Strategies to prevent and control the emergence and spread of antimicrobial-resistant microorganisms in hospitals - A challenge to hospital leadership
Strategies to prevent and control the emergence and spread of antimicrobial-resistant microorganisms in hospitals - A challenge to hospital leadership
复制标题
DOI：
10.1001/jama.275.3.234
复制
发表时间：
1996-01-17
影响因子：
120.7
通讯作者：
Martone, WJ
中科院分区：
文献类型：
--
作者：
Goldmann, DA;Weinstein, RA;Martone, WJ
目标-为医院领导提供可能对抗菌素耐药性产生重大影响的战略目标或行动，概述评估每个目标进展情况的结果和过程措施，描述成功的潜在障碍，并提出对策和新的改进战略。参与者-来自以下领域的多学科专家小组：医院流行病学和感染控制、传染病(包括研究生培训计划)、临床实践(包括护理、外科、内科和儿科)、药剂学、管理、质量改进、适宜性评估、行为修改、实践指南制定、医疗信息学和结果研究，来自适当联邦机构、医疗保健组织认证联合委员会的代表，制药业也参与了。证据。-发表了关于努力提高抗生素利用率和预防和控制医院中耐药微生物的出现和传播的文献、指南、专家意见和实践经验。协商过程。-参与者被分成两个质量改进小组：一个专注于改善抗菌药物的使用，另一个致力于预防和控制耐药微生物的传播。这些团队模拟了医院可能用来制定和实施对抗抗生素耐药性的战略计划的过程。结论：就十个战略目标以及相关的过程和结果措施达成一致，优化抗菌药物使用的五个战略目标如下：优化手术过程中的抗菌药物预防；优化经验性治疗的选择和持续时间；通过教育和行政手段改善抗菌药物处方，监测和提供关于抗生素耐药性的反馈；定义和实施针对重要类型抗菌药物使用的卫生保健提供系统指南，检测、报告和防止抗菌药物耐药性传播的五个战略目标如下。开发一个系统，以识别和报告机构内部的抗菌素耐药性趋势；开发一个系统，以快速检测和报告个别患者的抗药性微生物，并确保照顾者的快速反应；加强对基本感染控制政策和程序的遵守；将抗菌素抗药性的检测、预防和控制纳入机构战略目标，并提供所需资源；以及制定一项计划，以识别、转移、出院和重新接纳带有特定抗菌素抗药性病原体的患者。
Objective-To provide hospital leaders with strategic goals or actions likely to have a significant impact on antimicrobial resistance, outline outcome and process measures for evaluating progress toward each goal, describe potential barriers to success, and suggest countermeasures and novel improvement strategies.Participants.-A multidisciplinary group of experts was drawn from the following areas: hospital epidemiology and Infection control, infectious diseases (including graduate training programs), clinical practice (including nursing, surgery, internal medicine, and pediatrics), pharmacy, administration, quality improvement, appropriateness evaluation, behavior modification, practice guideline development, medical informatics, and outcomes research, Representatives from appropriate federal agencies, the Joint Commission on Accreditation of Healthcare Organizations, and the pharmaceutical industry also participated.Evidence.-Published literature, guidelines, expert opinion, and practical experience regarding efforts to improve antibiotic utilization and prevent and control the emergence and dissemination of antimicrobial-resistant microorganisms in hospitals.Consensus Process.-Participants were divided into two quality improvement teams: one focusing on improving antimicrobial usage and the other on preventing and controlling transmission of resistant microorganisms. The teams modeled the process a hospital might use to develop and implement a strategic plan to combat antimicrobial resistance.Conclusions.-Ten strategic goals and related process and outcome measures were agreed on, The five strategic goals to optimize antimicrobial use were as follows: optimizing antimicrobial prophylaxis for operative procedures; optimizing choice and duration of empiric therapy; improving antimicrobial prescribing by educational and administrative means, monitoring and providing feedback regarding antibiotic resistance; and defining and implementing health care delivery system guidelines for important types of antimicrobial use, The five strategic goals to detect, report, and prevent transmission of antimicrobial resistant organisms were as follows. to develop a system to recognize and report trends in antimicrobial resistance within the institution; develop a system to rapidly detect and report resistant microorganisms in individual patients and ensure a rapid response by caregivers; increase adherence to basic infection control policies and procedures; incorporate the detection, prevention, and control of antimicrobial resistance into institutional strategic goals and provide the required resources; and develop a plan for identifying, transferring, discharging, and readmitting patients colonized with specific antimicrobial-resistant pathogens.