Background: Healthcare-acquired infections (HAIs) that patients develop during the course of healthcare treatment are important causes of morbidity and mortality worldwide. Objectives: The aim of this study was to determine the epidemiology of HAIs in a tertiary-care teaching hospital in Zahedan, southeast Iran. Patients and Methods: This was a cross-sectional study of patients admitted to Ali-Ibn-Abitalib Hospital, a tertiary-care teaching center, from March 2013 through March 2014. All patients admitted during this study period were examined by head nurses on a daily basis for detecting four types of HAIs: surgical site infection, urinary tract infection, pneumonia, and bloodstream infection. All the identified HAIs were registered into the Iranian National Nosocomial Infections Surveillance System Software. Pathogens were identified using standard microbiological methods, and antimicrobial susceptibility was determined by disk diffusion tests according to the Clinical and Laboratory Standards Institute guidelines. Descriptive statistics were used for data analysis. Results: A total of 16,140 patients were admitted to the hospital during the study period, including 162 found to have HAIs (approximately 1%). The majority (79.6%) of the HAIs were reported from the intensive care units (n = 129), followed by the medical wards (10.5%, n = 17) and obstetrics/gynecology ward (7.4%, n = 12). The most common site of infection was the respiratory tract (67.9%) followed by the urinary tract (13.6%). Among the pathogens isolated, Acinetobacter and Enterobacter were the most common (17.6%) followed by Escherichia coli (11%). Overall, multidrug resistance was observed in 95% of the isolates. Conclusions:The HAI prevalence found in this study was lower than HAI rates reported in some other studies from Iran. The isolates showed high resistance to common antibiotics. Guidelines for improving HAI surveillance and stringent measures to reduce the prevalence of multidrug-resistant HAIs must be implemented to reduce the rate and the consequences of HAIs.

Background: Healthcare workers (HCWs) regularly face the risk of exposure to sharp injuries and splashes as an occupational hazard, which presents a major risk for acquiring blood-borne infectious agents. Objectives: This study aimed to determine the occurrence of needlestick injuries (NSIs) and other high-risk occupational exposures to blood and body fluids (BBFs) among HCWs in three teaching hospitals affiliated with the Zahedan University of Medical Sciences. Patients and Methods: A cross-sectional study was carried out from March 2013 to December 2014. Information on self-reported incidents, circumstances surrounding occupational exposure, and post-exposure management were collected from an ongoing surveillance system. Descriptive statistics and chi square tests were used for data analysis. Results: A total of 236 incidents of occupational exposure were registered during the study period. Nurses (82, 34.7%) were most frequently exposed to BBFs, followed by physicians (57, 24.2%). Two hundred and nineteen (92.8%) of the personnel sustained NSIs, and 17 (7.2%) had splashes to mucus membranes. The incidents were most frequently reported from the internal medicine ward (19.1%) followed by the operating theater (17.1%). Subjects with splashes to mucus membranes were more likely to postpone seeking medical advice following exposure, as compared with needlestick cases (23.5% versus 5%, P < 0.016). A significantly greater proportion of pediatric and emergency department staff were found to delay post-exposure measures (P < 0.040). Conclusions:The relatively high prevalence of percutaneous injuries and splashes in this study emphasized the importance of improved prevention strategies, better hospital surveillance for occupational exposure, and enhanced training of healthcare workers.

Background:Providing high-quality maternity services is crucial to increase utilization of these services and reduce maternal mortality. The quality of the maternity services provided to pregnant women in rural areas of Iran is poorly understood. Objectives: This study aimed to investigate the quality gap in the maternity care services provided by Rural Delivery Facilities and Safe Delivery Posts in Sistan and Balouchestan Province, southeast of Iran, as expressed by the difference in women's perceptions and experiences of services. Patients and Methods:In this cross-sectional study a total of 438 pregnant women who gave birth in rural maternity unit were recruited between February and May 2013. The SERVQUAL questionnaire was used for data collection. The Wilcoxon Signed-Rank test was used to compare the quality gap as expressed in the mean of differences in the expectation and perception scores. The quality gap was compared between demographic groups using Kruskal-Wallis tests. Results: There was a negative gap in all dimensions of the quality of services provided. The highest quality gap was found for the reliability dimension followed by tangibles, empathy, assurance and responsiveness. The participants' age, levels of education and the type of maternity unit were found to be associated with the clients' perceived quality of services. Conclusions:The quality gap in the services provided by maternity units showed that these units are not able to meet pregnant women's expectations completely. The negative quality gaps can be used as a guideline to improve the maternal health care quality and reduce maternal mortality, particularly in high-risk women such as those living in rural areas.

Background: Although Iranian women increasingly attend hospitals for childbirth, no information is available on programs and practices related to infection control in labor and delivery units. Objectives: This study aims to investigate infection control program management and midwives' practices in labor and delivery units. Patients and Methods:We analyzed data related to infection control program management and also practices performed by 88 midwives in four labor and delivery units in public hospitals in Zahedan, southeast Iran. Results:The evaluation scores for all aspects of infection control were suboptimal; infection control program management 38.1% to 71.4%, healthcare workers post-exposure measures 58.5% to 92.7%, medical waste management 73.9% to 87.0% and infection control related standard infrastructures and equipments 55.9% to 82.8%. The midwives mean scores for attending infection control training courses and hand hygiene were less than 40% of the maximum score, but the mean scores for normal vaginal deliveries scrub, and equipments and instruments hygiene practices were generally above 70%. Conclusions:The results of this study revealed a need for development of appropriate policies and protocols for infection control practices in labor and delivery units and also midwives training on clean delivery practices.

We found that both hospital and patient related factors contribute to DAMA among pregnant women. Early identification of women at risk of DAMA and improvement of medical staff communication skills may decrease the occurrence of DAMA and improve health outcomes of pregnant women.