Mahdi Farzadkia, Somayeh Golbaz, Haniye Sadat Sajadi,
Volume 14, Issue 1 (6-2015)
Abstract
Background: There are various departments in hospital that produce hazardous, infectious, pathological and radioactive wastes. Utilizing proper methods of waste management is of high priority in order to prevent from releasing these wastes to environment. This study aimed to evaluate waste management efficiency in Karaj hospitals.
Material & Methods: This cross - sectional study was conducted in Karaj during 2011-2013. All hospitals of Karaj had been selected as statistical population of this study (n=8) by census. The data had been collected by separating and weighting produced hospital wastes for 4 month (during one week at each month) and filling related checklists of health ministry. Collected Data had been analyzed using SPSS software.
Results: The daily capita of waste was 4.1 kg per active bed, 5.6 kg per occupied bed and 9.4 kg per patient. The overall percentage score of present status of hospital waste management was assessed 88% and in 12% which indicate moderate and weak levels respectively. Hospital waste management had been evaluated weak in terms of collection, transportation and personnel but seen from the viewpoint in the separation and temporary storage, it was assessed moderate. However, in terms of disposal, assessment of hospital waste management showed it is in a desirable status.
Conclusion: The present status of hospital waste management was far beyond the expectations among studies hospitals. Thus, developing an operational plan and monitoring its implementation is highly recommended to. Given the main weakness of hospital waste management was related to production, collection, separation, and transportation, taking these areas consideration is of high priority.
Javad Vatani Shoaa, Hossien Kardan Yamchi, Mirghani Seyyed Someah,
Volume 14, Issue 1 (6-2015)
Abstract
Background: Exposure to some volatile organic compounds such as benzene, toluene, ethyl benzene and xylene cause adverse effects on organs and nervous system and moreover causes spread of diseases such as cancer , leukemia which would result in increasing medical expenses. This study is aimed to detect and measure BTEX (benzene, toluene, ethylbenzene and xylene) in air and compare it with recommended standards for hospital.
Materials and methods: This study is a descriptive , cross - sectional study in which critical sectors of Imam Hossein hospital such as pathology and emergency had been examined initially.Air samples had been provided by using activated charcoal.During the next phase , identifying the pollutants and determining their amount had been done by using gas chromatography with mass spectrometry and flame detectors.
Results: In areas such as parts of the wards, operating room, emergency room and laboratory pollutants benzene, toluene, ethyl benzene and xylene had been identified .The toluene concentration of in waste elimination , landry and pathology parts had been observed at 0/1455 ppm, 0/1087 ppm and 0/215 ppm Respectively.The comparison of these pollutants with threshold limit value (TLV), indicates standard condition.
Conclusions:This study shows that selected pollutants exist in all parts of this hospital. Using control measures such as installing vapor recovery systems and monitoring the air of these areas can be useful in reducing the amount of pollutants.
Mohamad Fahiminia, Elham Taherian, Abolfazl Mohammadbeigi,
Volume 14, Issue 1 (6-2015)
Abstract
Background: Hospitals have been known as main water consumers .Moreover , the amount of their produced wastewater and contamination is much more than domestic subscribers. Hospital waste management has recently emerged as an issue of major concerns but wastewater produced has not received sufficient attention. As there is a separate source of drinking water from that of sanitary usage in hospitals of Qom, surveying the consumption of water and the amount of produced wastewater will provide a lot of information in order to estimate amount of water requirement and wastewater produced in the hospitals
Materials and Methods: The amount of water consumption in hospitals had been collected from the year of 2008 to 2013. Collected data and conversion ratio of water to wastewater had been used for estimating the amount of wastewater. The data was analyzed by SPSS 19 software. Pearson correlation test was used to determine the relationships between variables. By identifying strengths and weaknesses of current system , appropriate interventions for better management of water and sewage systems were presented.
Results: The average of water consumption was found to be 655.7 liter per day per bed and 8.6 liters per square meter of substructure area among all eight hospitals surveyed.There was a statistically meaningful relationship between consumed water in hospitals and substructure area (p<0.05).The average quantity of wastewater produced was estimated as 567.6 liter per day per bed. The main method of wastewater disposal is discharge in an absorbing well.
Conclusion: In order to improve the current situation of mentioned hospitals, reconstructing water and wastewater facilities , using wastewater treatment packages and connecting waste water of hospitals to systems of wastewater collection of city seems inevitable.
Mohammad Malakootian1, Maryam Sadeghi, Shidvash Dowlatshahi,
Volume 14, Issue 1 (6-2015)
Abstract
Background: Waste of health care centers is particularly important due to their major role in spreading various diseases and environmental pollution. Consequently, considering function of non-hazardous waste devices in hospitals seems vital. This study is aimed to assess function of non-hazardous non-incineration devices of waste in Kerman educational hospitals and Sirjan hospitals
Materials &Methods: This experimental study had been conducted between March and September in year 2013 at the engineering research center of environmental health affiliated with Kerman university of medical sciences. Physical, chemical and biological function of devices was examined. Mechanical function had been examined by monitoring and recording mechanical index through thermometers and registers of devices. Chemical and biological function had been examined by indicator strip and biological indicator strip respectively.
Results: Among hospitals in which the survey had been carried out, 96.3%, 85.3% and, 84% of non- hazardous waste devices had efficient function from mechanical , biological and chemical viewpoints respectively.
Conclusion: As the results show, mentioned waste devices are unable to decontaminate hospital waste from hazardous materials chemically and biologically. Although mechanical process is efficient enough by providing required temperature and time , hospitals waste are not yet defined non-hazardous. Thus the final functional assessment is identified as poor outcome.
Fatemeh Arabi Basharic , Mohammad Reza Mobinizadeh, Alireza Olyaeemanesh, Morteza Arab Zozani ,
Volume 15, Issue 2 (6-2016)
Abstract
Background: Intravascular imaging is a tool to detect coronary artery atherosclerosis which plays the major role in vessel stenosis degree determination and plaque pathology as a supplement of invasive angiography. This study aimed at comparing Intravascular imaging with invasive angiography.
Materials and Methods: For retrieving second type studies, PubMed, Cochrane Library and Centre for Review and Dissemination (CRD) were searched up to September 2013. Searching was carried out by two persons using angiography and intravascular imaging keywords. Studies which compared intravascular ultrasound technology with invasive angiography were analyzed.
Results: Based on studies which reported the rate of target lesion revascularization (TLR) after one year of follow-up, there was a statistically significant difference between intravascular ultrasound and invasive angiography alone. It seems that TLR rate was lower with intravascular ultrasound (P = 0.02).In terms of cost effectiveness, approximately 54, 000 USD spend per each QALY using IVUS method.
Conclusion: Although, intravascular ultrasound could be able to detect coronary arteries damages and help out physician in selecting the most appropriate treatment, but due to the high cost of an intravascular ultrasound catheter, the invasive angiography is choice of physicians and patients in coronary intervention.
Zohreh Kaheh, Dr Ali Husseinzadeh Kashan,
Volume 15, Issue 4 (1-2017)
Abstract
Background: medical centers location is one of the most important problems, which should be considered in different dimensions to improve the services. In this paper, we consider the hierarchical maximum covering problem for bi-level healthcare systems including Clinics and hospitals, by taking the service rates into account. In this problem, the initial objective is minimizing the uncovered demand nodes, and secondary objective is the minimizing the lost demand rate as a measure of potentially patients’ retention in coverage radius.
Methods: In this paper, the serving system in the Tehran heart center hospital is considered for queue analyses. The proposed method is a mathematical optimization model called probabilistic two-stage programming model. To evaluate this model, a number of numerical problems are solved through GAMS software.
Results: according to the results, we have found that the best condition for locating the medical centers is that the clinic are located adjacent to a hospital. Decision making about the location problem by considering the service rate in each healthcare centers, increases the reliability to the result of the optimization model.
Conclusion: The proposed model is able to help the decision makers to attain an optimized decision for locating the medical centers in deprived areas, inspired by the medical centers in areas with similar population. Therefore, if the clinics and hospitals are located by considering the hierarchical mode and their service rates, the patients’ welfare will be enhanced.
Cyrus Alinia, Dr Arash Rashidian, Dr Kazem Naddafi,
Volume 16, Issue 1 (4-2017)
Abstract
Background: This study aimed at assessing and economic analysis of the existing market of treatment devices of infectious waste in Iranian hospitals.
Material and Methods: In the current descriptive- analytical study which was performed in 2013, the data resulting from national cross- sectional study in Center of Environmental and Occupation Health in 2012 and interview with relevant authorities in 14 Tehran's hospital with at least three years experience using the facilities were utilized.
Results: Until 2012, 883 hospitals have been active in nationwide that more than 64% of them owned by university of medical sciences and SBMU and TUMS with 114 and 45 centers have the highest number of hospitals respectively. Also hospital beds per 1000 population in the country were calculated 1.78. About 80% of hospitals utilized wet thermal and mostly based on autoclave machines for treatment which market share of domestic products is about 55% that Koosha Company, TEM and KAZU have the largest share with 39%, 23.5% and 12.9% respectively.
Conclusion: Existence a large heterogeneity in the type and function of the studied devices has created possible of Cartel in an oligopoly atmosphere which with a targeted regulation and policy making toward protectionism, it can be observed price decreasing, enhancing effectiveness, quality and safety increasing of infectious waste treatment facilities
Dr Ali Bozorgi Amiri , Arian Hossainzadeh,
Volume 17, Issue 2 (9-2018)
Abstract
Background: Today, one of the most important issues in hospital site selection is to consider the equity. This study aimed to provide a multi-objective model for fair Hospital site selection considering cost and use for hospitals construction in the future.
Materials and Methods: This study was an analytical-descriptive one conducted to determine the best locations for hospitals construction with respect to criteria of equity in Rasht city. For this purpose, after literature review, a three-objective model consist of p-median, p-envy and equitable loads objects was proposed; and the Rasht city was analyzed by model using the real data. In order to achieve the results and comparisons, the total weighting technique from the multi-objective decision-making techniques was used and solved with GAMS 24.1.1 software.
Results: This research can assist the decision-makers to consider the equity criteria to Hospital site selection in addition to the costs. Citizenship equity establishment and increasing in hospitals efficiency along with cost considerations can be regarded as the major achievements of this research for decision-makers in the health field.
Conclusion: Lack of proper attention to equity criteria hospital site selection, the results can be very unfair and can lead to irreparable consequences. This case study indicated the desirable function of the proposed model in hospital site selection with respect to the citizenship equity criteria in Rasht city. This study results can be given to managers as the proper basis for decision-making.
Zahra Tahmasebi, Dr Maryam Tajvar, Dr Mohammad Arab,
Volume 18, Issue 1 (5-2019)
Abstract
Background: Due to the presence of valuable and expensive equipments in hospitals’ warehouses, scientific management and continuous evaluation plays an important role to improve the performance of warehouses and whereby the performance of hospitals’ wards. This study aimed to evaluate the performance of the central stores of hospitals affiliated to Tehran University of Medical Sciences (TUMS).
Materials and Methods: In order to conduct this cross-sectional study, a checklist was designed and validated to examine the warehouses’ status considering structural, process and outcome dimensions of 39 depots in 14 hospitals. The status of hospitals’ warehouses were assessed using descriptive analysis and in order to assess association between performance evaluation score and charchetristics of warehouses and its staff Pearson Correlation Coefficient was utilized.
Results: Although, warehouses’ performance of studied hospitals in general was satisfactory, there were some items in unsuitable condition particularly in structural and process dimensions which should be addressed quickly. Also, performance of warehouses revealed a positive and significant correlation with number of beds, area and size of warehouse and number of staff (p <0.05).
Conclusion: Given that fair warehouses status, some items particularly in structural and process dimensions were in inappropriate condition which needed rapid consideration. Furthermore, hospitals with more beds have more and bigger warehouses achieved better evaluation score, but some of warehouses without these condition should be addressed in priority.
Dr Azam Lari, Dr Kamran Hajinabi, Dr Ali Komeili, Dr Leila Riahi,
Volume 18, Issue 4 (1-2020)
Abstract
Bachground: The use of optimal purchasing methods in the medical equipment sector, along with the implementation of state laws and regulations by the government, can serve as a way to move towards smart purchases. To be raised. The aim of investigating the factors affecting the decision making of purchasing capital equipment in hospitals affiliated to Tehran University of Medical Sciences.
Materials and Methods: In this applied research, which was conducted in the year 2017, the statistical population of the study were directors, heads and supervisors of the diagnostic and therapeutic sections and medical equipment of all hospitals, and managers and experts of medical equipment of the University of Medical Sciences who were 631 They formed. Data gathering tool was a researcher-made questionnaire. After verifying their validity and reliability, the data were collected and analyzed using SPSS software.
Results: The most effective variables of the actual price of capital equipment at purchase time with a regression coefficient of 0.368 and against the least effective variable in this area is the competitive or exclusive sale of the market with a regression coefficient of 0.162.
Conclusion: Therapeutic centers to purchase capital equipment should use standard decision-making criteria. Considering the sensitive role of identifying and selecting the best brand for the purchase of equipment, as well as the costs that these purchases bring to the health system, the use of quantitative and qualitative criteria as well as the use of experts is very important, in this way, equipment Provides economical and quality services to provide the right services.
Masoud Etemadian, Ali Mohammad Mosadeghrad, Mahmoud Reza Mohaghegh Dolatabadi, Hamed Dehnavi,
Volume 19, Issue 1 (4-2020)
Abstract
Background: Public-private partnership (PPP) in constructing and operating hospitals is a good strategy to provide high quality services to people at lower cost for the government. However, PPP is facing several challenges. The objective of this research was to identify and explore the PPP challenges in building Moheb Yas hospital in Tehran, Iran.
Materials and Methods: A qualitative approach was used for this case study in 2018. In-depth semi-structured interviews were conducted with 24 key stakeholders, managers and employees who were involved in PPP initiative implementation using purposive and snowball sampling methods. Thematic analysis approach was used for data analysis.
Results: Moheb Yas hospital was built in the yard of a public hospital (Co-location PPP) by the private entity. Then, the public hospital was moved into the private hospital. The new hospital was transferred to the government after one year owing to some challenges. These challenges include an inappropriate PPP model, low government capacity and competency in PPP, low trust in private partner, difficulty in funding the project, demolishing the old building, applying for hospital licences, merging two public and private hospitals, and difficulties in equipping the new hospital with human and physical resources.
Conclusion: The PPP was not successful in this case. Although PPP initiatives have benefits for the health system, but, it comes with numerous challenges especially in developing countries owing to disparate goals, incentives, and management practices of public and private sectors. The research findings provide useful insights for policy makers and senior managers in health systems in similar countries about the main barriers of PPP initiatives in the health sectors.
Nader Markazi Moghadam, Sanaz Zargar, Zaniar Ghaderi, Ehsan Tofighi,
Volume 19, Issue 1 (4-2020)
Abstract
Background: Hospitals play a key role in ensuring community health. Among the hospital departments, the surgery room accounts for a significant portion of the cost and revenue of the hospital. Surgery timing is important to increase the efficiency of operating rooms. The purpose of this study was to optimize surgical hall scheduling based on discrete event simulation model.
Materials & Methods: This cross-sectional study was performed in the summer of 2018 in the operation room of one of the hospitals in Tehran. As people entered the operation room, their information about the cause and condition that caused the surgery, the type of surgery (elective or emergency) the time of being in the operation was recorded by details. Data analysis was performed SPSS software and simulation of therapeutic system was performed Arena software.
Results: By analyzing the input data of 625 patients during three months, more than 60% of patients were men and less than 40% were women. The first entry into the surgery room for the selected patients was at 7:10 am and the last was at 5:00 pm. Of the eight scenarios presented, two arrival rate correction scenarios (noon arrival distribution) and a combined scenario (noon queue correction and patient adding) resulted in the greatest reduction in waiting time.
Conclusion: The results of this study showed that changing the distribution of patients 'arrival to hours with less input time can decrease patients' waiting time and increase the efficiency of surgery room.
Mohammadreza Zahedi, Seyyed Mahdi Hosseini Sarkhosh,
Volume 22, Issue 2 (9-2023)
Abstract
Background and purpose: The Internet of Things (IoT) essentially refers to the connectivity of various objects through the internet to facilitate a more efficient and intelligent experience. However, due to the emerging nature of this technology in Iran, instances of its full deployment in service organizations, including hospitals, are rare or infrequent. Therefore, the aim of this study is to identify the key success factors for the deployment of IoT and assess the readiness for implementing this technology in Milad Hospital, Tehran.
Methods: This research is a descriptive-survey study conducted in two phases. In the first phase, 30 key success factors were identified through a review of previous studies. In the second, survey phase, 93 managers and staff members of Milad Hospital formed the statistical population, and data was collected through a researcher-made questionnaire. The comparison of the current and ideal states of success factors for IoT implementation, and their ranking, were done using the t-test and Friedman test in SPSS software.
Results: Based on this study, factors such as information technology, organizational culture, organizational structure, and human resources were identified as the most crucial for successful IoT deployment in the hospital. Additionally, the results showed that there is a significant gap between the hospital's current state and the desired state for IoT implementation in these identified areas.
Conclusion: Successful implementation of IoT requires enhancement in readiness, both in terms of technological and organizational-cultural infrastructures
Abbas Jahangiri,
Volume 23, Issue 4 (2-2025)
Abstract
Background and purpose: Pharmaceutical pollutants in hospital wastewater pose significant environmental and public health risks. This study aimed to identify and prioritize effective strategies for removing these contaminants from the wastewater of selected hospitals in Markazi Province, Iran.
Methods: This descriptive-analytical study employed a multi-criteria decision-making (MCDM) approach. Initially, a comprehensive review of scientific literature, expert interviews, and consultation with professionals in environmental health and wastewater treatment was conducted. Relevant strategies and prioritization criteria were identified using MAXQDA 2022. Subsequently, the Analytic Hierarchy Process (AHP) method was applied using Expert Choice version 11 software to assign weights to criteria and rank the identified strategies.
Results: Five key treatment strategies were identified: (1) integrated biological, physical, and chemical treatment methods (hybrid systems), (2) advanced oxidation processes (AOPs), (3) aerobic and anaerobic biological reactors, (4) membrane filtration, and (5) activated carbon adsorption. The prioritization was based on five criteria: (1) pollutant removal efficiency (0.357), (2) environmental compatibility (0.241), (3) implementation and operational costs (0.198), (4) technology durability and sustainability (0.123), and (5) implementation complexity and feasibility (0.081). The final priority scores of the strategies were 0.312, 0.256, 0.211, 0.134, and 0.087, respectively.
Conclusion: The findings indicate that hybrid treatment systems combining biological, chemical, and physical processes offer the most effective strategy for eliminating pharmaceutical pollutants in hospital wastewater. These insights can guide healthcare policymakers and hospital administrators in selecting optimal wastewater treatment methods, contributing to environmental protection and water quality improvement.
Amirhossein Abdolalipour, Masoumeh Mikailiy, Khadijeh Alizadeh,
Volume 23, Issue 4 (2-2025)
Abstract
Background and purpose: This study proposes an integrated model to explore the mediating role of financial performance in the relationship between quality indicators, learning and growth, and the overall performance of hospital facility management services.
Methods: The statistical population included hospital managers across West Azerbaijan Province, Iran. Based on Cochran’s formula, 147 participants were selected using a simple random sampling method. Data were analyzed using Structural Equation Modeling (SEM) via SmartPLS software. Standardized factor loadings were used to assess model fit, and the Z-test was applied to evaluate the statistical significance of the relationships. Predictive power was assessed using the adjusted R² and Stone-Geisser Q² criteria.
Results: The indirect effects of quality indicators (t = 2.41), learning and growth indicators (t = 2.20), and internal process indicators (t = 2.39) on hospital service performance—mediated by financial performance—were all statistically significant (t > 1.96). Standardized path coefficients of 0.201, 0.344, 0.359, and 0.805 further confirmed the model's empirical robustness and goodness of fit.
Conclusion :The findings suggest that improvements in internal processes, service quality, and organizational learning and growth significantly enhance financial performance, which in turn improves the effectiveness of hospital facility management services. These enhancements contribute to increased patient satisfaction, strengthened hospital reputation, reduced operational costs, and ultimately improved revenue and financial efficiency.
Fateme Mohammadi, Hossein Dargahi, Sara Emamgholipour Sefiddashti, Mohammad Mehdi Aladdin,
Volume 23, Issue 4 (2-2025)
Abstract
Background and purpose: The healthcare sector is undergoing a profound transformation driven by rapid scientific, economic, and social advancements. The World Health Organization (WHO) emphasizes the necessity of medical equipment and supplies for reducing health disparities and achieving strategic health system objectives. However, there is a notable gap in the literature regarding this cost component within the Iranian health system. This study, therefore, aims to quantify the share of pharmaceutical and medical consumable costs in Iran's total health system expenditure.
Methods: This retrospective, cross-sectional study analyzed outpatient and inpatient medical records from 2018 to 2020. Data on the costs of pharmaceuticals and medical consumables were extracted from Iran's National Health Accounts (NHA) and the SPAS dashboard. The collected data were statistically analyzed to determine the proportional costs of these items relative to total national health expenditure.
Results: Between 2018 and 2020, inpatient pharmaceutical and medical consumable costs constituted 12% of the total health expenditure, demonstrating an annual decrease of 1.8%. In contrast, outpatient costs accounted for 19.5% of the total, with an annual increase of 0.7%. Basic health insurance allocated approximately 10.3% of its budget to cover these items, which corresponds to 31.5% of the nation's total healthcare spending.
Conclusion: The findings highlight the critical need for strategic interventions within Iran's health system. Key implications include the necessity for effective supply chain management, strategic planning to reduce import dependency, and robust mechanisms for monitoring prices. Mitigating the adverse effects of inflation and sanctions is paramount. Furthermore, increasing the healthcare budget's share of the Gross Domestic Product (GDP) and expanding insurance coverage are essential for ensuring financial protection for the population and advancing towards Universal Health Coverage (UHC).
Abbas Jahangiri,
Volume 24, Issue 1 (5-2025)
Abstract
Background and purpose: Hospital wastewater infrastructure is critical for safeguarding public health and protecting the environment. Deficiencies in the management of these systems can precipitate severe public health and environmental crises. This study aimed to identify and prioritize investment risks associated with hospital wastewater infrastructure.
Methods: This applied case study was conducted in a general hospital in Arak, Iran, during April 2025. Initial risk identification involved a comprehensive literature review and semi-structured interviews with 14 experts, with data analysis facilitated by MAXQDA 2022 software. Subsequently, a Failure Mode and Effects Analysis (FMEA) approach, utilizing a customized checklist, was employed to score each identified risk based on its severity, probability of occurrence, and detectability. The Risk Priority Number (RPN) for each risk was then calculated using Microsoft Excel. Finally, risks were ranked in descending order according to their RPN values.
Results: A total of 23 key risks were identified and categorized into five principal areas: design, technical, environmental, operational, and managerial. The highest RPNs were attributed to "lack of pre-treatment systems," "insufficient capacity planning," and "wastewater leakage into surrounding soil". Additionally, managerial and operational risks, such as "insufficient budget for maintenance" and "shortage of skilled personnel," were recognized as significant aggravating factors for other risks.
Conclusion: The findings underscore that many critical risks within hospital wastewater infrastructure originate from fundamental weaknesses in initial design and ongoing management. The FMEA method proved to be an effective and systematic tool for identifying and prioritizing these risks, thereby facilitating improved engineering and managerial decision-making and enhancing the overall effectiveness of investments in this vital infrastructure.
