Journal of

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Abstract Background: Hand hygiene is the simplest and most effective preventive measures to reduce cross infection in hospitals. However, compliance with recommended instructions is commonly poor among healthcare workers. The present study aimed to explore potential behavioral determinants of hand hygiene compliance among healthcare workers in intensive care units. Methods and Materials: A qualitative study was conducted, consisting of 42 semi-structures interviews with physicians (attending physicians, non-attending physicians, residents), nurses, nursing students and medical students, who worked in the intensive care units. Results: Participants mentioned self protection as the main reason for the performance of hand hygiene. According to the participants, hand hygiene was often performed after direct contacts and tasks that were perceived to be dirty. Participants were most concerned about knowledge gaps in hand hygiene practice. Most participants believed that having a good theoretical knowledge of hand hygiene guideline may strengthen healthcare workers' attitudes toward hand hygiene. Junior practitioners believed that the superiors' hand hygiene practice could influence their performance both negatively and positively. Participant also believed that the lack of formal and informal control may hinder compliance among healthcare workers. High workload, interruptions, and limited access to hand hygiene products were mentioned as primary barriers to hand hygiene. Conclusion: The findings revealed that a number of factors can influence had hygiene practice. Recommendations of the current study are of value to future researches aiming to improve compliance with hand hygiene behavior among healthcare workers.

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Background: The goal of clinical risk management is to improve the quality of health care organization’s services and to ensure patients' safety. Thus, this study has identified and evaluated the potential failures by Failure Mode and Effects Analysis (FMEA) approach to eliminate errors occurrence of an Intensive Care Unit (ICU) in a hospital in Tehran city.

Materials and Methods: This study is a descriptive one in which data were gathered qualitatively by direct observation, document review, and Focus Group Discussion (FGD) with the process owners in an Intensive Care Units (ICUs) of a Tehran non-governmental hospital in 2014. According to FMEA method, quantitative data analysis was carried out based on failures’ Risk Priority Number (RPN).

Results: By FMEA, 378 potential failure modes in 180 ICU tasks were identified and evaluated. Then, with 90% confidence, 18 failure modes with RPN≥100 are identified and analyzed as non-acceptable risks totally.

Conclusion: Identifying 18 failures as non accepted risk from identified 378s, and identifying causes, analyzing and then suggesting correction actions reveals the FMEA high capability to identify, evaluate, prioritize and analyze potential failure modes in a such complex and critical hospital ward(ICU).

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Background: This study investigated the Length of Stay (LOS) in the Intensive Care Unit (ICU) and its influential factors as a step toward revising hospital policies, more appropriate resources usage and improving health system performance.

Materials and Methods: this cross-sectional study was conducted on 246 patients, among nine general ICUs of Tehran University of Medical Sciences. Variables such as age, type of disease, existing nosocomial infection and APACHE II (Acute Physiology and Chronic Health Evaluation) score were studied. SPSS software utilized for statistical analysis using Mann Witney U and regression.

Results: The mean and median of LOS was 8.6±19.2 and 2 (1-7) days, respectively. Mortality rate was 19.9% (N=49). The mean age was 52.7±22.07 yrs which LOS enhanced with increasing age (r=0.35, p<0.001). The mean  of APACHE II score was 14.2±6 and it raised  with increasing patients LOS (r=0.19, p=0.01). Average length of stay in patients with surgical diagnosis was 6.71 days less than others. Among effecting factors, nosocomial infection (p<0.001), need for mechanical ventilation in the first 24 hours of hospitalization (p<0.001) and a past medical history (p=0.012) which prolonged LOS significantly.

Conclusions: In this study, type of disease, hospital infection and age were the most important affecting factors on the length of stay. Thus, implementing effective interventions in order to maintain patients' health and safety is recommended. Since, half of the patients were hospitalized less than two days, providing protocols are necessary to make better use of ICU resources for patients who really need.

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Background: Injuries related to failures and errors due to clinical interventions in patient hospitalization period in hospital are the main reasons of mortality and mortality in worldwide. This study tries to identify and description ICU care failures and assessing the causes of risks, Severity, Occurrence and identifying risk probability ratio and risk prioritizing using FMEA method.

Materials and Methods: This study was carried out in order to evaluating existing situation using Failure Mode and Effect Analysis and utilizes volere logic to plan the patient safety management system. This study performed in the intensive care unit of Loghman Hakim hospital in Iran.

Results: Study finding revealed sixteen routine failures and its priorities which the five main issues were documented as error in decision phase for patients admission or in-admission (PRN 1000), error in discharge time of patient from ICU (PRN 1000), insufficient infection control (PRN 1000) and error in clinical ordering and prescriptions (PRN 800).

Conclusion: The main requirements of the patient safety management identified as planning standards and clinical guidelines, developing evidence based admission and non admission indicators, enacting infection control rules and education of anticipating standards places, hand washing and disinfecting instrument and equipments.