infection control and hospital epidemiology august 2006, vol. 27, no. 8 original article Knowledge, Attitude, and Practices Regarding Contact Precautions Among Iranian Physicians Mehrdad Askarian, MD, MPH; Ramin Shiraly, MD, MPH; Kiarash Aramesh, MD, MPH; Mary-Louise McLaws, DPHTM, MPH, PhD objective. To assess the knowledge, attitudes, and practices of Iranian physicians regarding contact isolation precautions. design. Data were collected between May and November 2002 using a cross-sectional survey design. setting. Teaching hospitals in Shiraz, Iran. participants. A total of 155 physicians: 78 attending clinicians and 77 resident physician surgeons or internists. results. The mean scores for knowledge and attitude were acceptable, with 71% of physicians scoring the maximum for knowledge and 65% achieving the maximum scores for attitude, whereas the mean score for practice was low, with only 26% achieving the maximum score. A good level of knowledge be associated with a good attitude (odds ratio [OR], 68.4 [95% confidence interval {CI}, 20.0-285.6]; ), good practices were associated with good knowledge (OR, 22.5 [95% CI, 7.1-91.3]; ), and a good attitude was associated P ! .001 P ! .001 with good practice (OR, 20.0 [95% CI, 5.7-105.2]; ). P ! .001 conclusion. Although strong associations were found among knowledge, attitude, and practice, the level of compliance with precautions was not nearly as high as it should be. Infect Control Hosp Epidemiol 2006; 27:868-872 From the Department of Community Medicine, Shiraz University of Medical Sciences, Shiraz, Iran (M.A., R.S., K.A.); and the School of Public Health & Community Medicine, University of New South Wales, Sydney, Australia (M.-L.M.) Received January 7, 2005; accepted March 21, 2005; electronically published July 20, 2006.  2006 by The Society for Healthcare Epidemiology of America. All rights reserved. 0899-823X/2006/2708-0013$15.00. Healthcare-associated infections have resulted in a significant increase in morbidity and mortality rates and high costs for hospitals worldwide. 1-4 More than 70% of bacterial healthcare- associated infections are caused by drug-resistant microorgan- isms, such as methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci. 5,6 We estimate that the prev- alence of infection with vancomycin-resistant enterococci is 14% in our teaching hospital in Iran. Although there have been reports on appropriate contact isolation precautions, scant at- tention has been paid to the equally important question of implementation of these practices. The present study surveyed physicians who hold a conjoint teaching position and resident physicians in a large Iranian city to determine their attitudes toward, knowledge of, and practice of contact isolation pre- cautions recommended in current guidelines. methods Subjects and Sampling Between May 2002 and November 2002, 78 attending phy- sicians who hold a conjoint teaching position and 77 resident physicians of surgical and nonsurgical fields at the University of Medical Sciences of Shiraz in Shiraz, Iran, completed an anonymous, self-administered questionnaire. Participants were provided with instructions, and written consent was obtained but delinked from the questionnaire. The study was approved by the University of Medical Sciences of Shiraz. Questionnaire Design The questionnaire was prepared by a team of infection control experts, including an infectious diseases physician. The ques- tionnaire included items regarding demographic information and 8 items regarding knowledge of, attitudes toward, and practice of contact precautions. An item about knowledge of the benefits of double gloving was included, because latex gloves are not always available. Originally, a 3-category re- sponse was provided for questionnaire items about knowledge of contact precautions (“Yes,” “No,” and “Don’t know”), a 5-category response was provided for items about attitudes (from “extremely important” to “no importance”), and a 5- category response was provided for items about practices (“always” to “never”). During analysis, responses about at- titude and practice were dichotomized into “good” (com- prising the responses “extremely important” to “important”) and “poor” (comprising the responses “low importance” and “no importance”) and also “correct” (comprising the re-