5 (20.8%) SCCmec type II. Of 24 MRSA isolates 20 (83.3%) carried MSCRAMMs genes including eno (70.8%), fib (54.1%), cna (25.0%), fnbB (16.6%), ebps 5 (20.8%), and the fnbA, bbp and clfA genes were not detected in any MRSA isolate. MLST analysis revealed 11 sequence types among MRSA isolates as follows: ST239, ST291, ST22, ST861, ST889, ST8, ST59, ST343, ST772, ST6 and ST1465. Also seven MLST-based clonal complexes (CCs) were identified among MRSA strains including: CC8, CC7, CC398, CC59, CC22, CC1 and CC5.ConclusionsA relatively high diversity was found in MRSA genotypes in Kashan and Isfahan hospitals, and seven clonal complexes were identified. Pandemic MRSA clones including CC8 and CC22 were the most prevalent clones and the novel ST types including ST1465, ST861, ST 889 and ST772 are reported for the first time in Iran in the present study. In addition the high prevalence of MSCRAMMs genes in MRSA isolates demonstrates the high potential of these strains for pathogenicity.

The Effect of Home Base Physical Activity Program based on the BASNEF Model on Motor Recovery in Patients with Stroke

ABSTRACT The present study aimed to determine the effect of education based on the BASNEF model on the physical activity and improvement of motor activity in patients with stroke. This randomized control trial study was conducted on 40 patients with acute ischemic stroke admitted to a teaching hospital in Isfahan, Iran from August 2017 to September 2018. The patients were randomly divided into intervention and control groups. The intervention included personal education and a manual CD of physical activity for the intervention group. After education, the mean scores of the BASNEF model’s constructs in the intervention group were significantly higher than those of the control group (P < .001). Furthermore, the motor ability of the intervention group in upper and lower extremities was significantly higher than that of the control group (p < .001). Interventions based on educational models can increase the motivation of patients with stroke in performing recommended physical activity.

Phenotypic and Genotypic Characteristics of Clostridium difficile Isolates in Patients with Type 2 Diabetes in Iran.

PurposeThis study aimed to investigate the phenotypic and genotypic characterization of Clostridium difficile isolates in type 2 diabetes patients with hospital-acquired diarrhea in four teaching hospitals in Isfahan, Iran.Patients and MethodsA total of 104 hospitalized patients with type 2 diabetes and nosocomial diarrhea were included in the current study over a 2-year period (2015–2017). C. difficile isolates were characterized by conventional microbiological methods including the presence of toxin genes, antibiotic resistance testing and molecular methods including multilocus sequence typing (MLST) and random amplification of polymorphic DNA (RAPD).ResultsAll 21 C. difficile isolates (20.2%) were detected from 104 studied patients. All isolates were susceptible to metronidazole and vancomycin. The antimicrobial resistance rates were distinctly higher for clindamycin and for moxifloxacin. Based on PCR amplification of tcdA and tcdB, 13 isolates (12.5%) carried both of these genes and were considered toxigenic. Thirteen toxigenic C. difficile strains were classified into two sequence types (STs), that is, ST54 and ST2 types. The RAPD-PCR amplification patterns of the detected toxigenic C. difficile revealed three distinct but related RAPD clusters. RAPD cluster 1 had the highest similarity with RAPD types 2 and 3.ConclusionA relatively high rate of CDI was observed in patients with type 2 diabetes and was associated with poorer health outcomes. These patients were exposed to multiple antibiotics and other therapeutic agents. We recommend close screening for the coexistence of CDI and type 2 diabetes in patients with diarrhea using a combination of conventional and molecular methods.

Molecular Characterization of Hospital- and Community-Acquired Streptococcus agalactiae Isolates among Nonpregnant Adults in Isfahan, Iran.

Background:The increasing incidence of Group B Streptococcus (GBS) infection among nonpregnant adults has become of growing clinical and public health concern. The current study investigated the distribution of important virulence determinants and antibiotic susceptibility of GBS isolates causing community acquired (CA) and hospital acquired (HA) infections among nonpregnant adults.Materials and Methods:A total of 62 GBS, including 31 CA GBS and 31 HA GBS, were collected from a teaching hospital in Isfahan, Iran. Capsular polysaccharide genotypes (CPS), PI 1, PI 2a, PI 2b, and hypervirulent GBS adhesin (hvgA) virulence genes and antibiotic resistance profiling were determined.Results:There were 19 (30.6%) cases of underlying disease that diabetes mellitus (20.9%) was most common. The rate of multidrug resistant GBS strains was accounted for 29%. Distribution of macrolide resistant phenotypes was as follows: constitutive macrolides, lincosamides, and streptogramin B (MLSB) (15 isolates); inducible resistance to MLSB; and L phenotype (each 5 isolates) and M phenotype (1 isolate). V and Ia serotypes were the most predominant capsular type in HA GBS and CA GBS isolates, respectively. The most frequent pilus types were PI 1, PI 1+PI 2a, PI 1+PI 2b, and PI 2a. PI 1 and PI 1+PI 2a had significantly different distributions between CA and HA GBS isolates. Three CA GBS isolates (9.6%) were positive for hvgA gene that belonged to clonal complex 17/sequence type 17/CPS III/PI 1+PI 2b lineage.Conclusion:There was a significant difference in the distribution of PIs among CA GBS and HA GBS isolates in our region.

The effects of a neonatal critical care nurse companionship with parents during hospital–home transfer of preterm infants on mothers' mood status

Background: Hospital discharge and transfer of a preterm infant from hospital to home are usually stressful for parents. Objectives: This study evaluated the effects of a neonatal critical care nurse companionship with parents during hospital–home transfer of preterm infants on mothers' mood status. Methods: This randomized clinical trial was conducted on 64 mothers of preterm infants discharged from the neonatal intensive care unit of a teaching hospital in Isfahan, Iran. Participants were randomly and equally allocated to an intervention and a control group. Each mother in the intervention group was accompanied by a nurse immediately from hospital discharge up to 3 h afterward. The nurse also supported the mother during the first 3–4 postdischarge days. Mothers' mood status was assessed using the 21-item Depression, Anxiety, and Stress Scale both groups 3–4 days before hospital discharge and 72 h after hospital discharge. Data were analyzed through the Chi-square, the paired-sample t, and the independent-sample t-tests. Results: The pretest mean scores of depression, anxiety, and stress, respectively, were 4.71 ± 4.43, 6.51 ± 4.04, and 9.17 ± 5.40 in the intervention group and 4.91 ± 2.59, 6.59 ± 2.92, and 8.77 ± 3.58 in the control group. The between-group differences respecting the mean scores of depression, anxiety, and stress were not statistically significant (P > 0.05). These mean scores significantly decreased in the intervention group after the intervention (P 0.05). Conclusion: Nurse companionship with parents during the transfer of preterm infants to home improves mothers' mood status.

Comparison of the Knowledge and Performance of Surgical Technicians and Technologists Regarding the Observance of the Aseptic Technique

Background & Aims Surgical site infection (SSI) is a common postoperative complication. The observance of the aseptic technique is an effective measure to prevent SSI. The knowledge and performance of surgical technicians and technologists play a pivotal role in the proper implementation of this technique. The present study aimed to compare the knowledge and performance of surgical technicians and technologists regarding the observance of the aseptic technique. Materials & Methods This cross-sectional, comparative study was conducted during 2017-2018 on 235 surgical technicians and technologists in eight teaching hospitals in Isfahan, Iran. The participants were selected via stratified random sampling. Data were collected using a researcher-made questionnaire for the measurement of knowledge, which was completed by the participants. In addition, a researcher-made checklist was completed by the researcher after observing the performance of the participants in three surgical procedures. Data analysis was performed in SPSS version 22.0 using descriptive and analytical statistics. Results The mean score of the knowledge of surgical technicians and technologists was favorable, while their mean score of performance was average. The mean score of knowledge (P=0.047) and performance (P=0.01) was significantly higher in the surgical technologists compared to the surgical technicians. Moreover, a direct correlation was observed between the scores of knowledge and performance in both surgical technicians (P=0.027) and surgical technologists (P=0.032). Conclusion According to the results, improving the knowledge of surgical technicians and technologists regarding the aseptic technique could enhance their performance in this regard. Therefore, the findings of this study could lay the groundwork for the proper supervision of the performance of healthcare providers in order to harmonize their knowledge and performance. Furthermore, considering the higher scores of knowledge in surgical technologists compared to the technicians, it is advisable that the latter be encouraged to continue their education. The implementation of effective training programs should also be considered in order to improve the performance of operating room personnel. Keywords: Knowledge , Practice , Nurse , Operating Room , Infection

Clostridium difficile infection in cancer patients with hospital acquired diarrhea at the teaching hospitals in Iran: Multilocus sequence typing analysis (MLST) and Antimicrobial resistance pattern.

This study aimed to investigate the phenotype and genotype characterization of Clostridium difficile isolates among cancer patients with hospital-acquired diarrhea in 4 teaching hospitals in Isfahan, Iran. This was a cross sectional study conducted on adult (>18 years old) between April 2015 and May 2017. Over two years, 67 diarrheic fecal samples were collected. C. difficile isolates were characterized according to the presence of toxin genes and antibiotic resistance. Multilocus sequence typing (MLST) was performed to evaluate the genetic relationships between different lineages of toxigenic strains. Seven toxigenic and 12 non- toxigenic strains were detected among stool samples. Patients with a history of previous surgery during hospitalization were more than 7 times likely to develop Clostridium difficile infection (CDI). All isolates were susceptible to metronidazole, vancomycin and fusidic acid. Toxigenic C. difficile strains were divided into 3 different sequence types. The detected types were ST-54, ST-2 and ST-37, while none of the isolates was identified as ST-1 or ST-11. This is the first description of the MLST analysis of C. difficile strains isolated from cancer patients in Iran. All of the studied population were exposed to multiple antibiotics and chemotherapeutic agents. Further research and clinical studies are recommended in the treatment through good antimicrobial stewardship and prevention of C. difficile infection in all healthcare settings.

Occurrence and reporting of nurses’ medication errors in a teaching hospital in Isfahan

مقدمه: خطاهای دارویی از شایع ترین خطاهای پرستاری بوده و تلاش برای شناسایی و آشکارسازی این خطاها مهم است. مطالعه حاضر با هدف بررسی وقوع و گزارش خطاهای دارویی پرستاران در بیمارستان آموزشی درمانی شهر اصفهان انجام شد. روش ها: پژوهش حاضر یک مطالعه توصیفی-تحلیلی بود که به صورت مقطعی در سال ۱۳۹۶ انجام شد. دیدگاه ۲۲۰ نفر از پرستاران شاغل در ۳۵ بخش بیمارستان آموزشی منتخب درباره فراوانی و نوع گزارش خطاهای دارویی با استفاده از پرسش نامه دو قسمتی شامل اطلاعات دموگرافیک، نوع خطاهای دارویی و گزارش آن گردآوری شد. سپس داده ها در نرم‌افزار آماری SPSS نسخه ۲۲ وارد شدند. تحلیل داده ها با استفاده از آزمون های آماری تحلیلی مجذور کای و من-ویتنی انجام شد. یافته ها: میانگین وقوع خطاهای دارویی ۸/۶۶ درصد، گزارش دهی رسمی ۲۲ درصد و گزارش دهی غیر رسمی ۳/۵۵ درصد بود. بیشترین میزان خطاها مربوط به دادن دارو دیرتر یا زودتر از زمان مقرر (۷۰ درصد)، بیشترین گزارش رسمی عدم رعایت زمان مناسب دارو ( ۸ درصد) و بیشترین گزارش غیر رسمی مخلوط کردن دو یا چند میکروست دارو بدون توجه به تداخلات (۲۹ درصد) بود. بین وقوع خطاهای دارویی با جنس (۰۱۴/۰=P )، وضعیت استخدامی(۰۳۱/۰=P ) و سابقه کار (۰۲۴/۰=P ) رابطه آماری معناداری وجود داشت. نتیجه گیری: به منظور ترویج شناسایی و گزارش خطاهای دارویی، بهتر است از ایجاد فضای سرزنش کننده در بیمارستان جلوگیری شود. در گام بعد، آموزش در خصوص انواع خطاها، تشویق پرستاران به ارائه و تسهیل گزارش خطاهای دارویی می‌تواند برنامه ریزی و اقدام برای کاهش خطاها را تسهیل نماید.

Investigation of Class I, II, and III Integrons Among Acinetobacter Baumannii Isolates from Hospitalized Patients in Isfahan, Iran.

This study aimed to determine the prevalence of class I, II, and III integrons among clinical Acinetobacter baumannii isolates collected from hospitalized patients. This cross-sectional study was conducted at two teaching hospitals in Isfahan, Iran, from October 2015 to October 2016. A total of 147 non-duplicate A. baumannii isolates were collected from clinical specimens and identified as A. baumannii using standard microbiological methods and confirmed by genotyping. Antimicrobial susceptibility was determined using disc diffusion method, and the presence of integron genes was performed using the polymerase chain reaction. Out of 147 confirmed A. baumannii isolates, 97.3% of isolates were extensive drug-resistant (XDR) and 2.7% were multidrug-resistant (MDR). Class I and II integrons were detected in 63.9% and 78.2% of the A. baumannii, respectively. Class III integron was not detected in any of the isolates. Our results show a high prevalence of classes I and II integrons which may play a key role in the acquisition of MDR and XDR phenotype among A. baumannii isolates in our region. Therefore, use of appropriate infection control in clinical settings and implementation of treatment strategies is necessary for our hospitals.

Proposing a Model of “Hospital Value-Based Purchasing” in Selected Teaching Hospitals in Isfahan, Iran: 2015 - 2016

Background: Recently, HVBP has been a tool for improving the quality of healthcare services and managing costs. This study was conducted to identify and propose an appropriate model of HVBP in the general selected teaching hospitals in Isfahan, Iran. Objectives: The purpose of this study was to propose an Iranian model of HVBP in the selected teaching hospitals in Isfahan, Iran, 2015 - 16. Methods: This study was a theoretical and qualitative study. It was cross-sectional and prospective in terms of time, direction, and trend. The sample was determined purposefully in Delphi methods. Three types of Delphi methods were conducted including: theory, policy, and implementation Delphi. The sample size in Delphi methods respectively included 9, 13, and 21 that were selected in type of experts sampling and cascading in 2015 - 16. Inclusion and exclusion criteria were designated to select sample in all three types of Delphi methods. Results: According to the results of the study, the proposed Iranian model of HVBP had seven dimensions including structure, process, outcome, patient experience, quality of clinical care, sensitivity of care team, and efficiency with the weight percentages of 5, 5, 25, 20, 15, 15, and 15, respectively. Each of the dimensions had 5, 6, 5, 7, 5, 4, and 1 components/component, respectively. Conclusions: This study identified and proposed a model of HVBP in the Isfahan selected general teaching hospitals. The practical application of the findings was to determine the dimensions and components of HVBP in Isfahan general teaching hospitals. According to the findings of this study, it is suggested that a series of related research be conducted to complete the identification process of HVBP in Iran in other types of hospital settings. © 2017, Iranian Red Crescent Medical Journal.

CONSTRUCTION OF A QUESTIONNAIRE TO ASSESS PARENTAL STRESS IN NEONATAL INTENSIVE CARE UNIT

Background: Once an infant is hospitalized in the Neonatal Intensive Care Unit (NICU), the entire family dynamics is disrupted due to stressors such as interruption in maternal-infant bonding, abandonment of other siblings and financial burdens. Combination of multiple stressors often ends in divorce or other devastating results. In this study, a novel survey questionnaire has been developed to assess the level of parental stress in NICU and identify the warning signs, in order to provide assistance to young couples in need of help. Methods: Qualitative content analysis was performed to survey 13couplesrecruited from various teaching hospitals in Isfahan, Iran. Results: The initial part of the questionnaire was designed to assess parents’ stress level with an expected content validity index of 0.78 or above and to measure face validity of the questionnaire, all the items received a mean impact score of 1.5 or above, and the Cronbach’s alpha reliability of the 12-item questionnaire equaled to 0.904.Based on the factor analysis, the items with a correlation coefficient of less than 0.4 were excluded (one item was omitted). Conclusion: Most survey questionnaires found in the existing literature have investigated the types of stressors experienced by parents with an infant in NICU. In this study, researchers offer a novel 11-item questionnaire designed to assess the level of stress among parents with a hospitalized infant in NICU.

Patient complaint′s profile in a teaching hospital

Introduction: Patient satisfaction represents the physician and medical staff's competence and shows the observance of patient's rights and as well the quality of treatment and complaint is expressing dissatisfaction, which requires the accountability and auditing. Now-a-days complaint handling is considered as an essential part of the health care system to promote health standards. Because complaint handling constitutes identifying the main causes of the problem, organizing performances and identifying reliable sources to find the reason of the complaint. In this study, the researchers intend to identify the sources, people, subjects of the complaints and the action taken in this regard in a teaching hospital in Isfahan. Methods: This paper is a descriptive cross-sectional study. The population of the study has been all the cases that have referred to the hospital's complaints unit. For data collection, we observed and checked the existing documents in complaints unit that due to the problems with data recording only the data related to 4 months of the year 2012 and those related to 1 month of 2013 were investigated. Results: On the basis of the results of this study, it can be demonstrated that the major subject of complaints has been the issues of public concerns and welfare of the hospital and the hospital's service quality. Most complaints filed by the patients and their families has been about the physicians and the hospital staff that finally, most of them have been settled in the complaints unit and in the next steps, raising complaint were not reasonable. Conclusion: According to the results it can be said that by detecting the subjects, resources, and people that have been complaining about in the hospital, weaknesses in providing the services were identified and by regarding them they can improve the service providing. Moreover, by sharing the findings from various hospitals, different experiences in this context can be utilized.

Carbapenem Resistance Pattern of Multiple Drug-Resistantand Extended-Spectrum Beta-Lactamase-Positive Klebsiella pneumonia in Isfahan

Background: Klebsiella pneumoniais producer of carbapenemase (KPC) an emerging pathogen with propensity to malady in weak patients, increasing their morality rates.Carbapenemaseis an enzyme that destroys all beta-lactam antibiotics and is the therapeutic choice for infections with extended-spectrum beta-lactamase (ESBL)-producing organisms.ESBLESBLs are penicillin, narrow spectrum also third-generation cephalosporin, and monobactams hydrolyser and checkrein by clavulanic acid. Objectives: The present study was performed to separate and identify the carbapenemase resistance pattern of multidrug-resistant (MDR) and ESBL-positive K.pneumoniaas well as its prevalence among different wards and various clinical specimens in Isfahan. Patients and Methods: Over 500 different clinical samples were collected from different sections of great teaching hospitals in Isfahan, in which K. pneumonia isolates were identified by IMVIC and urease standard biochemical tests and also were confirmed by determination of the ureD Gene. Antimicrobial susceptibility tests were performed as standard disk-diffusion on Mueller-Hinton agar (Merck, Germany) based on the instructions of Clinical Laboratory Standards Institute (CLSI, 2013). Sieving and phenotype conformation of ESBL isolates were performed by double disc synergy test (DDST), and then, the strains identified as ESBL were test by carbapenem, ertapenem, imipenem andmeropenem. Finally, the statistical analyses were performed using the WHONET software version 5.6. Results: Of clinical isolates of K.pneumonia, 142 were confirmed using biochemical methods and then the molecular confirmation was performed by PCR of the ureD gene. Of the total isolates, 57% were from males and 43% from females; 120(84%) of isolates were recognized as MDR. The highest rates of resistance were related to piperacillin (80%), ceftazidime (76%), and cefotaxime (73%). Among these MDR isolates, 101 (71%) were detected as ESBL, using DDST. The ward and the clinical specimen with the most prevalence were ICU with 55 (38.7%) and urine with 61(42.9%) samples, respectively. The lowest prevalence was related to the neurosurgery ward with 8 (5.6%) samples and the clinical specimen with the lowest prevalence was cerebrospinal fluid (CSF) with 2 (1.4%) samples. The susceptibility patterns to carbapenem agents were as follows: ertapenem50.7%, meropenem 44.8% and imipenem35.8%. ???

Molecular Identification and Antimicrobial Resistance Profile of Acinetobacter baumannii Isolated From Nosocomial Infections of a Teaching Hospital in Isfahan, Iran

Background: Multidrug resistant (MDR) and extensively drug resistant (XDR) Acinetobacter baumannii are among important causes of nosocomial infections and cause therapeutic problems worldwide. The emergence of extensively drug-resistant A. baumannii (XDRAB) cause serious threats to hospital acquired infections (HAI) worldwide and further limit the treatment options. Objectives: The current study aimed to identify and isolate the MDR and XDR Acinetobacter baumannii from different wards of a teaching hospital in Isfahan, Iran, and determine the susceptibility pattern of these bacteria. Materials and Methods: One hundred and twenty one (121) isolates of A. baumannii collected from a teaching hospital in Isfahan, Iran, within eight months (between September 2013 and April 2014) were included in the current study. The samples were isolated from different wards and different specimens. To confirm the species of A. baumannii, Polymerase chain reaction (PCR)was conducted to identify blaoxa-51 gene. Disk diffusion method was employed to evaluate antimicrobial susceptibility against cefotaxime, ceftriaxone, ampicillin-sulbactam, cefepime, meropenem, tobramycin, amikacin, tetracycline, ciprofloxacin, trimethoprim- sulfamethoxazole, and aztreonam. Results: Among the 121 isolated A. baumannii, 44% and 56% were isolated from female and male, respectively. Samples cultured from the trachea (36%), urine (15%), blood (10%), wound (10%), cerebrospinal fluid (7%), bronchial (4%) and the others (18%). Most of the isolates (50%) were obtained from intensive care unit (ICU). Isolated A. baumannii showed high resistance to the evaluated antibiotics except ampicillinsulbactam, which showed only 33.9% resistance. Also, 62.8% and 100% of the isolates were identified as XDR and MDR. Conclusions: The result of the current study showed the growing number of nosocomial infections associated with XDR A. baumannii causing difficulties in antibiotic therapy. Resistant strains increasingly cause public health problems; therefore, their early detection is essential for healthcare centers.

Comparison of the effects of povidone-iodine and chlorhexidine solutions on skin bacterial flora among hospitalized infants.

Background:Infection control is an essential part of caring for hospitalized infants. With regard to the change of bacterial resistance over time and places, as well as the need for periodic studies on the effectiveness of antiseptics, this study aims to compare the effects of both solutions of povidone-iodine and chlorhexidine on skin bacterial flora among hospitalized infants.Materials and Methods:This clinical trial recruited 98 hospitalized infants and each of the above-mentioned solutions has been applied to a small area in the left or right side of the infants’ bodies. Skin cultures were taken before, immediately after and 2 h after the randomly chosen infants’ skin areas that were disinfected by each solution (588 skin cultures in total). Colony count and determination of microorganism types were done by only one person in a single laboratory. The study has been conducted in two teaching hospitals in Isfahan, Iran.Results:Staphylococcus epidermidis was the most common microorganism prior to skin disinfection by either solution. Two hours after disinfection, “Staphylococcus epidermidis” and “Staphylococcus epidermidis and kelebsila” had the highest frequencies of 3.1% and 3.1%, respectively. Before and 2 h after disinfection, distribution of different types of microorganisms had no significant difference between the two groups (P = 0.84 and 0.13, respectively); however, the difference was significant immediately after disinfection, P < 0.01.Conclusion:The present study demonstrated that 10% povidone-iodine solution has more significant effect on reduction of skin pathogens promptly after application compared to 2% chlorhexidine. Therefore, prior to any catheterization procedures, it is imperative to use 10% povidone-iodine solutions for skin disinfection.