Optimising antibiotic use along surgical pathways: addressing antimicrobial resistance and improving clinical outcomes.

研究背景：抗生素对于预防几种类型的手术后感染很重要。越来越多的感染无法用抗生素治疗，这可能意味着许多基本类型的手术无法继续。在世界各地，手术过程中使用了大量的抗生素。手术中的抗生素用于预防手术后发生感染（称为“腹泻”）和治疗手术后感染。手术后感染是许多国家日益关注的问题。每年有2300万例手术后感染（或“手术部位感染”，SSI）导致200万人死亡。以正确的方式使用抗生素是预防手术后感染的可靠方法。例如，如果在手术前的正确时间给予正确的抗生素，那么手术后所需的抗生素将减少七倍，因为感染的人会减少。目的和目标：术前、术中和术后（医院内外）的护理必须包括在正确的时间和正确的时间使用正确的抗生素，确保没有漏服或迟服抗生素。患者的健康状况，包括营养和活动能力，也会影响他们在感染后的恢复速度。为了在每个阶段得到正确的护理，所有不同的卫生专业人员（护士，外科医生，麻醉师，药剂师），患者和护理人员之间需要进行大量的协调和沟通。由于许多关键方参与了这一过程，因此它是进行研究的理想场所，以了解正确使用抗生素的思维方式和手卫生等行为，这些行为可以首先预防感染的发生。这项研究将利用社会科学研究来找出什么可以帮助个人，团队和患者安全地使用抗生素，并以正确的方式使用抗生素。这项研究将在英格兰和苏格兰研究这些问题，因为他们各自有不同的组织和管理手术的方式。我们还将在资源较少但仍以相同方式管理手术的国家（印度，南非和向卢旺达学习）进行研究。英国以外国家的研究也将告诉我们，当不同的卫生专业人员参与时，以及当医院内抗生素供应较少但也可从其他来源获得时，行为如何改变。研究方法：这项研究将持续四年，首先将分析医疗机构内外可能影响抗生素使用方式的所有因素。我们目前使用的改变专业人员和患者行为的方法将被评估。还将设计、开发和评估新方法，可能包括使用计算机或智能手机等新技术。我们还可能改变团队中不同专业人员的角色和期望，或改变与正确使用抗生素相关的激励或惩罚措施。其中一些可能涉及患者和护理人员发挥更积极的作用。潜在的应用和好处：通过了解手术发生的全部背景，我们将涵盖医疗机构内外的护理方面。由于我们将了解抗生素的可用性，财务压力，监管以及患者对其医疗保健系统和专业人员的期望等因素，我们将提出的解决方案将针对每种情况量身定制。随着我们将研究专业人员、患者和护理人员的行为和使用抗生素的方式，我们提出的新解决方案很可能会成为常规做法的一部分，帮助我们使抗生素的作用时间更长。

Context of the research:Antibiotics are important to prevent infections after several types of surgery. The growing number of infections that cannot be treated with antibiotics may mean that many basic types of surgeries cannot continue. Around the world a large amount of all antibiotics are used during the surgical process. Antibiotics in surgery are used to prevent infections from happening after surgery (it is called 'prophylaxis') and for the treatment of infections after surgery. Infection after surgery is a growing concern in many countries. 23 million infections after surgery (or 'surgical site infections', SSIs) lead to 2 million deaths every year. Using antibiotics in the right manner is a sure way of preventing infections after surgery. For example, if the right antibiotics are given at the right time before surgery, then up to seven times less antibiotics are needed after surgery because less people get infections. Aims and objectives:The care before, during and after surgery (inside and outside of hospital) must include using the right antibiotics at the right time for the correct amount of time, making sure that there are no missed or late doses. The wellbeing of patients including nutrition and ability to move about can also affect how quickly they recover if they do get an infection. To get this care right at each stage, a lot of coordination and communication is needed between all the different health professionals (nurses, surgeons, anaesthetists, pharmacists), patients and carers involved. Because so many key parties are involved in this process, it is an ideal place to do research to understand ways of thinking about the correct use of antibiotics and behaviours such as hand hygiene which can prevent infections from happening in the first place. This study will use social science research to find out what helps individuals, teams and patients to practice safely and use antibiotics in the right way as described above. The study will research these issues in England and Scotland as they each have different ways of organising and managing surgery. We will also carry out research in countries where there are less resources but they still manage surgery in the same way (India, South Africa and learning from Rwanda). The studies in countries outside of the UK will also tell us how behaviours can be changed when different health professionals are involved, and when antibiotics are less available within hospitals but also available from other sources. Methods: The study will last four years and will start with an analysis of all factors within and outside of healthcare organisations which may influence how antibiotics are used. The methods we use at the moment to change behaviours of professionals and patients will be evaluated. New methods will also be designed, developed and also evaluated, and may include using new technologies such as computers or smartphones. We may also change the roles and expectations of different professionals within teams or changing the incentives or penalties associated with proper use of antibiotics. Some of these may involve patients and carers taking a more active role. Potential applications and benefits:By understanding the full context where surgery occurs, we will cover aspects of care within and beyond healthcare settings. As we will understand factors such as availability of antibiotics, financial pressures, regulation as well as what patients expect of their healthcare system and professionals, the solutions we will propose will be tailored for each setting. As we will be looking at how professionals, patients and carers behave and use antibiotics, it is likely that the new solutions that we propose would become part of routine practice, helping us to keep antibiotics working for much longer.