مجله ارتقای ایمنی و پیشگیری از مصدومیت ها
سال دوم شماره 2 (تابستان 1393)

Health care process cause many dangers for patient. Increasing medical errors are one of the important Consequences of these processes. The present research has been conducted to investigating the role of disclosure and reporting in medical errors prevention in hospitals of Tehran University of medical sciences. In this mixed (quantitative -qualitative) research, Statistical population includes those related people and the practitioners engaged in medical errors in hospitals of Tehran University of Medical Sciences. The sample consisted of 232 employees that were non-randomly targeted selected from these hospitals. Triangulation technique (review of literature, interview, and research-made questionnaire) were used to collection data. The data was analyzed through factor analysis technique, regression analysis and correlation. Varimax rotation and variables communalities tests have shown medical errors disclosure and medical errors reporting are the constituent factors of medical errors prevention management Medical errors disclosure consists of 6 factors (Organizational culture, factors associated with patient, factors related to the provider, factors associated with errors, structural factors. Medical errors reporting consist of 2 factors (individual factors and organizational factors) (Co-Variance=47). Regression analysis indicated that there is relationship between Medical errors disclosure and medical errors prevention management. Error disclosure is the most important factor in medical errors prevention in hospitals of Tehran University of Medical Sciences. Hospital administrators need to identify effective factors of Error disclosure and implemented them as effective step to prevention medical errors.

Human errors for long time have been on spotlight of safety and Ergonomics experts due to accidents and disrupted performance، planning، and human projections. After the failure of the theory of zero-error culture، new approaches «error management culture» with a positive look at the error، the human and the system introduces. The purpose of this study is to investigate the relationship between culture of fault and safety consequences among employees in a petrochemical industry. This study was a cross-sectional that was run among random sample of 424 individuals who were the employees of a petrochemical industry.. EOQ contained 5 scale and 19 items in Likret scale. Safety outcomes which includes events that occurred during past year، was assessed with four questions about the self-report. The Chi-square test was used to analyze the data، and to determine significant relationships. The mean of (EOQ) total score was 69. 91 with a standard deviation of 7. 34. The results of the Chi-square test of EOQ Score with minor injuries، serious injuries and damage to equip-ment revealed significant relationships. A significant relationship has been found between some error culture scale and safety outcomes. The result show the relationship between error culture and reduction of safety out-comes، our results are in line with previous research suggesting that an organizational climate of open communication with a focus on problem-solving and learning is vital to safety. We hope that future research by overcoming on limitations and shortcomings of the present study، with confirming of the findings of this study، introduced the error culture as an effective factor on safety.

Backgrounds and Infants and children needs to be protecting while in the cars، which are compatible with body condition and weight and be able to accompany them at different stages of development. Given that safety belt use any special conditions are applicable to their body، hence the use of child safety seats in cars is inevitable Therefore، the present study the importance of using child safety seats in cars and reduce traffic fatalities and identify the factors influencing its use in cars deals. this study، descriptive method and frequency distribution (mean، standard deviation) and Friedman ranking test such factors affect the use of the child seat in the vehicle were identified and prioritized. In this study، four groups، school teachers (22 people)، Kindergarten instructors (14 people)، Police staff (15 people)، random community (89 people) were selected through stratified random sampling and simple random sampling. The research devices consist of researcher-made questionnaire including sixteen questions with four indicators of Child Seat use، law approval، Design and installation of child car seat and Incentive policies. The results of the study show the highest score for design indicators and child seat installation in vehicles for research communities.

Backgrounds and Process industries are required to provide and maintain the working places safe for their workers، neighbors and environment. Safety may be provided through inherent safety design، providing several safeguards including instrumentation، applying proper procedures and training. Layer of protection analysis (LOPA) is a semi- quantitative technique. This technique has been used to analyze the protecting layers independently. This study was carried out to assess the independent layers of protection analysis in controlling the likely risks in sweetening gas units of two different gas purification plants. In the risk assessment process، hazards were identified by HAZOP technique at four nodes in each gas refinery and the incident scenarios were determined then. By using LOPA technique based on cause & effect، the level of risk for each scenario was determined considering the protective layers. Finally، the collected data was analyzed using the LOPA standard method and PHA-Pro6 software. Despite the fact that the independent protection layers (IPLs) were different in each re-finery sweetening towers، risk levels at different scenarios were similar. The application of Independent protection layers may decrease the likelihood of scenarios. The safety integrity level of control equipment was SIL-4 but total probability of failure on demand (TPFD) was higher in second gas refinery. The results suggested that safety integrity level (SIL) were the same in both gas re-finery sweetening towers while the protection layers were different. Results of research indicated that LOPA method can be used for controlling hazards based on layers of protection. Adding layers of protection to equipment are recommended to reduce the hazards to acceptable levels

FTA is an appropriate tool for failure analysis and determining the failure rate. Sometimes, the lack of information on the process and main events, it is difficult to accurately determine the probability rate of the failures. The application of Fuzzy tool can be help-ful in such cases. In present study the Fuzzy logic was applied to determine the failures probability of a distillation unit in an oil refinery in its risk assessment using FTA. The method and the results of the reactor risk analysis are discussed in present paper. In this descriptive study, HAZOP was applied to determine the process failures. Its fault tree was determined then. The probability rate of those failures which had the required input data for fault tree was determined using their equations. Otherwise, Fuzzy logic was used. The Fuzzy process began with the selection of an expertise team and ended with determination of the probability rate for the route events. The equation recommended by Onisawa was used to determine the probability rate. Then the probability of top events was determined using the appropriate equation. The critical Minimal Cut Sets (MCS) were determined using Fussell-Vesely equation. In the end, the influence of deleting three critical MCSs alone and simultaneously was studied. The application of HAZOP led to determine 4 main and 13 end failures. From 13 end failures, 7 failures were Fuzzy and 6 were probabilistic. The results revealed that cutting of the most critical MCS (e.g. A.3.2) may increase the reliability of top event by 5.9% from 0.914 to 0.968. Also cutting of all three main critical MCSs (e.g. A.2.2, A.3.1 & A.3.2) may increase the reliability of top event by 8.4% from 0.914 to 0.991. The failure probability can be determined using Fuzzy logic when there is not enough data on process and top events.

Backgrounds and Accidents caused deaths and injuries among pedestrians and motor-cyclists mostly in developing countries. The aim of this was to evaluate the relationship between the hazardous behavior among motorcyclists and death or injury in Bojnurd the capital of North Khorasan province. This cross-sectional study was done from March 16 until April 9 - 2012, in it all injured or victims of motorcycles accidents who referred to the emergency department of the Imam Ali Hospital formed the study population. Data were gathered by a checklist consisting of demographic and accident characteristics and the situation of injured motorcyclist. For victims and those who were not able to answer, we used the survivor for gathering the data. All data analysis was done in SPSS version 18. During the study period 122 injured people due to motorcycle accidents were admitted to the hospital. All drivers were male with the mean age of 27.3 years (±10.6), among them 106 motorcyclists (86.9%) did not have driver''s license, and 98.4% had not used helmet at the time of the accident. Most accidents happened (37.4 %) inside the city. The most common injured parts were extremities with 53%. Up to 64.1% of the head and neck injuries lead to hospitalization with 2.5% caused death.. 71.4% of the hips and trunk injuries, 64.3% of injuries to the extremities and 58.3% of multiple injuries in motorcycle accidents lead to surgical procedures. More supervision on the use of safety equipment, control on driver''s license and manufacturing the motorcycles with such high safety factors are effective strategies for reducing injuries and mortalities that need more attention.

Backgrounds and Bio aerosols are particles that have derived from microbes, viruses, fungi, pollen, that they can cause secondary hospital infections. This topic is important for patients with low immunity levels. The purpose of this study is compare two methods of passive and active environmental bio aerosol measurements in ICU Ayatollah Taleghani Hospital, Tehran. This is a field - cross – sectional study; the sampling carried out by active and passive methods at 120 cm height above the floor, on a suitable culture medium. The medium in both methods was placed in incubator (37 ±20c) and after 24 or 48 hours, the number of colonies by microscopy was counted, then bacteria’s density based on cfu / m³ was calculated. in most cases (6/97%), Bacterial contamination in air of ICU was Gram-negative and growth of Gram-positive bacteria no observed or was very small (37/2%).Compare two passive and active sampling methods in whole time of sampling in different stations, in view of colony number, Gram-positive bacteria was at A and B levels EU GMP standard (very clean and clean respectively), and for Gram-negative bacteria often found in the C level EU GMP standard (medium). The results showed that the lowest and the highest colony growth are related to Gram-positive and Gram-negative bacteria respectively.Finally, it is suggested discharge the air by exhaust fans and avoided from opening windows.

Chlorine is an irritant gas that has many applications including in chemical and paper industries. Although this substance is an upper and lower respiratory tract irritant، acute and chronic respiratory effects of occupational exposure to this substance have not been thoroughly investigated. Therefore، the aim of the present study was to assess the respiratory effects of occupational exposure to chlorine gas in a group of workers in the petrochemical industry. This was a cross sectional study in which a group of 54 workers with cur-rent exposure to chlorine gas (exposed subjects) and 38 healthy male office workers without history of exposure to chlorine gas (referent subjects) were investigated. Standard respiratory questionnaires were administrated to them. Additionally، the parameters of pulmonary function were measured both prior to shift and at the end of shift. The prevalence of respiratory symptoms in the exposed group was significantly higher than that of referent subjects (P<0. 05). Pulmonary function tests (before shift) showed that chlorine gas causes a significant reduction in the average of some pulmonary parameters. Spirometry (after shift) also showed that the average levels of all parameters decreased at the end of the work shift compared to the corresponding values of before exposure، although these changes were not significant. Exposure to chlorine gas is associated with irreversible chronic changes in the parameters of lung function and prevalence of respiratory symptoms.