目的:药物水蛭疗法-称为水蛭疗法(HT)-是一种经验性医学技术,在重建手术中再次流行。然而,在水蛭管理的每一步,都存在护理人员血液污染和患者严重感染的风险。这降低了治疗的成功率。这项研究的目的是改善水蛭从订购到处置的管理,以改善患者护理。
方法:首先,对文献进行了综述.第二,我们从2018年1月至2019年12月对患者进行了一项抗生素预防的回顾性研究.我们收集的数据是患者特征,医院的特定护理部门,指示,禁忌证,posology,HT的持续时间,交付的水蛭数量,抗生素预防处方和微生物,如果确定。第三,组织了一次跨学科会议来审查整个水蛭赛道:订购,维护,处方,配药,应用和处置。
结果:在文献综述结束时,选择了6篇基于法国实施的实践的文章纳入。这些文章讨论了抗生素预防,补铁,和水蛭储存,应用和处置。在进行的回顾性研究中,对60%(30/50)的患者进行了抗生素预防HT,77%(23/30)的处方遵循抗生素预防的建议,20例患者未接受抗生素预防。跨学科会议使得定义一个经过大学验证的协议成为可能,含有计算机化的抗生素预防处方,包括环丙沙星抗生素预防,静脉补铁和生物监测。创建了一个水蛭应用协议,并对水蛭的处理方法进行了修订。
结论:尽管缺乏明确的指导方针和不同的做法,这项研究揭示了包括水蛭使用前管理实践在内的标准程序的重要性,抗生素预防、应用和处置指南。跨学科协议允许改善患者护理管理,并使水蛭管理对护理人员更安全。
Medicinal leech therapy - known as hirudotherapy (HT) - is an empirical medical technique that has become popular again in reconstructive surgery. However, at each step of leech management there are risks for blood contamination of the caregivers and severe infections for patients. This reduces the success of the treatment. The aim of this study was to improve the management of leeches from ordering to disposal to improve patient care.
First, a review of the literature was performed. Second, we conducted a retrospective study of patients\' antibiotic prophylaxis from January 2018 to December 2019. The data we collected were patient characteristics, the specific care unit at the hospital, indication, contra-indication, posology, duration of HT, number of leeches delivered, antibiotic prophylaxis prescribed and microbial organism, if identified. Third, an interdisciplinary meeting was organised to review the entire leech circuit: ordering, maintenance, prescription, dispensing, application and disposal.
At the end of the literature review, six articles based on practices implemented in France were selected for inclusion. These articles discussed antibiotic prophylaxis, iron supplementation, and leech storage, application and disposal. On the retrospective study performed, antibiotic prophylaxis for HT was performed for 60% (30/50) of patients, 77% (23/30) of the prescriptions followed the recommendations for antibiotic prophylaxis, and 20 patients did not receive antibiotic prophylaxis. The interdisciplinary meeting made it possible to define a collegially validated protocol, containing a computerised antibiotic prophylaxis prescription, including per os ciprofloxacin antibiotic prophylaxis, intravenous iron supplementation and biological monitoring. A leech application protocol was created, and the method of leech disposal was revised.
Despite the absence of clear guidelines and heterogeneous practices, this study reveals the importance of a standard procedure including leech management practices before use, antibiotic prophylaxis and application and disposal guides. The interdisciplinary protocol allows improved patient care management and makes leech management safer for caregivers.