Major article Lack of optimum practice among health care workers regarding tuberculosis in Iran: A knowledge, attitude, and practice study Amin Doosti Irani MSc a, b , Abdolrazagh Hashemi Shahraki MSc, PhD a, c , Ebrahim Ghaderi MD, PhD d , Mahshid Nasehi MD, PhD e, f , Ehsan Mostafavi DVM, PhD a, c, * a Department of Epidemiology, Pasteur Institute of Iran, Tehran, Iran b Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran c Research Center for Emerging and Reemerging Infectious Diseases, Pasteur institute of Iran, Akanlu, Kabudar Ahang, Hamadan, Iran d Kurdistan Research Center for Social Determinants of Health, Kurdistan University of Medical Sciences, Sanandaj, Iran e Disease Control Department, Iranian Ministry of Health and Medical Education, Tehran, Iran f Department of Epidemiology and Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran Key Words: Tuberculosis Knowledge Attitude Practice Health care worker Iran Background: Lack of knowledge toward tuberculosis (TB) among health care workers (HCWs) increases the risk of developing TB. The aim of this study was to assess the level of knowledge, attitude, and practice of HCWs in Iran. Methods: We conducted a cross-sectional study in 50 universities of medical sciences throughout Iran. A questionnaire was developed to assess the knowledge, attitude, and practice of participants. The values of Cronbach a coefficients for the knowledge and attitude questions were .76 and .75, respectively. Results: The mean scores of knowledge, attitude, and practice among TB laboratory staff regarding TB was 82.6 (95% confidence interval [CI], 82.0-83.7), 87.6 (95% CI, 87.1-88.0), and 57.9 (95% CI, 56.9-58.9), respectively. The mean scores of knowledge, attitude, and practice among non-TB laboratory staff regarding TB was 69.5 (95% CI, 67.9-71.1), 50.7 (95% CI, 50.1-51.4), and 40.82 (95% CI, 38.2-43.4), respectively. Conclusion: TB laboratory staff scored relatively well in knowledge and attitude of TB, but they scored lower in practice regarding TB. Non-TB laboratory staff had lower scores than TB laboratory staff in knowledge, attitude, and practice. There is a major gap between knowledge and attitude and practice in both groups. It is therefore essential to plan for the continuing in-service training of HCWs and public training of the general population regarding TB. Copyright Ó 2015 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. Tuberculosis (TB), one of the world’s oldest diseases, is still one of the major killers among infectious diseases, and it is out of control in many parts of the world. 1 The World Health Organization declared TB as a universal emergency in 1993. 2 With the emergence and spread of multidrug resistance bacilli, it has been proposed that there will be the risk of the transformation of TB into an incurable disease. 3 Recent evidence on drug resistance warns that multidrug resistant and extensive-drug resistant TB are rapidly increasing. 4,5 It is estimated that in 2012, 8.6 million people fell ill with TB and 1.3 million died from TB. However, 95% of TB infection is believed to exist in an asymptomatic latent form, defined not by the identifi- cation of bacteria, but by a host immune response. 6 Ninety five percent of morbidity and 98% of deaths caused by TB occur in developing countries, 7 and TB remains a major public health problem in Iran. 8,9 TB is considered an occupational disease among health care workers (HCWs). 10-12 Physicians, nurses in hospitals, and other HCWs, particularly TB laboratory staff, are at high risk for TB. 11,13 The relative risk of TB infection in HCWs has been reported to be approximately 3 times higher than other groups in the commu- nity. 14 The prevalence of latent TB among HCWs was reported * Address correspondence to Ehsan Mostafavi, DVM, PhD, Department of Epidemiology, Pasteur Institute of Iran, Tehran, Iran; Research Center for Emerging and Reemerging Infectious Diseases, Pasteur institute of Iran, Akanlu, Kabudar Ahang, Hamadan, Iran. E-mail address: mostafaviehsan@gmail.com (E. Mostafavi). 553 of the Scientific Committee of the Pasteur Institute of Iran. Funding/Support: This study was supported by the United Nations Devel- opment Programme (contract no. PSC/13/10). Conflicts of interest: None to report. Contents lists available at ScienceDirect American Journal of Infection Control journal homepage: www.ajicjournal.org American Journal of Infection Control 0196-6553/$36.00 - Copyright Ó 2015 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajic.2015.01.020 American Journal of Infection Control xxx (2015) e1-e6