The Changes Of Using Antimicrobial Drugs For Prophylaxis In Surgical Perioperative Period After Standardized Management

[Objectives]1.To explore the changes of using antimicrobial drugs during surgical perioperative period in a2nd Level1st Class Hospital after the promulgation of The Modified Clinical Application of Antibacterial Drugs Action Plan in July2011and March2012by Ministry of Health, so as to provide the basis for the hospital to formulate the antimicrobial drugs policy in surgery.2.To provide the basis for hospitals to direct and supervise surgeons in providing different antimicrobial drugs for patients with different kind of sociological characteristics through an investigation about the knowledge, attitude, behaviors among patients in a2nd Level1st Class Hospital and a3rd Level1st Class Hospital.[Methods]We identified601eligible and valid medical records of patients who received a surgery in a2nd Level’1st Class Hospital in3periods around July2011and March2012. Type I incision surgery included herniorrhaphy and thyroid operation whereas type II incision surgery included caesarean. The content of the questionnaire we designed included informationon demographic characteristics, operations information, drug use information, medical cost, wound healing after operations, adverse drug reaction, etc. Excel2007and SPSS17.0were used in conducting the Statistical Analysis. The differences between the various demographic characteristics were compared by descriptive analysis, the difference between antimicrobial prophylaxis applications among three periods were compared using x2test. In addition, we selected110doctors and321patients randomly as subjects to finish our investigation. The differences of knowledge, attitudes, and behaviors towards antimicrobial drugs among subjects were compared by Wilcoxon test, whiles the relationship among knowledge, attitudes, and behaviors towards antimicrobial drugs were compared by Spearman rank correlation analysis.[Results]1. The changes of antimicrobial drugs use during surgical perioperative period in2nd Level1st Class HospitalAfter implementation of two plans, practices of antimicrobial drugs use that changed and met the standard were as follows:the antimicrobial drugs use decreased to0in thyoid surgery; the time of stopping medication after thyroid surgery; the appropriate time to use antimicrobial drugs during surgical perioperative period in the three types of surgerys(all antimicrobial drugs were used in0.5-2hours before operation or after omphalotomy); the combined application of antimicrobial drugs; and the types of antimicrobial drugs being used. Practices of antimicrobial drugs use that changed and but did not met the standard were as follows:the proportion of using antimicrobial drugs for prophylaxis in type Ⅰ incision operations, such as herniorrhaphy(64%); time of stopping medication after32%of herniorrhaphy was more than24hours; time of stopping medication after11%of type Ⅱ incision operations (caesarean) was more than48hours; samples of microbes from patients who received restricted antimicrobial drugs that were sent to be tested before medication increased from5%to45%; samples of microbes from patients who received special antimicrobial drugs that were sent to be tested before medication increased from9%to75%.However, some practices still didn’t changed at all, for example, operations whose total time exceeded3hours or with lots of blood loss did not receive second agent during operation.After implementation of two plans, the cost of antimicrobial drugs in three types of operations decreased to one fifth of original cost. Also, the average treatment time decreased, but the total cost did not change dramatically.In all patients who underwent operations, the use of antimicrobial drugs decreased to half of original use, and the cost of antimicrobial drugs decreased to one third of original cost. Although use of antimicrobial drugs decreased, the pace of infection rate after operation did not increase.2KAP of antimicrobial drugs among surgeons in two hospitalsTotally, the degree of mastering knowledge of antibiotics is low, and the awareness rate among surgeons in2nd Level1st Class Hospital(mean percent68.22%) is higher than those in third level1st Class Hospital(mean percent59.9%). Assessment method hadcertain influence on surgeons in the two hospitals. The rate of using antibiotics based on guiding principles increased from27.4%to60.9%. Main ways of obtaining knowledge about antibiotics were reading literatures and continuing medical education, the frequency and percent of each way were48(43.6%), and41(37.2%) respectively. Hospital penalty policy has more impact on2nd Level1st Class Hospital than third level1st Class Hospital, whereas professional ethics had more influence on third level1st Class Hospital besides national laws, regulations and policies. There was positive correlation between professional title and knowledge of antibiotics in2nd Level1st Class Hospital. Knowledge and attitude of antibiotics, knowledge and behavior had positive correlation respectively.3KAP of antimicrobial drugs among patients in two hospitalsAwareness rate of all patients was low,39.8%in2nd Level1st Class Hospital and44.96%in third level1st Class Hospital, and they didn’t have statistical significance; Satisfaction of patients about antibiotic using scheme made by doctors and effects of surgical treatment in third level1st Class Hospital is slightly lower than2nd Level1st Class Hospital, and also there was no statistical significance,but costs in hospital had the greatest impact on patients’ satisfaction. Patients’ main medication expectation is economic and effective. They learned of antibiotics knowledge mainly from doctors and friends, and this correlated with their education. Their attitude about antibiotics is correlated with their education and income, score of using antibiotics was correlated with their education. The relationship existed in their knowledge and attitude,but their behavior did not have association with knowledge and attitude.[Conclusion]In2nd Level1st Class Hospital, time of preoperative medication,combination medication, types of antibiotics in three kinds of surgery, duration of postoperative medication of patients with thyroid diseases were consistent with the regulations after two amendments. But interoperative additional medication in the three surgeries, duration of postoperative medication in cesarean section and hernia repair did not conform to the regulations. More antibiotics and longer duration can not get better prevention of infecton; Microbial inspection rate before using restricted and special antibiotics has greatly improved, but it still did not conform to the regulations.Surgeons of the two hospitals have different knowledge, attitude, and behavior about antibiotics and demographic characteristics. Hospitals should take corresponding policies according to different characteristics and set up a sound feedback mechanism. At the same time, knowledge of antibiotics should closely link with their prescription rights.Patients’behavior towards antibiotics are determined by their habit of using medications and economic status and not influenced by their knowledge of antibiotics. Different ways and contents of publicity and education should be taken in different groups. Improving patients’ satisfaction and solving the high costs of seeing doctors do not only rely on reasonable medication but also on national and hospital regulations.