Journal of Health and Safety at Work

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Introduction: Low back pain (LBP) is a common and costly health problem. It has high prevalence in nursing job and caused shortage of nursing staff. This study was conducted to determine the prevalence of LBP, knowledge level of LBP risk factors and assess relationship between LBP prevalence and nurses’ knowledge level of LBP risk factors among nurses of Shiraz University of Medical Sciences (SUMS).

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Material and Method: In this cross-sectional study, 118 randomly selected registered nurses participated from SUMS hospitals with at least one year of job tenure. In order to assess nurses’ knowledge of LBP risk factors, a self-administered survey questionnaire consisted of four parts was used as data collecting tool. Statistical analyses were performed using SPSS (version 11.5). Duncan, T-test and ANOVA tests were used for data analysis.

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Result: LBP prevalence rate was found to be 79.7% (94 nurses) during the previous year from which 12 nurses were male (63.2%) and 82 nurses were female (82.8%). Nurses’ knowledge level of LBP risk factors in different hospitals was not significantly different. The Results showed that nearly half of the nurses had poor knowledge about LBP risk factors and the remaining had good knowledge level. The main source of information about LBP risk factors among nurses were related to their university education.

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Conclusion: A high prevalence of the LBP was found among nurses working at SUMS hospital. Knowledge level of nurses about LBP risk factors needs improvement. In addition to university education, which is the main source of information of nurses about LBP risk factors, on-the-job training seems essential in this field.

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Introduction: Patient safety is an important issue in regard to hospital servicesand any problem can cause adverse consequences. The purpose of this study was to assess the patients’safety culture at educational hospitals in Tehran.

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Material and Method: The present descriptive-cross sectional study was carried out among 312 health care workers in Baharloo, Amir Aalam, Shariati and Sina hospitals in Tehran, which were selected by cluster sampling. The participants were chosen randomly in each cluster. Safety Culture Survey questionnaire including 12 dimensions was used to assess patient safety culture. Cronbach’s alpha and test-retest coefficient were estimated 81 and 79 percent, respectively.

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Result: Nurses comprised 61 percent of participants in the study. 42% of staff had less than 5 years work experience. Of the 12 dimensions of patient safety culture, the frequency of reporting and exchange of information had the minimum average of 56 and 55, respectively. Moreover, the dimensions of organizational learning and expectations-management measuresobtained the highestmean score (69)among 12 dimensions of patient safety culture. Total mean patient safety culture in understudy hospitals was 63.

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Conclusion: It should be noted that paying more attention to the patient safety culture can lead to improve hospitals condition, as a whole, and to have a patient-friendly environment. Special attention should be paid to dimensions with the lowest mean score in order to strengthen them.

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Introduction: Safety climate is the perception of personnel about the priority of safety in an organization. The objective of this study was to evaluate safety climate using Nordic questionnaire in a hospital.

Material and Method: In this cross-sectional study, 92 nurses working in different wards of a hospital in uromia city, Iran, filled out the NOSACQ-50 questionnaire. The responses of nurses were recorded with a 4-point Likert scale. The results were analyzed using descriptive and analytical statistics.

Results: Seventy-two percent of nurses were female and the remainders (28%) were men. The mean score of safety climate dimensions was different. “Management safety priority, commitment, and competence” and “Safety communication, learning, and trust in co-workers safety competence” dimensions obtained the lowest and the highest scores by nurses, respectively. The mean score of safety climate ranged 2.49 to 2.67 in different wards of the hospital. What is more, the mean safety climate was not statistically differed among nurses of various age and work experience categories (P-value> 0.05).

Conclusion: According to the results, it can be noted that the level of safety climate in the hospital was fairly good from the nurses’ viewpoint. However, attempts should be made to improve it, especially in the safety management related dimensions. Corrective control measures should be implemented in all wards of the hospital for all personnel with any age and work experience.

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Introduction: Provision of high quality nursing care for patients, has made patient safety culture as an important issue for improving the quality of health care in the country. This study aimed to determine the relationship between nurses’ job satisfaction and patient safety culture in hospitals of Rasht city, Iran.

Material and Method: This research is a descriptive-analytical, cross-sectional, and field data collection study. Nurses working in public and private hospitals in Rasht City comprised the study population, of whom 322 subjects were selected randomly as the study sample. The Wakefield questionnaire and the Agency for Healthcare Research and Quality questionnaire were employed to investigate nurses’ job satisfaction and patient safety culture, respectively. The Pearson correlation coefficient was used for statistical hypothesis testing, employing SPSS software version 19.

Result: The results showed that according to the respondents’ viewpoints, scores of job satisfaction (Mean(SD):3.59±0.68) and patient safety culture (Mean(SD):54/0±31/3) Rasht city hospitals were at the average level. Furthermore, there was a significant direct relationship between nurses’ job satisfaction and patient safety culture with the correlation coefficient of 0.643 at the 0.01 level of significance.

Conclusion: According to the findings, it is necessary to improve study nurses’ job satisfaction and patient safety culture. Moreover, according to statistical correlation between research variables, increasing nurses’ job satisfaction results in improvement of patient safety culture.

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Introduction: Annually, many accidents and preventable events happen for the patients hospitalized in treatment centers. Therefore, the related causing factors should be recognized in order to reduce the medical errors. Accordingly, the present study aimed to assess the relationship between patient’s safety culture elements and medical errors and also the ways to tackle them.

Material and Method: This cross-sectional study was conducted among 380 employees working in the education and treatment centers affiliated with Kermanshah University of Medical Sciences in 2015. The hospital version of patient safety culture questionnaire was used for data collection. Data were analyzed by SPSS software, version 19 using different statistical tests including multivariate analysis of variance and Pearson’s correlation.

Result: The patient safety culture was at an undesirable level in the study centers. Of the elements related to safety culture, the lowest positive scores belonged to ‘issues related to employees’, and ‘reporting’ with scores of 23% and 26%, respectively. On the other hand, ‘team working in the organizations’ (59%) and ‘organizational learning’ (57%) obtained the highest positive scores. Fifty-eight percent of the respondents did not report any errors.

Conclusion: The results of present study emphasize on creating a desirable organizational atmosphere, the need for staff participation in various levels of decision making, and creating the culture of reporting errors in order to recognize the causing factors and to promote patient safety culture.

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Introduction: Hospital acquired infections recognize as an important risk factor in health care. In this regard health care and hand hygiene is the first step in controlling the infections. This study, carried out with the aim of comparing the effect of hand washings in the usual way with disinfectants without water in microbial contamination of the hospitals hand nurses.

Material and Method: Accordingly, samples were taken from hand of 30 nurses in the wards of surgery, pediatrics, emergency, CCU, ICU and cardiology in 4 steps before and after washing with soap and washing with liquid hand rub. Samples were cultured in EMB and Blood Agar medium, then identified by gram staining, catagase and coagugas tests and growth on manitol salt agar.

Result: The findings showed that 30 samples were not grown on EMB medium، but 30 samples of Blood agar, before and after washing with soap and  liquid hand rub, were grown and applying hand rub alcohol liquid is most effective than washing with soap. Identification of bacteria in manitol salt agar medium and coagulas test revealed %80 were coagulas negative staphylococcus and %20 coagulas positive staphylococcus.

Conclusion: In this study washing with soap dose not effect on hand hygiene of nurses but disinfectant with liquid alcohol shows significant correlation in reducing microbial load on personnels’ hand that is revealed alcohol was more effective in reducing pollution.

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Introduction: There are some tensions in occupational activities that are caused by harsh conditions and occupational violence is considered one of these tensions. Workplace violence is a global problem. Healthcare workers are globally exposed to the workplace violence more than any other workers. The aim of this study was to investigate the relationship between some individual and job variables with exposure to occupational violence among health care workers in the hospitals in Yazd province, Iran.
 

Material and Method: This cross-sectional, descriptive-analytical study was conducted in eight educational hospitals in Yazd province, Iran. Research population (600 participants) consisted of all healthcare personnel employed in hospitals affiliated to the Shahid Sadoughi University of Medical Sciences in Yazd and were selected by stratified sampling. The Negative Act Questionnaire-Revised (NAQ-R) was used to investigate occupational violence and data analysis was performed using multiple logistic regression tests.
 

Result: The average score of occupational violence was 19.3. Among individual factors, gender (male) and educational level (MSc degree), and among job factors, shift work (morning shift) and type of work environment (genecology and pediatrics wards) had significant relationships with the incidence of violence among the employees.
 

Conclusion: The importance of these findings is in planning and deployment of intervention measures using educational training with regard to the ways of preventing violence, decreasing the coworkers’ aggression, dealing with and increasing awareness about personal and civilian rights in order to reduce the phenomenon of violence among employees.

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Introduction: Patients’ safety culture indicates the extent to which the staffs prioritize the safety of patients. In medical centers, it is very important to pay attention to the patients’safety. Hence, the patients’safety culture should be examined and improved. One of the factors which lead to the improved patients’ safety culture is structural empowerment. Structural empowerment refers to adjusting workplace structures by managers and facilitating the staffs’ access to organizational facilities. In other words, structural empowerment refers to the staffs’ access to four environmental factors (i.e., opportunity, information, support, and resources) in the organization. The objective of the present study was to investigate the relationship between the dimensions of structural empowerment and patients’ safety culture.
Material and method: The current study was descriptive-correlational research method, and the population included all staffs (i.e., 275 individuals) in the nursing department of a public hospital in Ahvaz. The research sample included 221 staffs who were selected through stratified random sampling. The data were collected through standardized tools, including Effective Working Conditions (the second version), and Patients’ Safety Culture in Hospitals questionnaires. The reliability of the questionnaires was examined through Cronbach’s alpha. Pearson correlation coefficient, multiple regression analysis (simultaneous method) and one-way analysis of variance were used to analyze the data through SPSS software, version 16.
Results: The dimensions of opportunity, support and resources have a positive and significant relationship with the patients’ safety culture. However, the information dimension is not significantly related to the patients’ safety culture. The results of multiple regression analysis showed that the dimensions of structural empowerment predict 59% of the variance of the patients’ safety culture, and from among all dimensions of structural empowerment, opportunity and information in the model do not have a significant effect on the patients’ safety culture. In addition, support and resources are the most important predictors of the criterion variables. The results of one-way analysis of variance showed that the score of safety culture among the midwives has the highest value, and the lowest value is attributed to the sitters. In other words, midwives pay more attention to the safety of patients and patients’ safety culture.
Conclusion: Structural empowerment is one of the factors affecting patients’ safety culture which increases patients’ safety. Focusing on structural empowerment improves patients’ safety culture because when the staffs are structurally empowered, their accuracy and performance would improve, and they would provide more safe services to the patients. Therefore, hospital managers are advised to pay attention to the issue  of structural empowerment in order to strengthen the patients’ safety culture, and to provide the necessary training and equipment to improve the structural empowerment of their staffs, especially nurses.

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Introduction: Considering the importance of identifying and tracing primary sources of Covid-19 crisis in infection control, this study was carried out with the aim of identifying the occupational tasks effective in transmitting Covid-19 in the event of death of a female staff in medical record unit in Shafa Takestan Hospital (Qazvin Province).
Material and Methods: This case study was performed on the death of a 26-year-old married woman working in the medical records department of Shafa Takestan Hospital in March 2019. After identifying and completing the tasks, hazards analysis was performed and finally, various tasks and amount of the Covid-19 sources were determined.
Results: Covid-19 risk sources are classified into three groups of human resources with 51 cases (38.06%), office tools and equipment with 46 cases (34.33%) and paper with 37 cases (27.61%). Four tasks were identified as major tasks with a 59.90% of the total number of COVID-19 risk sources. In this study, two critical tasks were determined with the titles of “reply to requests of forensic medicine and insurance” and “reviewing patients’ surgical reports” that contained a total of 39.06% of the Covid-19 sources.
Conclusion: The results showed that the human resources in two major tasks were the most critical sources of Covid-19. So, the control of these critical tasks is of special importance. The results also showed that it is necessary to transfer the special and unusual tasks to the time after the crisis, in order to reduce the sources of Covid-19 contamination.

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Introduction: Maintaining and improving organizational safety requires a strong safety culture. Following the occurrence of occupational incidents, proper registration, reporting, and investigation is a key requirement for safety culture to provide an appropriate learning culture. As a result, this study was carried out to assess the culture of occupational incident registration, reporting, and investigation in the province of west Azarbaijan’s industries.
Material and Methods: In this cross-sectional study, data on the culture of registration, reporting, and investigating occupational incident were collected using a 68-item questionnaire. A total of 420 employees from a number of construction and mine companies, as well as hospitals participated in this study.
Results: The results of study showed that the average total score for the culture of registration, reporting, and investigating occupational incidents was 3.08 (±0.38), with the factor of corrective action had the highest 3.17 (±0.72) and the reasons for lack of reporting had the lowest 2.90 (±0.54) scores. There was also a significant relationship between the average score of the culture of registration, reporting, and investigating occupational incidents with education, industries, and companies. Employees who attended training courses had a lower mean score for the culture of occupational incident’ registration, reporting, and investigation than those who did not take training courses. The mean score of the culture of registration, reporting, and investigating occupational incidents of the employees who had experienced an occupational accident was lower than those who had not experience occupational accidents in the past.
Conclusion: The findings of this study revealed that corrective actions is necessary after the occurrence of occupational incidents. Attending training courses and having an occupational accident experience had no positive impact on promoting culture of registration, reporting, and investigating occupational incidents.

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Introduction: Nosocomial infection (NI) is an infection occurring in a patient after 48 hours of hospitalization or up to 72 hours after discharge from the hospital, which was not present or incubating at the time of admission.  Hospital accreditation standards have a significant impact on the prevention and control of NI. Nevertheless, Iran’s hospital accreditation standards face challenges. The aim of this study was to compare the accreditation standards of NI prevention and control in Iran and leading countries.
Material and Methods: This research was conducted using the comparative review method in 2020. Hospital infection prevention and control (IPC) standards of Iran Hospital Accreditation Program was compared with those of international accreditation programs in the United States, Canada and Australia. Thematic analysis method was used to analyze the qualitative data.
Results: Iran and the United States had the highest share of nosocomial IPC standards. The Iranian Hospital IPC standards approximately comply with 62.1%, 46.6% and 49.9% of Hospital IPC standards of the United States, Canada and Australia, respectively. A hospital infection management system including constructs of NI leadership and management, NI planning, NI education, employee management, patient management, resource management, process management and outcomes is necessary for IPC. Iran Hospital Accreditation Program places great emphasis on process and resource management and less importance to leadership and management, planning, employee management, patient management and outcomes.
Conclusion: The Iranian Hospital Accreditation Program is progressing. However, its IPC standards need to be reviewed and updated. Using a systems approach including structures, processes and results in the development of hospital accreditation standards, leads to the optimal use of hospital resources and achieving better results.

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Introduction: Job burnout is a kind of psychological exhaustion that is associated with psychological stress or job and workplace stress and can affect the general health of the individual.  Job burnout is more likely to occur in jobs offering health and social services. Considering the special problems of hospital staff due to high work sensitivity, this study was conducted to identify the relationship between job burnout and mental health among non-medical staff of general, specialty and sub-specialty hospitals affiliated to the Iranian oil industry.
Material and Methods: This research is descriptive-analytical which is of correlation type. Cluster random sampling was used to select 251 non-medical staff members of Oil Company’s hospitals in Abadan, Ahwaz, Mahshahr and Tehran. The instruments used included demographic checklist, Goldberg General Health Questionnaire and Maslach Burnout Questionnaire. The data were analyzed by Spearman, Mann–Whitney U test and Kruskal-Wallis correlation test at the level of 0.05.
Results: The findings showed that the mean and standard deviation of age of participants were 38.82±8.3. 49.5% of participants were female  The mean and standard deviation of mental health was 2.12 ± 0.405 and the mean and standard deviation of burnout was 28.4 ± 0.634. There is a meaningful and reverse relationship between burnout and mental health, mental health and emotional exhaustion and depersonalization and personal adequacy in non-medical staff in general, specialty and sub-specialty hospitals affiliated to the Iranian oil industry.
Conclusion: Based on the findings of the study, job burnout affects mental health. Burnout affects both male and female. The findings of this study can be used in planning preventive measures, and identifying groups which are exposed to risk in work environments.

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Introduction: Oxygen-generating central plays a vital role in the continuous performance of hospitals. Any leakage or failure in this section can not only endanger the health and safety of patients but also cause fire and explosion. Probabilistic risk assessment is a useful tool for identifying the main root causes of leakage in oxygen-generating central. This study aimed at risk assessment of an oxygen-generating central in a hospital in Hamadan using fuzzy sets theory and Bayesian networks.
Material and Methods: First, all root causes supposed to contribute to oxygen leakage from any part of the oxygen-generating central were identified, and based on them a fault tree analysis (FTA) was constructed. Then, the FTA was mapped in a BN. The failure probability of root causes was calculated using fuzzy sets theory and experts’ opinions. Belief updating based on BN was utilized for subsequent analyses.
Results: According to this study, ignorance of labels on the oxygen generation and distribution system is the most important root cause leading to oxygen leakage. Moreover, removing masks from patient’s faces is the main cause of oxygen leakage in patient rooms. Once leakage occurred, the presence of an ignition source can lead to fire or explosion.
Conclusion: oxygen leakage can create considerable risks in hospitals. All staff should be provided with sufficient training regarding hazards of oxygen-generating and distributing systems and oxygen leakage. Particular attention should be paid to such leakages and their adverse consequence in emergency planning and hospital crisis management.

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Introduction: A hospital is one of society’s most important social institutions; however, poor organizational performance results in delayed treatment, disease progression, or patient mortality. This qualitative study seeks to investigate organizational excellence in Iranian medical sciences universities from the perspective of hospital managers.
Material and Methods: The present qualitative study was conducted in hospitals affiliated with medical sciences universities in Iran in 2021. Data were acquired using the purposive sample method through in-depth interviews with 15 hospital managers and analyzed using MAXQDA software. After transcription, concepts and components were extracted from in-depth interviews using the grounded theory (GT) method.
Results: Organizational excellence in hospitals has different elements that can be classify in the form of parameters of the grounded theory paradigm model (causal conditions, contextual conditions, intervening conditions and consequences). In causal conditions, it may include leadership, human resources, and strategies; in contextual conditions, resources and facilities; in intervening conditions, processes; and in consequence conditions, patient and family satisfaction, employee satisfaction, community satisfaction, and health system satisfaction. The findings revealed that leadership and human resources were the two most important factors in achieving hospital organizational excellence.
Conclusion: Further emphasis should be made on leadership and human resources to achieve organizational excellence in Iranian hospitals affiliated with universities of medical sciences. By recruiting specialized human resources, managers can consider various leadership styles to improve the current situation and deliver desirable services.

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Introduction: Fire in hospitals and medical centers can lead to unfortunate and dire accidents due to the immobility of most patients, the presence of expensive medical equipment, and the essential role of hospitals in providing health services to people. This study aims to increase fire safety in a healthcare training center in Qazvin.
Material and Methods: The latest NFPA 101A was used for fire risk assessment in seven departments of an educational hospital in Qazvin City in 2021-2022. The study calculated the residential risk factor for residents of each area, examined fire safety parameters and determined their risk factor, calculated the obtained points of the area under evaluation, determined the minimum required points in different areas of fire safety, and estimated the fire risk level.
Results:  ICU 1 and 2 departments, CCU 1 and 2, central warehouse, pharmacy warehouse, and hospital facilities were selected for fire risk assessment. The ICU building had the best condition with a total fire safety point of 21.1. The facility building, with a total fire safety point of -14.5, was in the worst condition.
Conclusion: The results showed the need for more attention from researchers to conduct studies in outdoor environments, in various parts of the country, on development and validation of novel heat stress indices, and on implementation and evaluation of control measures in environments with high heat stress.

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Introduction: Shift work combined with the nature of duty in occupations such as nursing can lead to the spread of psychological consequences and disorders in nurses. The aim of this study was investigating the cognitive and psycho-social consequences associated with shift work in nurses.
Material and Methods: This study was performed in 7 hospitals in 2023. The study population was 636 nurses. Data collection tool in this study was part of a comprehensive questionnaire that translated and modified by Choobineh et al. The data were analyzed using IBM SPSS software v. 22.0, and significance level in this study was considered 0.05.
Results: Out of 636 studied nurses, 474 were shift workers and 162 were day workers. The means of age and work experience of the study population were 37.26±5.25 years and 11.60±4.78 years, respectively. The results showed that the prevalence of psychological consequences in the shift workers group was significantly more than day work nurses (p<0.05). The highest prevalence of cognitive and psycho-social consequences in shift work nurses were related to fatigue (39.66%), insomnia (36.08) and decreased sleep quality (35.44%), respectively.
Conclusion: The findings of this study indicated that the parameters of the shift work system, working hours per week, education and hospital ward are the most important factors affecting the prevalence of cognitive and psycho-social consequences and sleep disorders in the nurses. Therefore, it is suggested that a separate program should be designed and implemented for each hospital ward to control and manage the psychological consequences associated with shift work in nurses.

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Introduction: Fire safety in healthcare centers is crucial due to the limited evacuation capacity of the occupants and the necessity of not disrupting the operation in these centers. In this study, the fire risk of a public hospital was evaluated using the Fire Risk Assessment Method for Engineering (FRAME). Additionally, the factors affecting fire safety in the hospital were analyzed quantitavely, and fire control strategies were presented. 
Material and Methods: First, the fire risk assessment checklist was filled in all the hospital departments. Then, the values of the factors affecting fire safety were obtained. In the next step, the fire risk for the building, occupants and activities were estimated using Excel software-FRAME. Finally, control strategies and intervention measures were presented based on the value of these factors. 
Results: In the hospital under study, 22% of the departments posed an undesirable fire risk to the building and its property. On the other hand, 90% of the departments had risk levels that were undesirable for the occupants. The results of the initial risk (R0) showed that a balance between potential fire risk and risk acceptance can be established by implementing manual fire extinguishing systems and automatic detectors in all departments. 
Conclusion: ased on the condition of the hospital studied, a balance between potential fire risk level and risk acceptance level was not established. Therefore, there is a need for fire control measures, especially fire safety measures for the occupants. The results of this study can be useful for readers and experts in interpreting fire risk assessments and presenting detailed control measures based on the risk assessment and the value of the parameters.