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目的探讨集束化干预策略对清洁手术围术期抗菌药物管理的应用效果。方法采用回顾性调查法和前瞻性调查法,抽取2012年1月~2013年12月清洁手术4256例作为对照组,应用常规手术预防用抗菌药物,2014年1月~2015年12月清洁手术4432例作为干预组,针对围术期抗菌药物的使用应用集束化干预措施,比较两组术后感染率、抗菌药物使用率、使用抗菌药物病原学送检率、患者日均药费、住院时间,评估集束化干预策略对清洁手术围术期的干预效果。结果对照组抗菌药物使用率81.6%,明显高于干预组的22.4%(P<0.05),两组年度对比呈逐年下降趋势;对照组使用抗菌药物病原学送检率为25.9%,干预组为49.7%,对照组使用限制级抗菌药物病原学送检率为39.1%,干预组为100.0%,比较差异具有统计学意义(P<0.05),两组使用特殊限制级抗菌药物病原学送检率均为100%;对照组患者日均药费(2482.53±38.34)元,高于干预组(1178.21±12.25)元(P<0.05);对照组患者平均住院时间手术前(2.49±1.32)d,手术后(9.36±2.74)d,干预组住院时间手术前(1.01±0.33)d,手术后(4.38±1.64)d;干预组手术后住院时间短于对照组(P<0.05)。两组患者清洁手术术后感染率比较差异无统计学意义(P>0.05)。结论集束化干预策略在清洁切口围术期抗菌药物应用中可以有效降低抗菌药物使用率,提高使用抗菌药物病原学送检率,减少患者的日均药费,缩短患者的住院时间,干预效果显著,值得在抗菌药物的管理中进行推广。
Objective To explore the effect of cluster intervention on the management of perioperative antibacterials during clean operation. Methods Using retrospective investigation and prospective investigation, 4256 cases of clean operation from January 2012 to December 2013 were selected as the control group, and the routine operation was performed to prevent the use of antibacterial drugs. From January 2014 to December 2015, 4432 Cases as an intervention group, for the use of perioperative antibacterial drugs cluster intervention interventions were compared between the two groups postoperative infection rate, antibacterial drug use rate, the use of antimicrobial drug etiology rate, the average daily patient cost, hospital stay, Evaluate the effect of the cluster intervention on perioperative intervention in clean surgeries. Results The use of antibacterials in the control group was 81.6%, which was significantly higher than that in the intervention group (22.4%, P <0.05). The annual comparisons between the two groups showed a declining trend year by year. In the control group, the rate of antimicrobial agents was 25.9% 49.7% respectively. In the control group, the use rate of restricted antibiotics was 39.1%, and the intervention group was 100.0%. The difference was statistically significant (P <0.05). The etiological detection rate The mean daily hospitalization cost was (2482.53 ± 38.34) yuan in the control group, which was significantly higher than that in the intervention group (1178.21 ± 12.25) yuan (P <0.05). The average length of stay in the control group was 2.49 ± 1.32 days, The postoperative length of stay in hospitalization group was (1.01 ± 0.33) d after operation and (4.38 ± 1.64) days after operation. The hospitalization time in intervention group was shorter than that in control group (P <0.05). There was no significant difference in postoperative infection rate between the two groups (P> 0.05). Conclusions The cluster intervention strategy can effectively reduce the usage of antimicrobial agents during the perioperative period of antimicrobial therapy in clean incisions, improve the use of antimicrobial agents for etiological examination, reduce the average daily medical expenses and shorten the hospitalization time of patients, and the intervention effect is significant , It is worth in the management of antibiotics to promote.