Preservation of fruit and vegetable discards with sodium metabisulfite

Two series of experiments were performed to investigate the aerobic preservation of fruit and vegetable discards (FVD) using sodium metabisulfite (SMB). In Exp. 1, metabisulfite was applied at 0, 2, 4, 6, and 8 g/kg FVD for 0, 3, 6, 9, and 12 d. Metabisulfite treatment at 6 and 8 g/kg FVD was highly effective in controlling putrefaction and preserving the nutrient components for 6 and 9 d, respectively. In the pilot-scale experiment (Exp. 2), SMB was applied at 0 and 8 g/kg FVD in a 600-L bucket for 0, 6, and 9 d in an outdoor environment. The SMB treatment was highly effective in maintaining the integrity and freshness of FVD, suppressing microbial proliferation, and preserving the nutrient constituents. Under the conditions of this study, SMB effectively preserved FVD in an aerobic environment, enabling their more efficient long-term recycling through livestock feed or development of value-added products.

The Effect of Temperature and Photoperiod on Diapause Induction in Pupae of Scrobipalpa ocellatella (Lepidoptera: Gelechiidae)

Scrobipalpa ocellatella (Boyd) (Lepidoptera: Gelechiidae) is one of the most important pests of sugar beet that causes quantitative and qualitative yield loss in the late summer. To locate the position for diapause induction, combinations of constant temperatures at 15, 18, 20, and 25°C and day lengths of 8, 10, 12, 14, 16, and 24 h were studied from egg to adult emergence. The incidence of diapause peaked at 15 and 18°C, with the day lengths of 12 and 11 h, whereas low temperatures did not improve the effects of short photoperiods (day lengths of 8 and 10 h) in diapause induction. The results showed that the critical day length for diapause induction was 12.8 h at overall 15 and 18°C. It was observed that the third instar larvae were the most sensitive stage to the inductive photoperiod (12:12 [L:D] h). The non-24-h light-dark experiment showed that the nigh length is more important than the day lengths measurement. In a set of 24-h light-dark cycles at 2:12 (L:D) h, a 1-h light pulse declined diapause induction markedly 1 h after scotophase. Field monitoring of the S. ocellatella for 2 yr (2015 and 2016) showed that the 50% of larvae enter winter pupal diapause in early September and this proportion increases in response to a decrease in the day lengths and temperature. From this study, it was concluded that low temperature acts in conjunction with short-day photoperiod in diapause induction of S. ocellatella.

House dust mite-driven neutrophilic airway inflammation in mice with TNFAIP3-deficient myeloid cells is IL-17-independent

BACKGROUND

Asthma is a heterogeneous disease of the airways that involves several types of granulocytic inflammation. Recently, we have shown that the activation status of myeloid cells regulated by TNFAIP3/A20 is a crucial determinant of eosinophilic or neutrophilic airway inflammation. However, whether neutrophilic inflammation observed in this model is dependent on IL-17 remains unknown.

OBJECTIVE

In this study, we investigated whether IL-17RA-signalling is essential for eosinophilic or neutrophilic inflammation in house dust mite (HDM)-driven airway inflammation.

METHODS

Tnfaip3^fl/fl xLyz2^+/cre (Tnfaip3^LysM-KO ) mice were crossed to Il17ra^KO mice, generating Tnfaip3^LysM Il17ra^KO mice and subjected to an HDM-driven airway inflammation model.

RESULTS

Both eosinophilic and neutrophilic inflammation observed in HDM-exposed WT and Tnfaip3^LysM-KO mice respectively were unaltered in the absence of IL-17RA. Production of IL-5, IL-13 and IFN-γ by CD4⁺ T cells was similar between WT, Tnfaip3^LysM-KO and Il17ra^KO mice, whereas mucus-producing cells in Tnfaip3^LysM-KO Il17ra^KO mice were reduced compared to controls. Strikingly, spontaneous accumulation of pulmonary Th1, Th17 and γδ-17 T cells was observed in Tnfaip3^LysM-KO Il17ra^KO mice, but not in the other genotypes. Th17 cell-associated cytokines such as GM-CSF and IL-22 were increased in the lungs of HDM-exposed Tnfaip3^LysM-KO Il17ra^KO mice, compared to IL-17RA-sufficient controls. Moreover, neutrophilic chemo-attractants CXCL1, CXCL2, CXCL12 and Th17-promoting cytokines IL-1β and IL-6 were unaltered between Tnfaip3^LysM-KO and Tnfaip3^LysM-KO Il17ra^KO mice.

CONCLUSION AND CLINICAL RELEVANCE

These findings show that neutrophilic airway inflammation induced by activated TNFAIP3/A20-deficient myeloid cells can develop in the absence of IL-17RA-signalling. Neutrophilic inflammation is likely maintained by similar quantities of pro-inflammatory cytokines IL-1β and IL-6 that can, independently of IL-17-signalling, induce the expression of neutrophil chemo-attractants.

Prevalence and related risk factors of diabetic foot ulcer in Ahvaz, south west of Iran

AIMS

The aim of this study was to evaluate the prevalence of diabetic foot ulcer and its related risk factors.

MATERIALS AND METHODS

In this descriptive cross-sectional study, 605 patients with diabetes were evaluated in July 2014. A checklist was used to obtain demographic data, diabetes related data, past medical history, and physical examination data.

RESULTS

The prevalence of diabetic foot ulcer was 6.4% (95% CI: 4.64-8.73). Seventeen cases of them were female (4.9%). In univariate analysis, the following variables had statistically significant relationship with DFU prevalence: diabetes duration, educational level, 10 g monofilament sensation, Ankle Brachial Index (ABI) and Body Mass Index (BMI). Patients' age, glycemic control and smoking did not show any significant relationship with DFU. After logistic regression analysis, the patients with decreased 10 g monofilament sensation had DFU more than patients with normal sensation (OR = 8.84, 95% CI: 3.5-22.3). Abnormal ABI increased the odds of DFU (OR = 5.6, 95% CI: 1.3-24.18). The DFU prevalence in patients with diabetes duration of 11-20 years, was more than patients with ≤5 years (OR = 3.8, 95% CI: 1.33-10.8).The odds of DFU development in educated patients compared with illiterate patients was 0.27(95% CI: 0.12-0.57). BMI had a significant relationship with DFU prevalence. The odds in overweight patients was 0.259(95% CI: 0.108-0.623) and in obese patients was 0.263 (95% CI: 0.1-0.687).

CONCLUSION

The prevalence of DFU was 6.4% in this study. Final associated risk factors of DFU were decreased 10 g monofilament sensation, abnormal ABI, diabetes duration, educational level and BMI.

The Effects of Hearing Aid Digital Noise Reduction and Directionality on Acceptable Noise Level

OBJECTIVES

Two main digital signal processing technologies inside the modern hearing aid to provide the best conditions for hearing aid users are directionality (DIR) and digital noise reduction (DNR) algorithms. There are various possible settings for these algorithms. The present study evaluates the effects of various DIR and DNR conditions (both separately and in combination) on listening comfort among hearing aid users.

METHODS

In 18 participants who received hearing aid fitting services from the Rehabilitation School of Shahid Beheshti University of Medical Sciences regularly, we applied acceptable noise level (ANL) as our subjective measure of listening comfort. We evaluated both of these under six different hearing aid conditions: omnidirectional-baseline, omnidirectional-broadband DNR, omnidirectional-multichannel DNR, directional, directional-broadband DNR, and directional-multichannel DNR.

RESULTS

The ANL results ranged from -3 dB to 14 dB in all conditions. The results show, among all conditions, both the omnidirectional-baseline condition and the omnidirectional-broadband DNR condition are the worst conditions for listening in noise. The DIR always reduces the amount of noise that patients received during testing. The DNR algorithm does not improve listening in noise significantly when compared with the DIR algorithms. Although both DNR and DIR algorithms yielded a lower ANL, the DIR algorithm was more effective than the DNR.

CONCLUSION

The DIR and DNR technologies provide listening comfort in the presence of noise. Thus, user benefit depends on how the digital signal processing settings inside the hearing aid are adjusted.

Exacerbated liver injury of antithyroid drugs in endotoxin-treated mice

Drug-induced liver injury is a major concern in clinical studies as well as in post-marketing surveillance. Previous evidence suggested that drug exposure during periods of inflammation could increase an individual's susceptibility to drug hepatoxicity. The antithyroid drugs, methimazole (MMI) and propylthiouracil (PTU) can cause adverse reactions in patients, with liver as a usual target. We tested the hypothesis that MMI and PTU could be rendered hepatotoxic in animals undergoing a modest inflammation. Mice were treated with a nonhepatotoxic dose of LPS (100 µg/kg, i.p) or its vehicle. Nonhepatotoxic doses of MMI (10, 25 and 50 mg/kg, oral) and PTU (10, 25 and 50 mg/kg, oral) were administered two hours after LPS treatment. It was found that liver injury was evident only in animals received both drug and LPS, as estimated by increases in serum alanine aminotransferase (ALT), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), and TNF-α. An increase in liver myeloperoxidase (MPO) enzyme activity and tissue lipid peroxidation (LPO) in addition of liver glutathione (GSH) depletion were also detected in LPS and antithyroid drugs cotreated animals. Furthermore, histopathological changes including, endotheliitis, fatty changes, severe inflammatory cells infiltration (hepatitis) and sinusoidal congestion were detected in liver tissue. Methyl palmitate (2 g/kg, i.v, 44 hours before LPS), as a macrophage suppressor, significantly alleviated antithyroids hepatotoxicity in LPS-treated animals. The results indicate a synergistic liver injury from antithyroid drugs and bacterial lipopolysaccharide coexposure.

Creating and validating e-cases as educational tools in general practitioners’ continuing medical education context

Objective

This study aimed at creating electronic cases (e-cases) and analyzing their validity as a diagnostic assessment tool within the context of continuing medical education (CME) to measure general practitioners’ (GPs) knowledge of common infectious disease.

Methods

We designed assessment e-cases in an electronic CME platform. The e-cases were designed to measure GPs’ knowledge about diagnosis and treatment of common infectious disease in outpatient settings. The data collected were analyzed for five forms of evidence: content, response process, internal structure, relations with other variables and consequences.

Results

A total of 46 GPs participated in the study. Among them, 87% perceived the e-cases as resembling the patients whom they visit in their everyday practice. Although attendance in this activity made 85% of the participants more cautious about prescription of antibiotics, we could not detect any statistically significant association between the assessment scores and the physicians’ previous antibiotic prescription. The diagnostic assessment with e-cases was supported by most of the elements of validity evidence, including content, response process, internal structure and consequences.

Conclusions

Overall, evidence suggests that using e-cases might be a valid diagnostic assessment CME activity to measure GPs’ knowledge of common infectious disease, but more research is necessary.

Plant virus nanoparticles: Novel and robust nanocarriers for drug delivery and imaging

Nanoparticles have been gained much attention for biomedical applications. A promising type of nanocarriers is viral nanoparticles (VNPs) which are natural bio-nanomaterials derived from different type of viruses. Amongst VNPs, plant VNPs present several pros over general nanoparticles such as liposomes, dendrimers or quantum dots. Some of these advantages include: degradability, safety for human, known structures to atomic level, possibility of attaching ligand with vigorous control on structure, availability for genetic and chemical manipulations and very flexible methods to prepare them. Variety of plant viruses have been modified by chemical and genetic modification of their inner cavities and their outer-surfaces. These modifications provide suitable sites for attachment of markers and drug molecules for vascular imaging and tumor targeting. In this review a brief description of plant virus nanoparticles and their biomedical applications especially in drug delivery is provided. The methods of loading cargos in these VNPs and their final biofate are also reviewed.

Hybrid Scaffolds of Hyaluronic Acid and Collagen Loaded with Prednisolone: an Interesting System for Osteoarthritis

Purpose: Cartilage regeneration by using polymeric scaffolds is a new option for treatment of osteoarthritis. A good scaffold for tissue engineering should copy the characteristics of natural extracellular matrix. The purpose of this study was to make a dosage form with proper reliability and stability for cartilage repair.

Methods: Hybrid scaffolds containing different ratios of hyaluronic acid (HA) and collagen were prepared and loaded with prednisolone as anti-inflammatory agent. Two different dosage forms (lyophilized implantable disk and thermo-sensitive gels) were examined. A scaffold of cross-linked HA was used as control. Different characterization tests were considered including differential scanning calorimetry (DSC), scanning electron microscopy, mechanical evaluations, and drug release.

Results: The physical and chemical performance of hybrid-scaffolds was better than HA scaffold. Increasing the concentration of HA and collagen improved the physical and chemical characteristics. Regarding the mechanical properties of the hybrid scaffold, the pore size was 20-200µm, compressive modulus was 54.77±0.31 kPa, more than 1200% water uptake was observed after 4 days, gelation temperature was 32±0.16°C, gelation time was 2.4±0.1 min, and drug release was controlled for 5 days by Higuchi release kinetic model.

Conclusion: It seems that this porous hybrid scaffold could be a suitable choice in cartilage regeneration as well as a controlled-release system for delivery of prednisolone in osteoarthritis.

An Automated Induction Microfluidics System for Synthetic Biology

The expression of a recombinant gene in a host organism through induction can be an extensively manual and labor-intensive procedure. Several methods have been developed to simplify the protocol, but none has fully replaced the traditional IPTG-based induction. To simplify this process, we describe the development of an autoinduction platform based on digital microfluidics. This system consists of a 600 nm LED and a light sensor to enable the real-time monitoring of  the optical density (OD) samples coordinated with the semicontinuous mixing of a bacterial culture. A hand-held device was designed as a microbioreactor to culture cells and to measure the OD of the bacterial culture. In addition, it serves as a platform for the analysis of regulated protein expression in E. coli without the requirement of standardized well-plates or pipetting-based platforms. Here, we report for the first time, a system that offers great convenience without the user to physically monitor the culture or to manually add inducer at specific times. We characterized our system by looking at several parameters (electrode designs, gap height, and growth rates) required for an autoinducible system. As a first step, we carried out an automated induction optimization assay using a RFP reporter gene to identify conditions suitable for our system. Next, we used our system to identify active thermophilic β-glucosidase enzymes that may be suitable candidates for biomass hydrolysis. Overall, we believe that this platform may be useful for synthetic biology applications that require regulating and analyzing expression of heterologous genes for strain optimization.

A comparative study on infusion of usual dose of oxytocin and 80 units dose of oxytocin in the prevention of postpartum hemorrhage in cesarean section

Postpartum hemorrhage is one of the main causes of mothers’ death mostly in developing country. The frequency of postpartum hemorrhage after natural pregnancy and cesarean are reported 2%–4% and 6%, respectively. The main goal of this study is to compare two regimens of oxytocine: One with high dose and the other with normal one to prevent uterine atony. The study has been done via a clinical trial method on 150 pregnant women in Zahedan, Iran. The society is randomly divided into two groups. The patients having risk factors of uterine atony and postpartum hemorrhage were omitted from the list. Oxytocin with 80 and 30 dose was, respectively, infused in 500 cc Ringer serum for control and witness group immediately after infant emersion during a period of 30 min. Decline of hemoglobin 6 and 24 h after cesarean section, uterine atony, blood infusion, and extra uterotonic drug needs after oxytocin infusion have been measured for both groups. The data have been analyzed using Chi-square via SPSS software. The result indicates that there exist meaningful differences between control and witness group in uterine atony and extra utertonic drug need while and after surgery (0 as compared with 22.6% and P = 0); whereas there is no significant difference between control and trial group in decline of hemoglobin 6 and 24 h after cesarean section (P = 0.714 and 0.231, respectively). It means that oxytocin infusion with 80 dose has a good impact on the above four variances. It is recommended that oxytocin infusion with 80 dose during a period of 30 min could be a good substitution for oxytocin infusion with 30 dose for the prevention of uterine atony during and after cesarean delivery, especially when utertonic drug is not accessible and in the case of counterindication of other drugs’ use.

Incidence and Risk Factors of Diabetic Foot Ulcer: A Population-Based Diabetic Foot Cohort (ADFC Study)-Two-Year Follow-Up Study

AIM/INTRODUCTION

This study was carried out to assess the incidence and risk factors of diabetic foot ulcer (DFU).

MATERIALS AND METHODS

In this prospective cohort study in a university hospital, all the participants were examined and followed up for new DFU as final outcome for two years. To analyze the data, the variables were first evaluated with a univariate analysis. Then variables with P value < 0.2 were tested with a multivariate analysis, using backward-elimination multiple logistic regression.

RESULTS

Among 605 patients, 39 cases had DFU, so we followed up the remaining 566 patients without any present or history of DFU. A two-year cumulative incidence of diabetic foot ulcer was 5.62% (95% CI 3.89-8.02). After analysis, previous history of DFU or amputation [OR = 9.65, 95% CI (2.13-43.78), P value = 0.003], insulin usage [OR = 5.78, 95% CI (2.37-14.07), P value < 0.01], gender [OR = 3.23, 95% CI (1.33-7.83), P value = 0.01], distal neuropathy [OR = 3.37, 95% CI (1.40-8.09), P value = 0.007], and foot deformity [OR = 3.02, 95% CI (1.10-8.29), P value = 0.032] had a statistically significant relationship with DFU incidence.

CONCLUSION

Our data showed that the average annual DFU incidence is about 2.8%. Independent risk factors of DFU development were previous history of DFU or amputation, insulin consumption, gender, distal neuropathy, and foot deformity. These findings provide support for a multifactorial etiology for DFU.

Induction of apoptosis in HeLa cancer cells by an ultrasonic-mediated synthesis of curcumin-loaded chitosan-alginate-STPP nanoparticles

Natural herbal compounds have been widely introduced as an alternative therapeutic approach in cancer therapy. Despite potent anticancer activity of curcumin, its clinical application has been limited because of low water solubility and resulting poor bioavailability. In this study, we designed a novel ultrasonic-assisted method for the synthesis of curcumin-loaded chitosan–alginate–sodium tripolyphosphate nanoparticles (CS-ALG-STPP NPs). Furthermore, antitumor effect of curcumin-loaded NPs was evaluated in vitro. Field emission scanning electron microscopy (FE-SEM) and atomic force microscopy (AFM) were used to characterize the properties of NPs. Antitumor activity of curcumin-loaded NPs was assessed by using MTT and quantitative real-time polymerase chain reaction (qRT-PCR). FE-SEM and AFM data revealed the spherical morphology, and the average size of NPs was <50 nm. In vitro cytotoxicity assay suggested that curcumin-loaded CS-ALG-STPP NPs displayed significant antitumor activity compared with the free curcumin. Gene expression level analyses showed that curcumin NPs significantly increased the apoptotic gene expression. Collectively, our results suggest that curcumin-loaded NPs significantly suppressed proliferation and promoted the induction of apoptosis in human cervical epithelioid carcinoma cancer cells, which might be regarded as an effective alternative strategy for cancer therapy.

Yield survey and nutritional evaluation of garlic stalk for ruminant feed

Background

Very limited information exists on the ruminal degradation kinetics of nutrients in garlic stalk. The present study aimed to survey the annual yield of garlic stalk in Korea and determine its feed-nutritive value for ruminants.

Methods

In Experiment 1, garlic stalk was incubated in situ in the rumen of two Hanwoo steers (360 ± 15 kg body weight) and removed after 12, 24, or 48 h to determine the ruminal degradation kinetics of DM and NDF. Rice straw was also included for comparison. In Experiment 2, In Experiment 2, six male Corriedale sheep were randomized to two dietary treatments to determine the apparent digestibility of nutrients in garlic stalk. Diets included a control ration without garlic stalk (60% concentrate mix +40% ryegrass) or a treatment ration (70% control diet +30% garlic stalk).

Results

The Korean national yield of garlic stalk (sun-dried basis) in 2016 was estimated to be 31,910 tons, with the southern coastal regions producing the highest quantity. Compared with rice straw, garlic stalk had lower NDF, higher ADF, and greater effective degradabilities of DM and NDF, resulting in a greater TDN value (56.3%), which was higher than that obtained for rice straw (43.7%).

Conclusion

These results provide basic information on the ruminal DM and NDF degradation kinetics of garlic stalk, which would be helpful for the efficient utilization of this by-product in ruminant diets.

Image-based feedback and analysis system for digital microfluidics

Digital microfluidics (DMF) is a technology that provides a means of manipulating nL-μL volumes of liquids on an array of electrodes. By applying an electric potential to an electrode, these discrete droplets can be controlled in parallel which can be transported, mixed, reacted, and analyzed. Typically, an automation system is interfaced with a DMF device that uses a standard set of basic instructions written by the user to execute droplet operations. Here, we present the first feedback method for DMF that relies on imaging techniques that will allow online detection of droplets without the need to reactivate all destination electrodes. Our system consists of integrating open-source electronics with a CMOS camera and a zoom lens for acquisition of the images that will be used to detect droplets on the device. We also created an algorithm that uses a Hough transform to detect a variety of droplet sizes and to detect singular droplet dispensing and movement failures on the device. As a first test, we applied this feedback system to test droplet movement for a variety of liquids used in cell-based assays and to optimize different feedback actuation schemes to improve droplet movement fidelity. We also applied our system to a colorimetric enzymatic assay to show that our system is capable of biological analysis. Overall, we believe that using our approach of integrating imaging and feedback for DMF can provide a platform for automating biological assays with analysis.

Curcumin-loaded chitosan-alginate-STPP nanoparticles ameliorate memory deficits and reduce glial activation in pentylenetetrazol-induced kindling model of epilepsy

Despite several beneficial effects of curcumin, its medical application has been hampered due to low water solubility. To improve the aqueous solubility of curcumin, it has been loaded on chitosan (CS)-alginate (ALG) - sodium tripolyphosphate (STPP) nanoparticles (NPs). Then, the effect of curcumin NPs on memory improvement and glial activation was investigated in pentylenetetrazol (PTZ)-induced kindling model. Male NMRI mice have received the daily injection of curcumin NPs at dose of 12.5 or 25mg/kg. All interventions were injected intraperitoneally (i.p), 10days before PTZ administration and the injections were continued until 1h before each PTZ injection. Spatial learning and memory was evaluated using Morris water maze test after the 7th PTZ injection. Animals have received 10 injections of PTZ and then, brain tissues were removed for histological evaluation. Nissl staining was used to determine the level of cell death in hippocampus and immunostaining method was performed against NeuN and GFAP/Iba1 for assessment of neuronal density and glial activation respectively. Behavioral results showed that curcumin NPs exhibit anticonvulsant activity and prevent cognitive impairment in fully kindled animals. The level of cell death and glial activation reduced in animals which have received curcumin NPs compared to those received free curcumin. To conclude, these findings suggest that curcumin NPs effectively ameliorate memory impairment and attenuate the level of activated glial cells in a mice model of chronic epilepsy.

Generation of recombinant protein shells of Johnson grass chlorotic stripe mosaic virus in tobacco plants and their use as drug carrier

The development and use of virus-like particles (VLPs) is a growing field with a powerful potential in generation of nanoparticles. In the present study we have attempted to generate and use empty shells of Johnson grass chlorotic stripe mosaic virus (JgCSMV, a member of the genus Aureusvirus, family Tombusviridae) as VLP nanoparticles for drug loading. In order to successfully produce recombinant JgCSMV-derived VLPs, we followed an approach based on cloning of the JgCSMV CP gene into pBI121 vector and introduction of the latter into Agrobacterium rhizogenes and transformation of tobacco cells for coat protein expression. Expression in tobacco tissue was demonstrated in transformed hairy roots as a model system. Recombinant VLPs were purified, analyzed by immune assay and visulalized by electron microscopy. Next, we explored the possibility of using JgCSMV-derived VLPs as a nanocontainer for loading the anticancer drug doxorubicin (DOX), taking advantage of the reversible swelling of VLPs in vitro. The results showed that transformed hairy roots produced high levels of the recombinant protein that readily assembled to form empty shells with overall structure similar to native virus particles. In addition, we demonstrated that JgCSMV-VLPs could function as vehicles able to load the chemotherapeutic drug doxorubicin. To our knowledge, this is the first research addressing the question of how this icosahedral virus (JgCSMV) can be used for the production of nanocontainers for biomedical applications.

The knowledge of hand hygiene among the healthcare workers of two teaching hospitals in Mashhad

INTRODUCTION

Healthcare-associated infections (HAIs) affect millions of patients worldwide annually. Hand hygiene (HH) has been identified as the single most important factor preventing HAIs. The aim of this study was to determine the knowledge regarding hand hygiene practices amongst health care workers, and identifying the areas of gaps in their knowledge.

METHODS

This cross-sectional analytic study was conducted in two university hospitals in Mashhad, Iran between May 2014 and September 2015. Data was collected using a translated version of the World Health Organization (WHO) Hand Hygiene Knowledge Questionnaire (revised 2009). The questionnaire contained questions on the participants' age, gender, profession, year of the course, formal training in HH and 27 multiple choice and "yes" or "no" questions to assess HH knowledge. Data were entered into IBM SPSS Statistics, Version 16. Descriptive statistical methods and also analytical statistical methods include ANOVA and Independent-samples t-test were used in data analyzing.

RESULTS

In total, 161 respondents including 32 residents, 92 nurses and 37 nursing assistants enrolled in this study. All study groups had a moderate knowledge of HH. The score of 21% was ≤ 50% (poor) and only 10.6% had a good knowledge score (i.e. the score ≥75%). There was no significant difference in the knowledge level of the participants who had received formal training in HH and those who had not (p=0.68). Also, the mean knowledge score was not associated with age (p=0.12), gender (p=0.84), department (p=0.96) or profession (p=0.43).

CONCLUSION

This study highlights the importance of applying the multimodal training program addressing providers' knowledge regarding hand hygiene, as well as strategies for cognitive, emotional and behavioral methods such as patient engagement in hand-hygiene interventions.