Changing use of surgical antibiotic prophylaxis in Thika Hospital, Kenya: a quality improvement intervention with an interrupted time series design.
Changing use of surgical antibiotic prophylaxis in Thika Hospital, Kenya: a quality improvement intervention with an interrupted time series design.
复制标题
肯尼亚锡卡医院改变外科抗生素预防的使用：采用间断时间序列设计的质量改进干预措施。
DOI：
10.1371/journal.pone.0078942
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发表时间：
2013
期刊：
影响因子：
3.7
通讯作者：
Scott JA
中科院分区：
文献类型：
--
作者：
Aiken AM;Wanyoro AK;Mwangi J;Juma F;Mugoya IK;Scott JA
在低收入国家，手术部位感染（SSI）是医院获得性感染的常见形式。抗生素预防是预防这些感染的有效方法，如果在手术开始前立即给予。虽然在非洲的几项研究比较了术前和术后预防，但没有研究描述非洲医院实施政策以改善外科抗生素预防处方的情况。我们在2010年8月至2011年12月的16个月期间，在肯尼亚一家典型的政府医院进行了SSI监测，使用SSI的标准定义和手术伤口的污染程度。作为干预措施，我们制定了一项医院政策，建议术前抗生素预防并不鼓励术后延长抗生素使用。我们测量的过程中，结果和平衡的影响，这种干预使用中断的时间序列设计。从术后抗生素几乎完全使用的起点开始，在2011年2月政策出台后，迅速采用了术前抗生素预防（60%的手术在1周; 98%在6周）和术后抗生素的使用大幅减少（40%的手术在1周; 10%在6周）在清洁和清洁污染的手术。SSI的风险没有立即的阶跃变化，但总体而言，在所有伤口污染水平上，浅表SSI的风险似乎适度降低。与抗生素使用相关的费用、静脉注射次数和护理时间都有明显减少。在低收入国家，实施当地制定的外科抗生素预防政策是医院可实现的质量改进目标，并可为患者个人和机构带来实质性利益。
In low-income countries, Surgical Site Infection (SSI) is a common form of hospital-acquired infection. Antibiotic prophylaxis is an effective method of preventing these infections, if given immediately before the start of surgery. Although several studies in Africa have compared pre-operative versus post-operative prophylaxis, there are no studies describing the implementation of policies to improve prescribing of surgical antibiotic prophylaxis in African hospitals. We conducted SSI surveillance at a typical Government hospital in Kenya over a 16 month period between August 2010 and December 2011, using standard definitions of SSI and the extent of contamination of surgical wounds. As an intervention, we developed a hospital policy that advised pre-operative antibiotic prophylaxis and discouraged extended post-operative antibiotics use. We measured process, outcome and balancing effects of this intervention in using an interrupted time series design. From a starting point of near-exclusive post-operative antibiotic use, after policy introduction in February 2011 there was rapid adoption of the use of pre-operative antibiotic prophylaxis (60% of operations at 1 week; 98% at 6 weeks) and a substantial decrease in the use of post-operative antibiotics (40% of operations at 1 week; 10% at 6 weeks) in Clean and Clean-Contaminated surgery. There was no immediate step-change in risk of SSI, but overall, there appeared to be a moderate reduction in the risk of superficial SSI across all levels of wound contamination. There were marked reductions in the costs associated with antibiotic use, the number of intravenous injections performed and nursing time spent administering these. Implementation of a locally developed policy regarding surgical antibiotic prophylaxis is an achievable quality improvement target for hospitals in low-income countries, and can lead to substantial benefits for individual patients and the institution.
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DOI：
10.1046/j.1365-2710.2002.00430.x
发表时间：
2002-08-01
影响因子：
2
作者：
Wagner, AK;Soumerai, SB;Ross-Degnan, D
通讯作者：
Ross-Degnan, D
影响因子：
168.9
作者：
Allegranzi, Benedetta;Nejad, Sepideh Bagheri;Pittet, Didier
通讯作者：
Pittet, Didier
影响因子：
7.2
作者：
Owens, Stephanie M.;Brozanski, Beverly S.;Wiesenfeld, Harold C.
通讯作者：
Wiesenfeld, Harold C.
影响因子：
4.9
作者：
Horan, Teresa C.;Andrus, Mary;Dudeck, Margaret A.
通讯作者：
Dudeck, Margaret A.
影响因子：
6.9
作者：
Aiken, A. M.;Wanyoro, A. K.;Mwangi, J.;Mulingwa, P.;Wanjohi, J.;Njoroge, J.;Juma, F.;Mugoya, I. K.;Scott, J. A. G.;Hall, A. J.
通讯作者：
Hall, A. J.