Journal of

Background: In recent years lots have been done for hospital automation but this non harmonized ac­tions leads to different software usage and entrance of different data into the system when partly is not useful . In this way, usage of soft wares in medical records specialty in the high loaded reception and recording will decrease defect in registration and storage of medical data. Using computerized system which cover applied soft wares could decrease many problems in medical data records. Any research in medical record area needs to be fed with data there fore it should be to use and evaluation of comput­erized systems. 

Method: This cross sectional study was conducted in reception and recording department teaching hospitals of Tehran University of Medical Sciences (TUMS), Iran, using check list and direct collection of the data in the hospital. We used descriptive statistics tools to analysis the data.

Results: Specialized hospital and general hospital use computerized system for medical record with percents of 49.06% and 40.73% respectively .search of the input data and output data were considered as 66.7%.

Conclusion: The usage of automation in reception and recording departments of TUMS hospitals was low and even the operating system was not capable to register the patients data. Even though a few humble of systems in medical records awards were set which would be the source of some problems is saving and processing the data.

Background: With due attention to the prevalence of thalassemia in Iran and patients' importunate needs for blood intake, this study aimed to inspect contaminations due to repeated blood transfusion which does not sift in blood donation. One such contamination is cytomegalovirus infection, which is an important pathogen in immunosuppressive patients or receivers of transplanted organs.

Methods: This cross sectional study was conducted on 311 thalassemia patients under age of 15 yr who was receiving blood from Hospitals in Tehran and Noorabad Mamasani repeatedly. To determine active infection (presence of IgM antibodies) of cytomegalovirus, ELISA method was used. In addi­tion, 225 healthy people under age of 15 yr were studied as testified group and finally all data were analyzed using SPSS ver. 11.5.

Results: 12.9 % of patients were positive from the view point of active infection. Regional separation of patients showed that the patients resided in Tehran are more contaminated to this virus than patients of other cities.

Conclusion: The range of cytomegalovirus active infection in thalassemia patients is high. One reason might be the infected blood intake or immunosuppressant (weakness of immune system) in patients, there­fore immunity care of these patients and negative serologic blood intake with respect to and also he­matic parents (parents with the same blood) are important.

Background: Septicemia is a life threatening status and needs rapid antibiotic treatment. Enterobacteri­acea are one of the most important causes of septicemia. So this study is therefore aimed to evaluate antibiotic sus­ceptibility of enterobacteriacea isolates in blood cultures in Shariati Hospital, Tehran, Iran.

Methods: This retrospective study was performed on 138 patients with positive blood culture in Shariati Hospital, Tehran, Iran in 2004, using disk diffusion and Macfarland standard. 

Results: Prevalence of isolated enterobacteriacea was respectively E. coli (n=74, 53.6%), Klebsiella (n=37, 26.8%), Enterobacter (n=21, 15.2%), Citrobacter (n=4, 2.9%), Salmonella paratyphi (n=1, 0.7%) and Proteus mirabilis (n=1, 0.7%). The most antibiotic susceptibility among enterobacteriaceaes was ciprofloxacin (60.4%), cloramphenicol (56.8 %) and gentamycin (49.3%). The most antibiotic re­sistance were seen among cephalotine (78%), cotrimoxazole (62.3 %) and ceftriaxon (57.5 %).

Conclusions: Due to dissimilarity between antibiotic consumption in laboratories and hospitals, it seems that to reach more proper conclusions and choosing better strategy for antibiotic consumption, cooperation should be between laboratories and physicians, plus synergism between drug prescription and antibiotic discs in laboratories.

Background and Aim: Currently in most hospitals medical mission and medical  documents secession don't be notified  about any disciplines in the framework of documenting medical data and in parallel the document makers will be overshadowed by non-executing these principles qualitatively and quantitatively(1).

Materials and Methods: The above study is a sectional one that describes the situation of recording informational items in the surgical special sheets. In order to collect information collect information from considered sheets, it has been used of 1040 files of hospitalized because of surgery operation in the under study hospitals.

Results: The results of the study showed that 67.5% and 53.4% of informational items have not been recorded in nte sheets General and special hospitals. In the operation report sheet more informational items has been recorded in proportion to others which amounts to 59.9%. Informational items related to the tests in the pre operation care sheet, complementary information in the operation report sheets, and after surgery care and observed side-effects in the anesthesia sheet have the most non recording information.

Conclusion: The situation of recording informational items in the surgical special sheets in contrast to previous studied samples is not desirable. Regarding to the importance of these sheets and their position in relation to the information recorded in them, it is necessary to take needed measures to remove the factors that result in non recording the informational items.

Background and Aim: The risk of infectious diseases in laboratory's personnel is high and several factors can increase these risk. Some of these factors are general, such as burning (with stray acid and base) and electric shock hazards. Which are not exclusive for laboratories. In other hand some several risk factors such as burning liquids are exclusive for laboratories. And there is limited information available about them.

Materials and Methods: This cross-sectional study was designed to evaluate accidental exposures of all laboratories personnel of Teaching Hospitals of Tehran University of Medical Sciences during 2004- 2005. We selected 416 laboratories personnel's in 15 different teaching hospitably TUMS for our study. The data were collected using a questionnaire and SPSS software was applied for data analysis.

Results:There was no significant association between accidental exposures with gender (p=0.51), educational level (p=0.11) and age (0.09) of laboratories personnel. But, accidental exposures were lower among those who had job experience between 5 to 10 years (p<0.05) compare to less than 5 years or more than 10 years job experience.

Conclusions:Although age, gender and educational level of laboratories personnel did not influence their exposure to laboratory's accidents, little or extensive job experience may increase accidental exposures among them. 

Background and Aim: General Store department is responsible for on time preparing commodities for hospitals departments. It's a place for saving materials and resources. Safety in store department and its materials has importance due to preserving high quality and continuous services.
General Store department safety should be audited by assessment System to reduce waste materials and human resources such as building, commodities and patient and personnelُ s lives and in case of facing with a problem, try to solve it. The aim of this study was determination of safety standards in hospital general stores in TUMS.

Materials and Methods: This research was conducted as a cross-sectional study safety and usage of management principles was advised and measured in hospitals of TUMS sampling was nُ t performed.

Results: Safety rate in research population was more than 85/42 percent. Score in safety aspects like as physical spaces, preventing robbery, blazing materials appropriate storing, commodities arrangement, utilizing suitable tools was more than 80%. Protection against fire and storing rote able materials estimated 79% and 77%.
Safety rate in several aspects was assessed in the study hospitals.

Discussion and Conclusion: Although, hospital store rooms assessed as safe but they should try to develop fire protection systems and store rote able materials preservation appropriately.

Background and Aim: Enteroinvasive Escherichia coli (EIEC) strains include a group of diarrheagenic Escherichia coli (DEC) and are known to cause shigellosis-like symptoms in both adults and children. They belong to a limited number of serotypes and their somatic (O) antigens are identical with, or related to, certain Shigella antigens. EIEC strains are confirmed by demonstration of invasiveness by polymerase chain reaction (PCR) for detection of the ipaH (invasive plasmid antigen H)  gene that is specific for these strains among DEC.Since in our country,Iran study for detection of  these strains. hasnot been carried out therefore the aim of this study was detection of EIEC in diarrheal under 5 year old children in Tehran.

Materials and Methods: During the descriptive study,300stool samples were collected from children with diarrhea in Ali Asghar Hospital and children medicinal center of Tehran during 4 months (April-Jul 2008). E.coli species were isolated by standard bacteriological and biochemical tests. Presence of invasive plasmid antigen H (ipaH) gene in confirmed colonies was investigated by PCR technique.

Results: Among 300 stool specimens studied using culture method and biochemical tests,39(13%) E.coli species were isolated. Among these 39 strains,7(2.3%) strains containing ipaH gene (EIEC) were detected by PCR technique.

Conclusions: Enteroinvasive Escherichia coli (EIEC) in our country, Iran, may be as bacterial pathogen causing childhood diarrhea. Therefore we should apply new techniques for investigation of these strains.

Background and Aim: Because of preventing of radiation damages, special safety issues are considered in radiology departments: But, the other safety aspect issues are not observed regularly. As an important part of safety plan, radiology departments should be assessed from physical, building design aspects and cope with fire.

Materials and Methods: This descriptive study was directed as a cross sectional research. Tehran University of Medical Sciences hospitals radiology department were assessed for standards of physical spaces, radiation preventing, and cope with fire, patient's and staff safety.A Check-list was used as data collection instrument.Each safety issue estimated as safe (>80%), not safe (<50%) and relatively safe (between 50 and 80 %).

Results: Overall, safety standards were observed in Tehran university of Medical Sciences Hospitals Departments,with relatively safe standards regarding patient's safety and cope with fire.

Conclusions: Fire protocols must be regarded in radiology wards in hospitals. Appropriate designing and programming which considers patient's safety from the time of  entering to radiology ward until leaving is offered.

Background and Aim: Procalcitonin is prohormone of calcitonin and is made 116 amino acids. The normal value of procalcitonin is less than 0.5 ng/ml, that if this amount exceeds, infection is indicated. This poly-peptide is a marker for the diagnosis of primary infection. Increased amounts of procalcitonin is associated with infection especially bacterial infections.

Materials and Methods: 32 patients with liver cirrhosis and 16 healthy controls enrolled in this study were. Serum PCT levels in these subjects was measured. PCT level was measured by semi-quantitative method.

Results: Patient group included 23 males and nine females with mean age of 45 years and SD= 17.44 years, the control group included 11 males and 5 females with mean age of 46 years and SD=15.5 years.
The statistical analysis showed that there was significant difference between PCT levels in patients and controls (P<0.05).Furthermore PCT levels was significantly hgher in cirrhotic patients with hepatitisec background.

Conclusion: Since these patients had no symptoms of infection and were hospitalized for endoscopy test and the PCT test was positive in 78.1% of cirrhotic patients ,whereas this ratio was 25% in the control group, the patients probably were infected and should be under proper treatment.

Background and Aim: Group B streptococcus(GBS)(Streptococcus agalactiae) is the leading cause of morbidity and mortality of the newborn infant and accounted as a factor leading septicemia after birth in mothers. Infections in infants are usually acquired by contact with the genital tract of the mother during labor and delivery. So a rapid screening test for group B streptococcus that could accurately identify pregnant women who are carrying the bacteria at the time of delivery would obviate the need for prenatal screening.The goal of this study was molecular epidemiology of group B beta Hemolytic Streptococcal(GBS) colonization in the vaginal flora of pregnant women.

Materials and Methods: Samples were taken from mucus of anal and vaginal of 250 pregnant women during 35-37 week's ingestion by swap. Samples were tested by standard culture using Todd Hewitt Broth and Blood Agar and also by PCR using cfb gene.

Results: Culture identified 21(8.4%) women as carriage of GBS from 250 women but PCR assay could identify 24(9/6%) women. In comparison to culture results, sensitivity, NPV Specificity PPV of PCR Were(100%, 100% and 97%, 82%) respectively. The times that used for PCR assay and culture were 2h and 36h respectively.

Conclusion: In conclusion, we found that group B streptococci can be detected rapidly and reliably by a PCR assay of combined vaginal and anal secretions from pregnant women at the time of delivery. Also this study shows that incidence of GBS is at high rate in Iranian pregnant woman, so we recommend screening of pregnant woman for detecting of GBS emphatically.

Background and Aim: Annually, large amounts of fees that paid by hospitals will not be reimbursed as deductions by health insurances and takes irreparable financial losses to hospitals. The purpose of this study was to determine the amount of deductions imposed on hospital bills of Tehran University of Medical Sciences and their causes related to documentation.

Materials and Methods: The present research was a cross-sectional and descriptive study performed in year 2009 on educational hospitals of Tehran University of Medical Sciences. All deductions reports related to Medical Services and Social Insurance related to year 2008 was collected from Income Unit of hospitals. The amount of deduction of each hospital was extracted and organized in the form of comparative tables. Data was analysed by descriptive statistics and Excel application. Then, the amount, type and causes of annually deduction of each hospital was determined.

Results: Most deductions imposed on inpatient bills have been related to the tests, appliances, medicine, residency, surgeon commission, and anesthesia and for outpatient bills have been related to visit, tests and medicine which most of them have been created due to documentation deficiencies.

Conclusion: Most of deductions are due to unfamiliarity of care staff with documentation requirements of insurance organizations. Therefore it is necessary to use a multi-aspect mechanism including education of documentation principles to staff, supervision on record control in the Medical Record Unit and establishment of a committee by university for related activities.

Background and Aim: Although vancomycine is used for the treatment of methicillin resistant Staphylococci, but vancomycine alone might not be effective for the treatment of methicillin resistant Staphylococci in compromised host. In the same time antimicrobial activity of cefepim on gram positive bacteria especially Staphylococci is well known. In this study the synergism effect of cefepim and vavcomycin on positive and negative coagulase Staphylococci in vitro condition was investigated.

Materials and Methods: In total, 100 clinical samples of coagulase positive and negative Staphylococci were isolated from urine and blood samples from patients in Imam Khomeini Hospital during one year and identified .The modified Bauer-Kirby were used for the antibiotic susceptibility and macrodilution method for the MIC according to NCCLS procedure.

Results: The results showed that after adding vancomycin to cefepime in concentration from 0.05+ 0.5 , to 0.8+8 , growth reduction reached from 3.5% to 100%.The synergism effect of the two mentioned antibiotics on coagulase negative Staphylococci resistant to methicillin were shown that from concentration of 0.05+ 0.5 to 0.8+8 , a reduction in growth from 4.5% to 100% was observed.

Conclusion: The results of this study showed that vancomycin and cefepime has synergic effect on Staphylococci

Background and Aim: Staphylococcus aureus(SA) may cause infection in all body organs. Many personnel and patients in hospitals may become carriers of this species. The aim of this study was to investigate relative frequency of SA and its resistance to Methicillin.

Materials and Methods: A couple of swabs were taken from nose and nails of 151 personnels working in operation room of Shahid Sadoughi Hospital in Yazd. Samples were inoculated into Mannitol salt agar medium and S. aureus colonies were antibiogramed to determine the rate of resistance to methicillin. Statistical analyses were performed by chi-square and Fishers' exact test.

Results: Overall prevalence of SA was 35.09%(19.2% and 15.9% in noses and nails, respectively). Prevalence of methicillin-resistant SA(MRSA) was 11.92%(5.3% and 6.6% in noses and nails, respectively). Surgeons had the highest, and workers the lowest prevalence of nasal SA carrier rate. In contrast, the nails of servants had the highest, and surgeons the lowest SA carrier rate. No significant difference was found between carrier rate and age, sex and duration of employment. But a meaningful relation was found between type of job and MRSA in both noses and nails. All of the MRSA isolates were sensitive to vancomycin.

Conclusion: Since employees of operation room are continuously working with patients undergone operation, screening both the personnel and patients to determine the rate of carriage, preventing transfusions of fore mentioned bacterium is necessary and highly recommended.

Background and Aim: Dental caries in children caused by repeatable consumption of sweet product especially at night, that itself mostly depend on economic and cultural background of the society and family.
One of the most common diseases of human being is dental caries, which are caused by many factors, such as microorganisms, dieting, passing time, and the host itself. Among the microorganisms Streptococci mutants play the major role in causing dental caries. The aim of this research was to investigate the role of Streptococci mutants in dental caries between two groups of children sensitive and resistance to caries.

Materials and Methods: This was a cross-sectional research, in which 120 children(60 susceptible and 60 resistance) aged between 3 to 5 referred to Tehran University dental school were selected randomly. The selection criteria for the sensitive and resistance dental caries were dmfs > 5 and dmfs < 10 respectively. None of the groups had used any drug or fluoride products before sampling. Saliva of both groups were collected, and transferred to the specific culture media(Mitis Salivarious Agar). After incubation at 37 oC colonies of S.mutans were counted.

Results: There was a significant difference between the number of colony counting(cfu/ml) with age and consumption of repeated sugar product, while. there was no significant difference between(cfu/ml) sex, oral hygiene, and nutrition period during infancy.

Conclusion: The results of this study showed that the consumption of sugar product in childhood results in dental carries.

Background and Aim: Early diagnosis of pregnancy is very important to prevent fetal damage due to specific drug consumption and high-risk behaviors. The objective of this study was to compare the sensitivity and specificity of quantitative agglutination pregnancy tests in urine and rapid β hCG immunoenzymatic assay test in serum as a gold standard.

Materials and Methods: This cross-sectional study was performed among 390 women who referred to healthcare centers where their urine samples were tested with latex agglutination (direct agglutination and agglutination inhibition) and the results were compared with rapid β hCG immunoenzymatic assay test in serum as a gold standard.

Results: The sensitivity of direct agglutination (82.05 % ) was more than that of agglutination inhibition (81.2 % ), but the specificity of the tests were equal (99.27 % ). The agreement coefficients between direct agglutination and agglutination inhibition on the one hand and rapid β HCG immunoenzymatic assay on the other were 0.859 and 0.853, respectively.

Conclusion : The possibility of negative results in direct agglutination is more than that of agglutination inhibition, but the specificity of both qualitative tests is equal. Besides, both tests may have an equal possibility of false positive results. Since the occurrence of false negative results in qualitative tests is higher than that in serum gold standard, the negative results of such tests should be confirmed with more sensitive methods such as rapid β hCG immunoenzymatic assay.

Background and Aim: If the evaluation is done from the perspective of users, Successful development of measures and features related to use and implementation of hospital information system and identify areas that need further consideration is to be provided. The main purpose of this study was assessment the views of physicians and nurses of hospital information system identify the effective criteria for the use of it and their satisfaction.

Materials and Methods: Present research is a descriptive cross-sectional study and was applied in public- education hospitals of Tehran University of Medical Sciences in 2012- 2013. The main tool was a questionnaire prepared by reviewing relevant literature in databases Iranmedex, Magiran, SID, PubMed, Science direct, Google scholar, and surveys by experts. In order to determine the validity, a questionnaire was distributed among 5 experts in the area of ​​information technology. After completion of the questionnaires, results were analyzed using software SPSS17.

Results: Information systems in half of the hospitals surveyed from the perspective of research community have an average of 30 - 60 percent capabilities in order management. Also users in all surveyed hospitals with more than 43 % agree the ease of using hospital systems.

Conclusion : User satisfaction is a guarantee for the implementation of information system. To improve the situation and move towards the ideal condition we suggest users needs in hospital information systems should be considered. Also design and system should be Compatible with the skills and knowledge of users as possible.

 Background and Aim: Cream is a rich dairy product with the pH close to neutral and limited preservation capability. Cream is suitable and rich for microbial growth. In the past few decades, there was a great concern in contamination of food products.

 Salmonella and Yersinia species are two important pathogens causing food poisoning and human gastroenteritis. The aim of the present study is to investigate the quality of traditional cream for bacterial contamination.

 Materials and Methods: This is a cross-sectional study. In total, 100 unpasteurized cream samples were collected from 5 regions in Tehran. The Salmonella was enriched in Selenite-F broth, and Yersinia in phosphate buffer in two weeks in cold condition according to CDC, and then were inoculated in MacConky and CIN agar for 24 hours. The suspected colonies were examined for phenotype and their identification was confirmed by API-20 E.

 Results:  In general, 29% of tested cream samples were contaminated with at least one kind of bacteria, 3% with Yersinia (1strain Y.enterocolitica, 1 Y.intermedia, 1 frederiksenii), and 2% with Salmonella paratyphi B. The other bacteria like Escheichia coli, Enteobacter, klebsiella, and Citobacter were also isolated. Five samples were contaminated with two kinds of bacteria.

 Conclusion: The results of this study indicate that more quality control should be applied on the cream produced in the city of Tehran by health control office for food products. 

 Background and Aim: Along with the constant increase in world population and consequently, the growing need to provide cellulose, as the most abundant organic substance in nature to produce cellulose products, concerns regarding the possible contamination of these products might cause skin, and genital and urinary infections. The aim of this study is to determine the possible microbial contamination of these products supplied in the city of Tehran.

 Materials and Methods: This is a descriptive study on 200 samples of unexpired cellulose products including napkins, nappies, sanitary napkin, and cardboard boxes to carry sweets. Fifty samples were obtained in the city of Tehran during six months from September 2011 to February 2012. Microbial contamination was investigated according to the procedure proposed by the Institute of Standards and Industrial Research of Iran.

 Results: The results obtained indicate that 18 samples (9%) exceeded the level allowed for aerobic bacteria and molds in one gram of specimens. Besides, 16 samples (8%) were contaminated with at least one of the following bacteria: Streptococcus Group D, Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli. A total of 34 samples (17%) could not be consumed. The least and the most contaminated products were sanitary napkins (0.5%) and cardboard boxes to carry sweets (5%), respectively.

 Conclusion: The presence of pathogenic bacteria in cellulose products that could cause skin, and genital and urinary tract infections asks for more control over such sanitary products.

Background and Aim: Learning is essential in healthcare environments, where knowledge and skills are quickly outdated due to continuous advances in medical science. Organizational learning is a dynamic process that enables learning organizations to be campatible with change in good time. The aim of this study was to determine the status of organizational learning in an Iranian healthcare organization in Tehran, and to assess the extent to which this organization could be considered as a learning organization.

Materials and Methods: In this cross-sectional and descriptive study, 200 nurses were selected in an Iranian healthcare organization. Dimension Learning Organizational Questionnaire (DLOQ) was used to collect data to be analyzed using descriptive statistics methods by frequency, percentage, mean, and standard deviation.

Results: The mean overall score for organizational learning was 3.36±0.69. Among the various dimension of organizational learning, continuous learning had the highest average (3.44±0.39), and the empowerment had lowest amount (2.72±0.06).

Conclusion: The findings from this study provide useful information for these organization's managers regarding the areas where there is a need for improvement in OL and to make it a more LO.

Background and Aim: Organizational productivity and efficiency depends on staff members’ job satisfaction and performance. Without the participation of staff members, hospitals cannot play an important role in promoting the society’s health. This study aimed to determine staff’s job satisfaction in a teaching hospital of Tehran university of Medical Sciences (TUMS).
Materials and Methods: This descriptive, analytical cross-sectional research was conducted on 172 staff members of a teaching hospital, who had been selected through random sampling. The data-collection tool was a researcher-made questionnaire. The validity of the questionnaire was confirmed by the clinical governance department members and Cronbach’s alpha reliability estimate turned out to be 0.88. 
Results: Para-clinical and service employees getting the mean scores of 72.55 and 70.71 demonstrated desired job satisfaction; nursing and administrative-financial staff members, however, showed a relatively desired job satisfaction with mean scores of 60.04 and 53.52, respectively; and the difference between job groups was significant (p=0.02) regarding job satisfaction. The highest job satisfaction figure was related to job success and the lowest pertained to the nature of the job. There was a meaningful relationship between job satisfaction on the one hand and staff members’ gender, marital status, and type of employment on the other.
Conclusion: Staff’s job satisfaction in the studied hospital has increased due to the establishment of Iran’s Healthcare Reform Plan at the beginning of 2014. However, compared with other job groups, nurses are less satisfied; therefore, it is necessary to improve nursing job satisfaction through timely payments based on job performance and difficulty level.