在儿科心脏重症监护病房的抗生素管理和改善抗生素利用
Margot M Hillyer1, Preeti Jaggi2, Nikhil K Chanani3
1Division of Critical Care Medicine, Department of Pediatrics, Emory University School of Medicine.
Pediatric quality & safety
|February 7, 2024
概括
一项质量改善计划成功地减少了儿童心脏重症监护病房的广泛抗生素使用. 抗微生物管理小组的干预导致治疗万科米辛和美罗胺几天持续下降,但不增加死亡率.
科学领域:
- 儿科重症监护医学 儿科重症监护医学
- 传染性疾病 传染性疾病
- 医疗保健服务研究 医疗服务研究
背景情况:
- 成立了一个多学科的抗菌药物管理团队,以优化儿童心脏重症监护室 (PCICU) 的抗生素处方.
- 一项旨在提高质量的倡议,旨在将不必要的广谱抗生素使用量减少20%,并产生持续的影响.
- 该倡议的重点是通过提供者教育和实践标准化来解决过度使用抗生素的问题.
研究的目的:
- 评估质量改善计划在减少PCICU中广泛抗生素使用方面的有效性.
- 评估抗生素管理干预措施对抗生素消费和患者结果的影响.
- 确定特定抗生素使用的减少是否导致替代性宽谱药物的使用增加或不良事件.
主要方法:
- 质量改进倡议利用四级护理中心内的计划-做-学习-行动 (PDSA) 周期.
- 主要结局是在针对性抗生素每1000个患者日治疗日 (DOT) 中测量.
- 使用统计过程控制图表来分析抗生素使用趋势,并监测过程和平衡措施.
主要成果:
- 观察到,使用万科米辛 (31%) 和美罗 (67%) 的时间有显著而持续的减少.
- 总体而言,グラム阴性抗生素的使用量下降了26%,而替代性广谱药物,如塞费皮姆或皮佩拉-塔扎巴克坦,则没有增加.
- 电子医疗记录干预,包括自动停止时间和标准化的实证订单,是变革的关键驱动力. 所有原因的死亡率保持不变.
结论:
- 实施专门的抗微生物药物管理倡议有效地减少了PCICU中的万科米辛和美罗的使用.
- 这些干预措施成功地减少了宽频抗生素的使用,但没有对患者的死亡率产生负面影响,也没有增加替代宽频药物的使用.
- 未来的努力将集中在扩大管理干预措施以准其他广泛的抗微生物药物.
相关概念视频
01:22Healthcare Associated Infections II: Preventive Measures
2.6K
Essential infection prevention measures are based on the knowledge of the infection chain, the modes of transmission in healthcare settings, and the use of the best practices in all healthcare settings. Compulsory public reporting of healthcare-associated infection rates is needed to allow individuals and the community to make informed choices regarding selecting a healthcare facility.
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
The best practices for preventing healthcare-associated infections include hand hygiene, patient risk...
2.6K
01:26Standard Precaution
1.9K
Standard precautions are the minimum infection control safeguards used while caring for all patients, irrespective of their disease condition. They help prevent the spread of common infectious microorganisms to healthcare workers, patients, and visitors in all healthcare settings.
Hand hygiene is the most crucial means to prevent the transmission of disease. Employers are legally required to provide their workers with personal protective equipment (PPE) to minimize exposure or contact with...
Hand hygiene is the most crucial means to prevent the transmission of disease. Employers are legally required to provide their workers with personal protective equipment (PPE) to minimize exposure or contact with...
1.9K
01:27Parentral Nutrition: Centeral and Peripheral Parental Nutrition
162
Parenteral Nutrition (PN) delivers essential nutrients directly into the bloodstream, bypassing the digestive system. It is commonly used for individuals with severe digestive disorders or conditions that prevent normal nutrient absorption.
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...
PN can be administered through two primary routes:
1. Central Parenteral Nutrition (CPN):
CPN involves delivering a high concentration of nutrients through a large vein. This is typically achieved using a Peripherally Inserted Central Catheter (PICC) or,...
162
01:23Antimicrobial Proteins
992
Antimicrobial proteins are important components of the immune system. They aid the body in combating pathogens by either killing them directly or hindering their replication processes. Four main types of antimicrobial substances are interferons, the complement system, iron-binding proteins, and antimicrobial proteins.
Interferons
Interferons (IFNs) are proteins produced by lymphocytes, macrophages, and fibroblasts infected with viruses. While IFNs cannot prevent viruses from entering and...
Interferons
Interferons (IFNs) are proteins produced by lymphocytes, macrophages, and fibroblasts infected with viruses. While IFNs cannot prevent viruses from entering and...
992
01:25Transmission-based Precautions II: Airborne and Protective Environment
1.3K
Transmission-based precautions are for patients infected or suspected to be infected (or colonized) with organisms posing a significant risk to others. The transmission precautions include airborne and protective environment precautions.
Airborne precautions:
Use airborne precautions when treating patients known or suspected to have diseases that spread through the air—for example, tuberculosis or measles. These organisms are present in smaller droplets expelled by an infected person and...
Airborne precautions:
Use airborne precautions when treating patients known or suspected to have diseases that spread through the air—for example, tuberculosis or measles. These organisms are present in smaller droplets expelled by an infected person and...
1.3K
01:23Hand hygiene
3.2K
Asepsis is the practice of preventing or breaking the chain of infection. The nurse employs aseptic techniques to prevent the spread of microorganisms and reduce the risk of diseases. Hand hygiene is the cornerstone of aseptic techniques and is classified into medical and surgical asepsis. Medical asepsis includes hand hygiene and the use of gloves. Surgical asepsis, or the sterile technique, refers to practices that render and keep objects and areas free of microorganisms.
Hand washing...
Hand washing...
3.2K