Tehran University Medical Journal

Background: The idea of integration of medical education into health care system with the goal of comprehensive self sufficiency and complete response to public health needs were initiated in 1985. There were many prose and cones in this procedure which raised many controversies. The dilemma about strengths and weaknesses increased in 2002 during which Iran parliament tried to change the situation. In this study we tried to conclude and exit the dilemma.

Materials and Methods: We studied the attitude of key academic person regarding the integration. In a cross-sectional study using a pretested questionnaire, we assessed the attitude of 556 academic staffs and managers from eight randomly selected medical universities.

Results: Most of respondents agreed the positive out come of integration like establishment of disease surveillance and improving in health indicators, but they believed that the quality of medical education has decreased. Most of respondents suppose that dissociation of medical education may cause a lot of problems.

Conclusion: There are a lot of controversies regarding the strengths and weaknesses of integration. External factors were causes of decreasing the quality of education so it is important to decide about the future by considering external factors.

Background: Health care workers (HCWs) are at substantial risk of acquiring bloodborne pathogen infections through contact with blood and other potentially infectious materials. The main objectives of this study were to determine the epidemiological characteristics of occupational exposure to blood/body fluids, related risk factors of such exposure, and hepatitis B vaccination status among HCWs.
Methods: This cross-sectional study was conducted from December 2004 to June 2005 at three university hospitals in Tehran, Iran. Using a structured interview, we questioned HCWs who had the potential for high-risk exposure during the year preceding the study.

Results: With a total number of 467 exposures (52.9%) and an annual rate of 0.5 exposures per HCW, 391 (43%) of the 900 HCWs had at least one occupational exposure to blood and other infected fluids during the previous year. The highest rate of occupational exposure was found among nurses (26%) and the housekeeping staff (20%). These exposures most commonly occurred in the medical and emergency wards (23% and 21%, respectively). The rate of exposure in HCWs with less than five years of experience was 54%. Percutaneous injury was reported in 280 participants (59%). The history of hepatitis B vaccination was positive in 85.93% of the exposed HCWs. Sixty-one percent had used gloves at the time of exposure. Hand washing was reported in 91.4% and consultation with an infectious disease specialist in 29.4%. There were 72 exposures to HIV, HBV and HCV exposure to HBV was the most common. In 237 of the enrolled cases, the source was unknown. Job type, years of experience and hospital ward were the risk factors for exposure.
Conclusion: Education, protective barriers and vaccination are important in the prevention of viral transmission among HCWs.

Viruses are important causes of acute and chronic diseases in humans. Newer viruses are still being discovered. Apart from frequently causing infections in the general community, many types of viruses are significant nosocomial pathogens that with emerging viruses has become a real issue in medical field. There are specific treatments, vaccine and physical barrier to fight some of these infections. Health care-associated viral infections are an important source of patient’s morbidity and mortality. The method of sterilization or disinfection depends on the intended use of the medical devices (comprising critical, semicritical and noncritical items) and failure to perform proper sterilization or disinfection of these items may leads to introduction of viruses, resulting in infection. Disinfection is an essential way in reducing or disruption of transmission of viruses by environmental surfaces, instruments and hands which achieves by chemical disinfectants and antiseptics, respectively. This review discusses about chemical agents with virocids properties (e.g. alcohols, chlorine compounds, formaldehyde, phenolic compounds, glutaraldehyde, ortho-phthaldehyde, hydrogen peroxide, peracetic acid, iodophor, ammonium compounds quaternary, bigunides and so on.), mechanisms of action and their applications in health care-associated viral infection control. As well as, we described an overview for hierarchy of viruses in challenge with disinfantans, effective agents on viral inactivation, i.e.targect viruses, viral stability or survival duration time in enviromental surfaces and hands. We explained disinfection of surfaces, challenges in emerging viral pathogens inactivation, viral resistance to chemical disinfectants and antiseptics. Because, there are laboratory studies and clinical evidences for some viruses which viral resistance to biocide or failure to perform proper disinfection can lead to infection outbreaks. Also, we described virucidal properties of antiseptics and introduced selected antiseptics with extensive virucidal action, because hands play an important role in the spread of many viral diseases, and regular proper hands hygiene is essential to decontaminate hands and can interrupt the spread of viruses. Here, we compared the currently available laboratory methods, standard methods from many countries and kinds of viruses in these methods for evaluation of virocide activity. Finally, it’s good to know: any disinfectant is not virocide unless it confirms by laboratory methods.