Narges Asadijanati, Dr Ali Maher ,
Volume 16, Issue 4 (2-2018)
Abstract
Background: microbial contamination of hospital wards is one of the most important factors in the transmission of hospital infections among inpatients in hospital units.
This study aimed to analyze the error in the diagnosis of microbial contamination in the hospital's intensive care unit and its root causes analysis in 2015.
Materials and Methods: This study was conducted in three stages. The first stage conducted as a case report. The second stage was designed to identify the factors affecting the occurrence of error by Root Causes Analysis and conducting an interview and panel. Third stage was provided using self-made questionnaire and Delphi technique to obtain appropriate strategies to identified errors. In order to data analysis SPSS software was utilized.
Results: The main causes of hospital infections were organizational and managerial causes, task related causes, laboratory-related causes, causes associated with training, causes associated with work teams and causes related to working conditions in the intensive care unit. The study findings extracted from the Delphi technique revealed that simple actions such as hand wash and disposable appliances usage are significantly effective in hospital infection prevention.
Conclusion: One of the most important ways of preventing and controlling hospital infections is investigating the root causes of these infections. Also, personnel training regarding effective methods to nosocomial infections’ care and control and patient safety culture should be considered by managers.
Sepideh Safaverdikhan, Asgar Aghaei Hashjin, Aidin Aryankhesal,
Volume 20, Issue 4 (12-2021)
Abstract
Introduction: Root cause analysis is one of the most important tools in disaster management that aims to identify the real causes of an issue and find ways to eliminate them. Surgery is one of the areas in which the possibility of clinical error is significant. Therefore, the study aims to explain the weaknesses and challenges of root cause analysis in surgical events and identify the experience of staff around the technology.
Materials and methods: This qualitative study was conducted through interviews in 2021. Twenty members of the root cause analysis team working in teaching hospitals affiliated to Iran University of Medical Sciences were interviewed. After conducting the interviews, MAXQDA software version 10 was used to analyze the thematic content and extract concepts related to the research objectives.
Results: The majority of participants were female, head nurse, aged 30 to 40, work experience of 11 to 15, and employed in Hasheminejad Hospital. The most important weaknesses identified for root cause analysis included the lack of proper implementation of the root cause analysis process and the lack of participation of individuals, hospitals and universities in this process.
Conclusion: Health managers and policymakers should address the weaknesses of root cause analysis by explaining the necessity of the process, root cause analysis immediately after each clinical event, evaluating the effectiveness of root cause analysis, and providing adequate feedback from the authorities. Upstream therapy, creating a culture of root cause analysis, providing the necessary facilities to perform these analyzes, providing clear instructions to encourage and punish employees.
