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目的:以医院等级评审为契机,探讨某院Ⅰ类切口围手术期预防用药的管理方法,提高抗菌药物的应用合理性。方法:利用FOCUS-PDCA循环法对Ⅰ类切口抗菌药物的预防使用进行干预,选取该院2015年1~12月全部Ⅰ类切口患者出院病例进行回顾性分析,根据干预进程分为4个阶段,对每一阶段的抗菌药物应用指标进行比较,评价围术期抗菌药物的合理使用改进效果。结果:与干预前比较,干预第三阶段的Ⅰ类切口预防用药比例从62.90%降至28.32%,术前给药时机合理率从50.1%升至71.0%,品种选择合理率由53.5%提高至79.5%,预防用药疗程合理率从26.8%上升至56.3%,差异均有统计学意义(P<0.01),而干预前后手术部位感染率无明显差异(P>0.05)。多项指标的好转促进了该院等级评审相关条款评分结果的提升。结论:医院等级评审中利用FOCUSPDCA循环法规范Ⅰ类切口围术期抗菌药物预防使用效果显著。
OBJECTIVE: To assess the perioperative management of class I incision in a hospital and improve the rationality of antimicrobial agents by taking the opportunity of hospital grade evaluation. Methods: The preventive and therapeutic use of Class I incision antimicrobial agents was intervened by FOCUS-PDCA cycle method. All patients discharged from Class I incisions from January to December in 2015 were retrospectively analyzed. According to the intervention process, the patients were divided into four stages, For each stage of antimicrobial application of indicators to compare the evaluation of perioperative rational use of antimicrobial agents to improve the effect. Results: Compared with pre-intervention, the proportion of prevention of type Ⅰ incision in the third stage of intervention decreased from 62.90% to 28.32%, the rational timing of preoperative administration rose from 50.1% to 71.0%, and the reasonable rate of variety selection increased from 53.5% to 79.5% respectively. The reasonable rate of prophylaxis treatment increased from 26.8% to 56.3%, the differences were statistically significant (P <0.01). There was no significant difference in the infection rate of the surgical site before and after intervention (P> 0.05). The improvement of a number of indicators promoted the improvement of the grading results of the relevant articles of the hospital’s grade assessment. Conclusion: The use of FOCUSPDCA circulation method in the evaluation of the hospital class Ⅰ class Ⅰ incision perioperative antibacterial drugs to prevent the use of significant effect.