title: Assessment of injection practice in primary health care facilities of Shiraz, Iran.
abstract: BACKGROUND
  Occupational risk for several bloodborne viruses is attributable to unsafe injection practices. To understand injection frequency and safety, we surveyed injection rates and factors influencing injection prescription in primary health care facilities and associated health clinics in Shiraz, Iran.
  
  
  METHODS
  We used both quantitative and qualitative approaches to study the frequency and safety of injections delivered in 27 primary health care facilities. We used observations and 3 data collecting tools. Patterns of 600 general practice physicians' (GPs) prescriptions were also reviewed. In-depth interviews to elicit the factors contributing to injection prescriptions were conducted.
  
  
  RESULTS
  The annual per capita injection rate was 3.12. Corticosteroids were prescribed more frequently than antibiotics (P < .001). Knowledge of participants concerning transmission risks for 3 of the most common bloodborne infections (BBIs) was less than 75%. Factors affecting use of injections by GPs included strong patient preference for injections over oral medications and financial benefit for GPs, especially those in private practice settings.
  
  
  CONCLUSIONS
  Frequency of therapeutic injections in the participating facilities in Shiraz was high. Sociocultural factors in the patient community and their beliefs in the effectiveness of injections exerted influence on GP prescribing practices. Programs for appropriate and safe injection practices should target GP and injection providers, as well as patients, informing them about alternative treatments and possible complications of unnecessary and unsafe injections.
authors.affiliation: School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Sydney, Australia.
authors.forename: Mary-Louise
authors.initials: ML
authors.lastname: Mclaws
authors.affiliation: Student Research Center, Resident of Community Medicine, Department of Community Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Sulmaz
authors.initials: S
authors.lastname: Ghahramani
authors.affiliation: Infection Control Research and Services, Indiana University School of Dentistry, Indianapolis, IN.
authors.forename: Charles John
authors.initials: CJ
authors.lastname: Palenik
authors.affiliation: Department of Community Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Vahid
authors.initials: V
authors.lastname: Keshtkar
authors.affiliation: Department of Community Medicine, Shiraz Nephro-urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address: askariam@sums.ac.ir.
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Askarian
mesh_terms: D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D018562:Disease Transmission, Infectious / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007267:Injections / Q000379:methods* / Q000592:standards / Q000706:statistics & numerical data*; D007492:Iran; D008297:Male; D008875:Middle Aged; D016602:Needlestick Injuries / Q000517:prevention & control*; D016272:Occupational Health; D011320:Primary Health Care / Q000379:methods*; D055815:Young Adult
keywords: Antibiotic; Medication; Prescribing; Route; Unsafe