综合干预对病原微生物标本送检的临床效果评价

Clinical effect of comprehensive intervention on submission rates of microbiological specimens

摘要:

目的探讨综合干预措施对治疗性使用抗菌药物前微生物标本送检的效果。方法2014年8月 —2015年8月为干预前组，2015年9月开始实施综合干预措施，2015年9月—2016年9月为干预后组，比较干预前后全院及重点科室住院患者治疗性使用抗菌药物前微生物标本送检情况、血培养阳性率、抗菌药物使用率等情况。结果干预后全院总体、限制级和特殊级抗菌药物治疗性使用前微生物标本送检率由干预前的42.21%、45.19%、74.71%分别提高至53.54%、55.68%、89.70%，差异均有统计学意义 （均 P＜0.01）；实施干预后除胃肠外科、创伤骨科外，其他科室均达到了医院设定的微生物标本送检率的要求；但胃肠外科、创伤骨科分别由干预前的5.46%、11.67%提高至干预后的11.66%、29.45%，差异有统计学意义（均P＜0.001）。医院感染漏报率由干预前的13.56%下降至10.98%（P＜0.05）；抗菌药物使用率由干预前的57.36%下降至54.47%（P＜0.001）。结论通过综合干预措施有效提高了治疗性使用抗菌药物微生物标本送检率，同时，医院感染漏报率、抗菌药物使用率降低，取得了一定的临床效果。

关键词:

抗菌药物; 微生物标本送检率; 干预措施; 临床效果

Abstract:

ObjectiveTo investigate the effect of comprehensive intervention measures on submission of microbiological specimens before therapeutic use of antimicrobial agents. MethodsAugust 2014 to August 2015 was as preintervention group, comprehensive intervention measures were started to carry out from September 2015, September 2015 to September 2016 was as postintervention group. Microbiology specimen submission rates before therapeutic antimicrobial use, positive rate of blood culture, and rate of antimicrobial use in all departments and key departments were compared between preintervention group and postintervention group. ResultsThe submission rates of microbiological specimens before general, restricted, and special therapeutic antimicrobial use increased from 42.21%, 45.19%, and 74.71% of preintervention respectively to 53.54%, 55.68%, and 89.70% of postintervrntion respectively, showing significant difference (all P<0.01); after intervention, except gastrointestinal surgery and trauma department of orthopedics, the other departments all met the requirements of the microbiological specimen submission rates set by the hospital; but submission rates of microbiological specimens from department of gastrointestinal surgery and trauma department of orthopedics increased from 5.46% and 11.67% before intervention to 11.66% and 29.45% respectively after intervention, difference was statistically significant (both P<0.001). The missing report rate of healthcareassociated infection(HAI) dropped from 13.56% before intervention to 10.98% (P< 0.05), and the use rate of antimicrobial agents decreased from 57.36% to 54.47% (P<0.001). ConclusionComprehensive intervention measures can effectively improve the submission rates of microbiological specimens before therapeutic use of antimicrobial agents, reduce missing report rates of HAI and utilization rate of antimicrobial agents, and achieve certain clinical effectiveness.

Key words:

antimicrobial agent; submission rate of microbiological specimen; intervention measure; clinical effectiveness