Rational Utilization Of Antimicrobial Prophylaxis In Perioperative Period Of Clean Incision Operations: An Intervention Control Study

Currently, there is a common phenomenon of unreasonable application of antimicrobial agents over the world, which could lead to bacterial resistance, hospital infection rates increased and other issues. Although our implementation of rational utilization of antimicrobial agents has been for many years, the Ministry of Health has promulgated and implemented in 2004,"the Basic Principles of Clinical Use of Antimicrobial agents", but there are still many problems in the implementation process. To explore the hospital perioperative application of antimicrobial agents and problems of rationality, especially for such research to perioperative application of antimicrobial agents to prevent the situation of research, looking for practicable intervention rational utilization of antimicrobial agents measures to standardize surgical perioperative prophylaxis and to promote the level of rational use of antimicrobial agents, so as to improve health care quality and reduce waste of resources.OBJECTIVE To explore a set of scientific intervention methods in perioperative period which promote the development of rational utilization of perioperative antimicrobial agents.METHODS Selected the eligibled cases totally of 11 types of clean incision operations which were discharged into pre-intervention (March 2010), the first phase of the intervention (June 2010) and the second phase of intervention (September 2010), to compare pre-intervention with the two phase of post-intervention to promote reasonable use of antimicrobial agents. According to "the Basic Principles of Clinical Use of Antimicrobial agents", some of the indicators were used in this study to examine the feasibility and effeetiveness. These indicators invovled antibiotic indication, medication timing (preoperative, intraoperative, postoperative), combination, replacement, antibiotic selection (type, starting point), duration, usage, dosage, route of administration, solvent (type and amount), length of stay, hospital costs, costs of all drugs, costs of antimicrobial agents, nosocomial infection rates and so on. Through the perioperative management of prophylactic antimicrobial agents, the promulgation of implementation details, clinical pharmacists close guide, professional knowledge training, publicity and education of patients and other interventions. In addition, supervision and management of polity means a combination of interventions, problems and deficiencies to be amended and improved during the intervention process, thus contributing to antimicrobial agents perioperative standardization and rationalization.RESULTS Through a unified inclusion and exclusion criteria, 620 cases were selected to meet the requirements, of which 210 cases at pre-intervention group, 203 cases at the first post-intervention group, and 207 cases at the second post-intervention group. On one hand, rate of antimicrobial prophylaxis decreased from 87.62% before intervention to 74.88% and 69.08% after the intervention. On the other hand, comprehensive rationality rate was improved from 12.38% in pre-intervention to 33.99% and 51.21% in the two phase of post-intervention.After the implementation of intervention, most of the indicators had been significantly improved. Firstly, the indicators of medication timing changed significantly(P<0.05), to prevent surgical site infection, antimicrobial agents were administrated within 30 min and 2 h before incision, 30 patients (14.29%) in pre-intervention, 37 cases (18.23%) after at the first phase of post-intervention, and 68 cases (32.85%) at the second phase of intervention. Secondly, reasonable rate of duration was also increased(P<0.05), the number of patients who were withdrawal antimicrobial agents within 48 h in three phases was 40 (19.05%), 91 (44.83%) and 130 (62.80%) respectively. Thirdly, a total of 39 kinds of drugs were involved, leading the first three places on the list of DDDs were Cefathiamidine, Amoxicillin and clavulanate potassium, Penicillin and flucloxacillin, while at the second phase of post-intervention, the list of DDDs changed with Cefathiamidine, Cefotiam and Amoxicillin and clavulanate potassium, Forthly, the average hospital stay was significantly lower, and the average cost of drugs and the average cost of antimicrobial agents in the second phase after the intervention decreased significantly (P<0.05). Moreover, average hospital costs were not very different in the post-intervention group, surgery healing and secondary infection were no significant difference.CONCLUSIONSAfter implementing intervention measures for 11 kinds of clean incision operations in perioperative period, effectively reduced prevent application rates, significantly improved the reasonable rate, shortened the patient length of hospital stay and the cost of antimicrobial agents, all of these explained the implementation rules and management measures were feasible and effective. Therefore, it's a useful management experience for expansion of other clean incision and clean-pollution, pollution incision operation. It provides a reference for hospital clinical path and a new mode for the pharmacy staff to serve patients in the clinical better.