背景:手术中抗生素预防(AP)的依从性不当与手术部位感染(SSI)的风险增加有关,并影响医疗保健的效率。
目的:评估在选定的外科手术中干预对AP依从性的影响及其对抗生素消耗和成本的影响。
方法:于2022年1月至12月在社区医院进行了一项前瞻性干预研究。基线期为2022年1月至4月,干预期为2022年5月至12月。所有行剖宫产术的患者,阑尾切除术,疝气手术,切开复位内固定(ORIF),腹部成形术,选择研究期间的胆囊切除术。干预措施包括员工教育,药学干预,监控处方和反馈的质量,麻醉人员的作用得到改善,和部门冠军。
结果:该研究在基线和干预阶段分别涉及192和617例外科手术。遵守时间安排,选择,剂量,并实现了100%的停药,99.2%,和92.7%的基线数字的97.6%,95.8%,和81.3%,分别。干预期间抗生素消耗量减少了55.1%,其他抗生素的贡献更高(减少了94.1%),与按照政策的抗生素相比(减少了31.2%)。成本降低了47.2%(抗生素按照政策31.9%,其他抗生素94.2%)。
结论:实施的策略在提高抗生素预防质量方面是有效的,在减少抗生素消耗和成本方面具有显著影响。
BACKGROUND: Improper compliance with antibiotic prophylaxis (AP) in surgery is associated with an increased risk of surgical site infection (SSI), and impacts the efficiency of healthcare.
OBJECTIVE: Evaluate the impact of an intervention in compliance with AP in selected surgical procedures and its effect on antibiotic consumption and cost.
METHODS: A prospective interventional study was performed in a community hospital from January to December 2022. The baseline period was considered January-April 2022 and the intervention period May-December 2022. All patients who underwent cesarean section, appendectomies, hernia surgery, open reduction and internal fixation (ORIF), abdominoplasty, and cholecystectomy during the study period were selected. The intervention includes staff education, pharmacy interventions, monitoring the quality of prescriptions and feedback, and improved role of anesthesia staff, and department champions.
RESULTS: The study involved 192 and 617 surgical procedures in the baseline and intervention periods respectively. The compliance with timing, selection, dose, and discontinuation achieved 100%, 99.2%, and 97.6% from baseline figures of 92.7%, 95.8%, and 81.3%, respectively. The antibiotic consumption was reduced by 55.1% during the intervention with a higher contribution of other antibiotics (94.1% reduction) in comparison with antibiotics as per policy (31.2% reduction). The cost was reduced by 47.2% (antibiotic as per policy 31.9%, other antibiotics 94.2%).
CONCLUSIONS: The implemented strategy was effective in improving the quality of antibiotic prophylaxis with a significant impact in reducing antibiotic consumption and cost.