شیرین افهمی

 This study was conducted with the aim of investigating methods to reduce the use of urinary catheters in hospitalized patients, which can reduce the occurrence of urinary infections.

This prospective study was conducted during 10 months by collecting information from the files of 694 patients (in two groups before and after the intervention) in the non-Intensive Care Unit wards of a university hospital. The required information before and after the educational and managerial interventions were collected and compared.

 In the pre-intervention phase, 217 out of 347 patients (62.5%) and in the post-intervention phase, 199 out of 347 patients (57.3%) were male. Before the intervention, the average duration of hospitalization and urinary catheter utilization days were 8.7 and 7.9 days, respectively, which were decreased to 7.2 and 6.3 days, respectively, after the intervention. After the intervention, the number of catheters that were placed by the doctor's written order increased significantly (P-value: 0.002); Also, after the intervention, the cases of catheterization with indication increased significantly (P-value: 0.001). The most common indication for urinary catheter insertion was before and during surgery and later, was severe weakness of the patient to get out of bed.

 Combination of educational, executive and managerial interventions can reduce the number of urinary catheter insertion without physician's order and the number of urinary catheter insertion without indication. In this study, the number of cases who used catheter due to inability of getting out of bed, did not change significantly by the interventions.

The rational use of antibiotic prophylaxis before surgery can reduce surgical site infection, microbial resistance, and economic burden. Therefore, the present study was carried out to optimize the use of antibiotic prophylaxis before surgery using a ready-made drug package prepared in the pharmacy of Dr. Shariati Hospital. The current study is a semi-experimental intervention type, carried out in two stages before and after on 260 patients hospitalized in the heart surgery and neurosurgery departments of Dr. Shariati Hospital who were candidates for surgery and received antibiotic prophylaxis before surgery. A checklist containing patients ' information was completed before and after the preparation of antibiotic prophylaxis packages. Data were analyzed in spss18 software with descriptive and analytical statistics (p≤0.05). Before and after the optimization of antibiotic use, a statistically significant difference was observed in the two study groups regarding dosage, administration intervals, time, and duration of administration. (P<0.001) A 63.42% reduction in the number of doses of antibiotic prophylaxis was observed after the implementation of optimization. Also, there was a 57.33% reduction in the cost of antibiotic prophylaxis after the implementation of optimization. The use of a ready-made drug package before surgery optimizes the use of antibiotic prophylaxis. Also, the economic burden caused by inappropriate use of prophylactic antibiotics for the patient and the hospital is significantly reduced with this method.

Ventilator-associated pneumonia is One of complication of mechanical ventilation and Its diagnosis in surveillance system based on the judgments of clinical, causing a large difference in reporting it. Centers for Disease Control and Prevention(CDC)has used objectively measures(ventilator-associated events) to overcome these barriers. Considering that in Iran, for surveillance system and reporting ventilator-associated pneumonia in hospitals, as well as from previous surveillance definitions of CDC are used ,and the new surveillance definitions (VAE) are supposed to replace the previouse surveillance definitions in Iran, this study was conducted to compare ventilator-associated pneumonia based on previous and new surveillance definitions of CDC.
In order to do this prospective study, Information on surveillance system in 4 intensive care units during 1 month were collected. The diagnosis of ventilator-associated pneumonia with CDC previous definitions (PNEU1) based on radiographic finding and clinical signs or symptomes(cnange in temperature,change in white blood cell count,altered mental status,change in respiratory secretions,cough or dyspnea,rales and worsening gas exchanges) and ventilator-associated events (VAE) based on daily minimum PEEP or FIO2, change in temperature,change in white blood cell count,start of new antimicrobial agent and culture of respiratory secretions,lung tissue,pleural fluid or lung histopathology.
12 Ventilator-associated pneumonia during a month in which all of them were PNEU1. Ventilator- Associated Events, in 6 cases (50%) were seen; 2(33%) were Infection-related Ventilator-Associated Complication(IVAC) and 4 (67%) were Possible Ventilator –Associated Pneumonia (PVAP). ventilator associated events revealed about half of the cases of ventilatorassociated pneumonia. McNemar non-parametric test showed no significant difference between the two methods (P = NS), obtained content of the agreement between the two methods using the Kappa was 0.656.
In our study, VAE surveillance detected half of VAP cases, but there was no statistically significant difference between the two methods which may be due to the small number of pneumonia cases and short duration of study. Also,given that the new surveillance definitions are supposed to be in place of the previous definitions in Iran and this, requires the accurate recording and daily monitoring of PEEP or FIO2 in the manual chart of intensive care units and requires a sufficient number of trained personel .the operation of Ventilator –Associated Pneumonia based on the new surveillance definitions of CDC,requires further study in Iran.

Background and To prevent Surgical Site Infection (SSI), a short duration of antimicrobial agents is prescribed just before the surgery which is known as preoperative antibiotic prophylaxis (PAP). In spite of evidenced-based guidelines for PAP administration, many studies have shown poor adherence to the guidelines. The aim of this study was to determine an effective intervention in improving surgeons’ adherence to the standard guideline of PAP administration in cardiac surgeries.
An interventional prospective study (before-after design) was performed in 335 patients undergoing cardiac surgery during 2011-2012. Three consecutive interventions were conducted including educational, managerial and regulatory interventions. The outcome measures were the duration and type of the PAP administration which was measured before and after each intervention. The changes were also monitored through a 5 months follow up.
No significant changes were detected after the educational intervention. After the managerial intervention significant changes in the type and duration of the PAP were detected in coronary artery bypass grafting (CABG) (P= 0.03), but no significant change was observed for PAP administration in valve repair/replacement surgeries (P= 0.54). Regulatory intervention caused significant changes in the type and duration of PAP in both CABG and the valve repair/replacement surgeries (P=0.01). The improvements lasted for at least 5 months after the regulatory intervention.
Managerial and regulatory interventions in addition to educational intervention could be of benefit in optimizing the PAP administration.

Aim. The aim of the study is to investigate the need for hospital infection control and prevention.
Background. Nosocomial infections are among the major health problems which increase mortality and hospital costs, especially in intensive care units. Successful control of nosocomial infections depends on recognition of hospital challenges in this issue.
Method. This study is an overview study. The keywords “hospital infection” and “ICU”, alone or together, with Persian equivalents were searched in websites such as Iranmedex, CINAHL, Scopus, Medline, Embase, SID, PubMed, Magiran and Irandoc.
Findings. Based on the findings, the main causes of nosocomial infections included multiple procedures and invasive diagnostic and therapeutic treatments, especially in ICUs. Compromised immune system, duration of hospitalization, absence of hospital surveillance reporting system, inappropriate disinfection and sterilization of equipment, inappropriate physical structure of ICU, non-cooperative managers and departments, and lack of knowledge of medical staff, especially physicians and nurses.
Conclusion. Identifying causes of hospital infections and the use of especial measures to promote safety and enhance quality of care in the treatment and prevention of these infections are necessary for a comprehensive and integrated controlling program.

Despite the possibility of curing TB with medical therapy، it has a sizable impact on the lives of afflicted patients. This study aimed to evaluate of treatment effect of anti-tuberculosis drugs on the quality of life on tuberculosis patients admitted in Imam Khomeini hospital in Tehran. The investigation was a before and after study. It was done in 2006-2007 by fill in Persian translated questionnaire of WHOQOL- BREF on 46 pulmonary or extra pulmonary TB infected patients. Paired samples T-test was performed to find out the differences. After 8 weeks of treatment، mean score elevation was significant in physical (15. 76±23. 89، p<0. 001)، psychological (7. 84±17. 57، p=0. 004)، and social (6. 83±19. 48، p=0. 02) domains. It was not significant in environmental domain (2. 15±8. 48، p=0. 09). Mean score elevation at the discharge time in physical، psychological، social and environmental domains were: (5. 65±16. 56، p=0. 09)، (11. 69±19. 22، p=0. 001)، (1. 04±8. 60، p=0. 41)، and (4. 37±17. 77، p=0. 1)، respectively. In our study، after treatment of tuberculosis، patient’s physical، psychological and social -not environmental- domains of quality of life were elevated، but at the discharge، there was a significant elevation in physical and psychological domains. These results emphasize the importance of patient’s treatment at the first days of admission، with special attention to social and environmental domains.

Catheter-related bloodstream infections (CR-BSIs) are the most serious and frequently occurring complications of vascular catheters, carrying a high morbidity and mortality, and increasing the cost of medical treatment and length of hospitalization. This study was designed to determine both the incidence of CR-BSIs and the accuracy of Iran Nosocomial Infections Surveillance Software (INIS Software). A prospective study was performed during a 4 month period in 2009 to assess the incidence density of CR-BSI per 1000 catheter-days in patients with central venous catheter admitted to the ICUs of a teaching hospital in Iran, according to the CDC criteria for diagnosis of CR-BSIs. Then the primary data were input to the INIS Software, and the results were compared. In this study, among 67 admitted patients, blood cultures were positive in 9 patients (13%) and 2 patients (2.98%) developed CR-BSI. The incidence of CR- BSI was 1.98 per 1000 catheter days. The mean age of patients in CR-BSI group was 66 ±19.79 years. The mean length of ICU stay was significantly higher among patients with CR-BSI (49±14.14 days) than patients without CR-BSI (14.41±11.62 days) (P value < 0.001). The mean catheterization days was also higher among CR-BSI group (49±14.14 days) than non CR-BSI group (14±11.34 days) (P value<0.001).These results were 100% consistent with Iran Nosocomial Infections Surveillance Software. The incidence of CR-BSI in our study was not high, and there was a positive correlation between ICU stay and catheterization days and occurrence of CR-BSI. The application of INISS can cause convenience and accuracy in diagnosis of CR-BSI.

Introduction & Although one of the most influential modality for decreasing wound infections is utilizing prophylactic antibiotic before surgery, inappropriate use of antibiotics before operation is a major concern and can increase the prevalence of antibiotic resistant strains and adverse reactions, and negatively affect hospital budget. The aim of this study is to assess the appropriateness of surgical antibiotic prophylaxis among patients admitted in the surgical wards of a teaching hospital relative to the international guidelines and standards. In this descriptive cross-sectional study, surgical antibiotic prophylaxis of 172 surgeries was evaluated prospectively but discontinuously. During 2 years in six surgical wards of a teaching hospital. Information including demographic data of patients, wound classification, type of surgery, indication, selection of the prophylactic antibiotics, time, interval, duration and route of antibiotic administration were collected through a questionnaire; the sources of data were patient’s records and charts, physicians and nurses. Then the results of prescribed prophylactic antibiotics were compared with the international guidelines on antibiotic prophylaxis in surgery. All data were coded, entered, and analyzed using SPSS 13. For descriptive statistics, data were summarized using tables, measures of dispersion and central value, and frequency and percentages were calculated and presented. Among 172 operations, the overall adequacy of indication of prophylactic antibiotic (PA) was 71.5%. Of the 108 patients with indication, the timing of PA was appropriate in 95 (88%) patients; the choice of antibiotic was adequate in 44 patients (40.7%); the dosage and interval of PA were appropriate in 34 (31.5%) and 26 patients (24%), respectively, and the duration of antibiotic prophylaxis was appropriate in 5 cases (4.6%). The route of drug administration in all patients, except one, was intravenous. Considering all variables (indication, selection of the prophylactic antibiotic, time, interval, duration and route of antibiotic administration), the overall appropriateness of PA was 4.6% (5 cases) according to guidelines. Considering all variables (indication, selection of the prophylactic antibiotic, time, interval, duration and route of antibiotic administration), pre-operation antibiotic prophylaxis had little concordance with standard guidelines, especially regarding prolonged duration of antibiotic use, though after excluding the variable of duration of antibiotic administration, the prophylactic antibiotic was prescribed appropriately in one-fourth of patients. For appropriate use of antibiotic before operations, interventions including developing local hospital guidelines, implementing educational programs, and monitoring antibiotic prophylaxis should be considered.

Brucellosis is one of the most common infectious diseases in some area of Iran. It has very different clinical sings and symptoms, thus it should be considered in differential diagnosis of most infectious and non-infectious diseases. 415 Brucellosis patients, who referred to Imam Khomeini and Sina Hospitals of Tehran during 1998 to 2005, were studied from epidemiological, clinical, laboratory and treatment protocols aspects. 52.5% of patients were female and 47.5% male with mean age of 35.5 years old. 84.3% of subjects were living in urban and 15.7% in rural area. The commonest transmission way was consuming of contaminated dairy products however 17.1% of patients had history of animal contact. The most contagious seasons were summer and spring. Family history of brucellosis was positive in 19.51% of the patients. The most common symptoms were fever (67.22%), sweating (73.25%), malaise and fatigue (65.45%), arthralgia (29.15%), headache and coughing. Whilst the most common clinical signs were fever (56.62%), peripheral arthritis, sacroilitis and splenomegaly. CBC analysis showed normal range in majority of subjects. Although doxycycline and Rifampin were the most common prescribed medicines combination of cotrimoxasule and doxycyline showed more efficient effects to control the diseases. Regarding variable clinical presentations, brucellosis should be considered in differential diagnosis in subjects with chronic fever or chronic fever plus other organs abnormalities.

Hospitals are habitually thought of as places where people "recover from disease". But failure to control agents of disease in these institutions can create or worsen disease and infection; such nosocomial infections constitute a major threat to all hospitalized patients. The German cockroach (Blattella germanica) can be an effective transmitter of nosocomial infections by virtue of its ubiquitous presence and its behavioral characteristics. This research is focused on nosocomial organisms in Imam Khomeini and Shariati hospitals (belonging to Tehran University of Medical Sciences) and may be a first step in devising effective infection control strategies.After recording data on the collection site, the collected cockroaches were transferred to a laboratory, where bacteria and fungi were isolated from the body surface and the digestive tube. The specimens were also subjected to insecticide sensitivity tests by the mortality and knock-down test methods.Cultures of the external body surface yielded a total of 77 fungal colonies (filamentous fungi, Actinomycetes, yeasts and yeast-like organisms), while those of the digestive tract produced 83 colonies. Notable among these isolates were the highly virulent Aspergillus fumigatus and Aspergillus flavus species.Bacterial studies showed that 100% of the roaches carried rich bacterial floras, most commonly including Klebsiella, Pseudomonas, Proteus, Citrobacter, Enterobacter and Serratia species. Many of these bacteria demonstrated antibiotic resistance, suggesting that the contaminants belonged to the hospital milieu. These results establish cockroaches as effective mechanical transmitters of multi-drug resistant bacteria.Mortality tests revealed a high degree of resistance to permethrin, tolerance to Aicon, and sensitivity to other insecticides. Knock-down tests showed high permethrin resistance, tolerance to Aicon and deltamethrin, and sensitivity to Sulfac.