某三甲医院抗菌药物使用情况调查

目的调查某三甲医院2006~2008年住院患者抗菌药物使用情况,以促进抗菌药物合理应用。方法随机抽查该医院2006~2008年住院患者病历每年各120份,其中手术和非手术病历每年各60份,调查抗菌药物使用率及药物使用排序,围术期预防用药使用情况,联合用药情况,病原学检查及药敏实验情况,并依照《抗菌药物临床应用指导原则》进行简单评价。结果该院抗菌药物使用率高,围术期预防用药率100%,非手术患者抗菌药物平均使用率为70%;病原学送检率及药敏试验率低,围术期预防用药药物选择及给药不规范,联合用药存在一定不合理现象。结论该三甲医院抗菌药物的使用存在一定问题,尚需严格规范。     

抗菌药物分级管理制度在西药房抗菌药物管理中应用的意义分析

目的：探讨抗菌药物分级管理制度在西药病房抗菌药物管理中的意义。方法：对本院自2011-2012年西药房中抗菌药物的等级使用品种进行归纳性的统计分析,采用金额排序法以及用药频度（DDDs）对药物等级管理效果进行评估。结果：西药房中抗菌药物的用药金额逐年升高,但占总药品的销售比例逐年降低,比例分别为36.21%、29.26%。用药金额位居前列的药品主要为头孢菌素类药物、青霉素类药物、喹诺酮类药物。采用药品分级管理之后,一线（非限制使用的药物）、三线（特殊使用的药物）抗菌药物的用药频次每年下降,二线（限制使用的药物）抗菌药物使用率逐渐上升。结论：采用抗菌药物分级管理制度,可以有效地指导本院抗菌药物的使用,但也存在某些问题,需要在各个科室医师、药师以及管理部门的共同努力下解决存在的问题,提高西药房抗菌药物的合理管理。     

儿科抗菌药物临床应用的调查分析

目的:探讨儿科住院患者抗菌药物应用现状.方法:对2009年1月至2009年6月儿科出院病历进行随机抽样并做回顾性调查分析.结果:调查的180份病历中,使用抗菌药物177例(98.33 %),其中抗菌药物单独使用157例(88.89 %),二联使用20例(11.11 %);青霉素类的使用占抗菌药物的67.78 %.结论:儿科住院患者抗菌药物的应用存在明显的不合理现象,加强抗菌药物临床应用的管理显得尤为重要.     

浅谈医院抗菌药物合理应用的管理

目的 探讨现代医院如何以有效的管理方法,控制抗菌药物的滥用,以达到最佳的治疗效果. 方法建立健全抗菌药物合理使用的管理组织和制度;加强对医务人员合理使用抗菌药物的知识培训;加强对患者及其家属进行抗菌药物合理使用的宣传教育;制定抗菌药物合理应用的规定;建立完善的合理用药网络;对抗菌药物的应用情况进行督查,奖优罚劣. 结果 采取这些综合管理与控制措施,以较完善的医院合理用药管理手段,达到抗菌药物最合理应用的目的 . 结论 医院合理应用抗菌药物的管理是全方位的工作,调动各方面的积极因素,密切配合,才能使临床抗菌药物的应用科学合理.     

某医院抗菌药物不合理应用现状及对策

目的分析某医院抗菌药物临床合理应用情况,旨在提高临床合理用药水平。方法对某医院2009~2011年抗菌药物临床使用情况进行调查,分析该院抗菌药物不合理使用现状并剖析问题的成因。结果某医院抗菌药物临床应用中存在用量、配伍和选择的不合理,以及抗菌药物在医院应用比例较高的问题。结论应提出建立抗菌药物使用规范标准、强化使用环节监督和加强医务人员培训等改进对策,以应对药物的不合理使用。     

某三级甲等综合性医院住院患者抗菌药物使用横断面调查

目的了解医院抗菌药物应用现状。方法采用横断面调查方法,对2010年7月6日所有住院患者进行抗菌药物使用调查。结果横断面抗菌药物使用率为61.90%,联合用药占54.68%,预防用药比例(57.17%)>治疗用药比例(42.83%),预防用药集中在外科、五官科等手术科室,规定日剂量频率(DDDs)列前5位的抗菌药物为头孢呋辛钠、美洛西林钠、奈替米星、头孢他啶、头孢替唑。结论加强围手术期抗菌药物合理应用的管理是降低医院抗菌药物使用率的关键。     

临床药师在抗菌药物临床应用管理中的作用

为全面贯彻落实《抗菌药物临床应用指导原则》,促进临床抗菌药物使用安全、有效、经济。临床药师通过对围术期抗菌药物预防使用干预、处方点评、药品不良反应报告、细菌耐药监测等工作,使抗菌药物临床应用进一步规范,药品不良反应明显减少,抗菌药物使用比例逐步下降。临床药师要充分发挥专业特长,在促进抗菌药物合理使用方面发挥重要作用。     

某院抗菌药物临床应用与细菌耐药分析

目的了解某院2007年抗菌药物的使用情况,分析评价其发展趋势及合理性。方法对2007年抗菌药物用药频度和临床主要致病菌对常用抗菌药物的耐药性进行分析。结果抗菌药物在临床使用中,头孢呋辛、头孢替安（0．5g）、头孢硫脒应用处于较前位置,其DDDs值分别为271872、233276、177100;临床分离茵中最常见的菌种为大肠埃希菌、肺炎克雷伯菌、铜绿假单孢杆菌,其耐药率分别为26．25％,41．58％,55．85％。结论统计数据全面反映抗菌药物临床应用现状,合理用药有待进一步提高。     

抗菌药物的临床应用（I）

怎样使抗菌药物的临床应用更有效和更为合理化 ,是长久以来临床医师感兴趣和不断探索的问题。笔者认为 ,君欲将抗菌药物在临床上用得如鱼得水 ,则需对抗菌药物的“本性”有充分的掌握和了解 ,要做到“知已知彼” ,才能“百战不殆”。1　抗菌药物概念抗菌药物 (ａｎｔｉｂａｃｔｅｒｉａｌａｇｅｎｔｓ)是指由微生物产生或经化学合成的具有杀菌或抑菌作用的药物。2　抗菌药物在人体中的过程与其疗效间的关系抗菌药物也和其他药物一样。有自己的药物代谢动力学过程 (简称药动学 ) ,它包括药物进入人体后的吸收 (Ａｂｓｏｒｐｔｉｏｎ) ,分布 (…     

ICU病房医院感染的分析及护理措施

目的 探讨ICU病房医院感染的原因和护理措施.方法 对我院ICU病房所发生的医院感染进行回顾分析.结果 IUC病房医院感染多见于呼吸道感染,泌尿系统感染,血管内导管相关感染,切口感染及烧伤创面的感染.结论 必须加强预防控制医院感染措施,严格执行无菌技术操作,是控制ICU病房医院感染的主要措施.     

Paediatric admissions at a tertiary hospital in Kuala Lumpur--a case for a short-stay ward

The profile of admissions staying less than 24 hours admitted to the paediatric wards of University Malaya Medical Center, Kuala Lumpur, over a period of six weeks was reviewed to ascertain the need of a short-stay ward. Ninety-three (22%) of the 428 admissions admitted during the study period were discharged within 24 hours, 56 (60%) were discharged within 12 hours. Major categories of admissions were: elective investigative procedures (43%), and emergency admissions (44%). Reasons for emergency admissions: infections 42%, minor trauma/cerebral concussion 25% and febrile/afebrile seizures 11%. Only 20% required percutaneous oximetry monitoring and 2% required observations more frequently than 2 hourly. There may be a case for a short stay ward in a big paediatric unit in Malaysia.     

Evaluation of an infrared/radiofrequency equipment-tracking system in a tertiary care hospital

Optimal management of assets in large hospitals is important to both cost control and patient care. A prospective controlled evaluation was conducted to determine whether an asset-tracking system using combined radiofrequency and infrared signals could increase equipment utilization, increase appropriate charge capture, and decrease personnel time spent looking for equipment. Two wards at Duke University Medical Center were randomly assigned as intervention and control. Beds, sequential compression devices (SCDs), and infusion pumps were monitored during a 6-week intervention period, preceded and followed by 6-week control periods. The system's accuracy for detecting equipment, relative to a trained surveyor, was greater than 80%. Accuracy for locating equipment to a specific room was 60–80%. With the system available, we observed increased utilization of infusion pumps but not of beds or SCDs. Nursing staff and system users had positive impressions of the system and its potential. Tracking systems can successfully locate hospital equipment and may improve utilization.     

Incidence of healthcare associated infection in the surgical ICU of a tertiary care hospital

Background

Healthcare associated infections (HAI) have taken on a new dimension with outbreaks of increasingly resistant organisms becoming common. Protocol-based infection control practices in the intensive care unit (ICU) are extremely important. Moreover, baseline information of the incidence of HAI helps in planning-specific interventions at infection control.

Methods

This hospital-based observational study was carried out from Dec 2009 to May 2010 in the 10-bedded surgical intensive care unit of a tertiary care hospital. CDC HAI definitions were used to diagnose HAI.

Results

A total of 293 patients were admitted in the ICU. 204 of these were included in the study. 36 of these patients developed HAI with a frequency of 17.6%. The incidence rate (IR) of catheter-related blood stream infections (CRBSI) was 16/1000 Central Venous Catheter (CVC) days [95% C.I. 9–26]. Catheter-associated urinary tract infections (CAUTI) 9/1000 urinary catheter days [95% C.I. 4–18] and ventilator-associated pneumonias (VAP) 32/1000 ventilator days [95% confidence interval 22–45].

Conclusion

The HAI rates in our ICU are less than other hospitals in developing countries. The incidence of VAP is comparable to other studies. Institution of an independent formal infection control monitoring and surveillance team to monitor & undertake infection control practices is an inescapable need in service hospitals.     

Incidence of healthcare associated infection in the surgical ICU of a tertiary care hospital

Background

Healthcare associated infections (HAI) have taken on a new dimension with outbreaks of increasingly resistant organisms becoming common. Protocol-based infection control practices in the intensive care unit (ICU) are extremely important. Moreover, baseline information of the incidence of HAI helps in planning-specific interventions at infection control.

Methods

This hospital-based observational study was carried out from Dec 2009 to May 2010 in the 10-bedded surgical intensive care unit of a tertiary care hospital. CDC HAI definitions were used to diagnose HAI.

Results

A total of 293 patients were admitted in the ICU. 204 of these were included in the study. 36 of these patients developed HAI with a frequency of 17.6%. The incidence rate (IR) of catheter-related blood stream infections (CRBSI) was 16/1000 Central Venous Catheter (CVC) days [95% C.I. 9–26]. Catheter-associated urinary tract infections (CAUTI) 9/1000 urinary catheter days [95% C.I. 4–18] and ventilator-associated pneumonias (VAP) 32/1000 ventilator days [95% confidence interval 22–45].

Conclusion

The HAI rates in our ICU are less than other hospitals in developing countries. The incidence of VAP is comparable to other studies. Institution of an independent formal infection control monitoring and surveillance team to monitor & undertake infection control practices is an inescapable need in service hospitals.     

Intravenous immunoglobulin utilization in a tertiary care teaching hospital in Saudi Arabia

OBJECTIVE: To evaluate the effect of intravenous immunoglobulin IVIG utilization at King Khalid University Hospital, an 850 bed tertiary care academic center, over a-3-year period. METHODS: Patients who received IVIG in the period from January 2003 to December 2005 at King Khalid University Hospital were identified retrospectively using the hospital computer system. Their charts were subsequently reviewed. We collected data pertaining to patients' demographics, indication of IVIG, dose regimen and physician specialty. Indications were categorized into 4 different categories: US Food and Drug Administration FDA-labeled; off-label recommended as first line; off-label recommended as alternative; and not recommended. RESULTS: A total of 305 patients were identified. Intravenous immunoglobulin was given to 109 (35.7%) patients for FDA-labeled indications, 29 (9.5%) patients for off-label recommended as first line indications, 97 (31.8%) for off-label recommended as alternative indications, and 70 (23%) for not recommended indications. The amount of IVIG consumed during the study period was 43.65 Kgs with an estimated cost of $1.75 million, 24.4% of which was considered inappropriate use. Hematologists and neurologists were the most frequent prescribers. CONCLUSION: A significant amount of IVIG was prescribed for inappropriate indications. This had a large financial burden on an already strained hospital budget.     

Evaluation of a multimodal teaching method on essential newborn care among health providers at a tertiary care hospital

BackgroundThere is an unmet need for in-service training of health providers for essential new-born care. This study evaluated the ability of a multi-modal training workshop on new-born care to improve the knowledge and skills of health providers.MethodsThis was an intervention based pre-and post-study on 54 students who attended a two-day workshop on essential new-born care. The teaching used self-directed learning, demonstration, videos, webinars, podcasts, group discussion, role-play and individual feedback. Knowledge was assessed by a set of 25 peer-reviewed multiple-choice questions (MCQs), both pre-and post-test and skills by 3 peer-reviewed and validated objective structured clinical examination (OSCE) stations in the post-test period. Follow-up assessment after 10 months was also done for 30 students.ResultsThere was a significant improvement in the knowledge scores on MCQs after the workshop [16.65 ± 1.84 vs 12 ± 2.98, mean difference 4.65, 95%CI (3.85 to 5.44); p value < 0.0001]. The skill scores assessed by the OSCE were 92.35%, 83.50% and 78.86% of the expected scores respectively with a composite OSCE stations score of 83.90% of the expected score (100%). Follow-up assessment after 10 months showed a significant decline in knowledge scores, though skill scores were retained.ConclusionAn essential new-born care workshop using multi-modal teaching methods resulted in an improvement in knowledge and skill scores among a diverse mix of nurses and doctors. This model of learning was acceptable and can be adapted for future training of health providers. There is a need for regular refresher training to maintain knowledge and skills.     

Depression in chronic respiratory disorders in a tertiary rural hospital of Central India

Objective： To determine prevalence of depression in chronic respiratory disorders in a tertiary rural hospital of Central India. Various studies done in past have shown that prevalence of depression in diabetes and hypertension is around 40% -57%. Few studies have been done to screen depression in chronic respiratory disorders. This study was conducted in a tertiary rural hospital of Central india to find out prevalence of depression in indoor patients suffering from chronic respiratory disorders. Methods： Total 68 patients were evaluated for depression. Patients suffering from chronic respiratory disorders （ total duration of illness 〉 3 months） were evaluated using Prime MD Questionnaire. Patients suffering from diabetes, heart diseases, stroke, having past history of psychiatric illness, drug abusers, having lack of social support and suffering from chronic upper respiratory tract infections were excluded from this study. Questionnaire was asked when treatment for acute phase of illness is over. Results： Out of 68 patients evaluated, 36 （53%） were found out to be suffering from depression. Female gender （80%） was more prone to depression, inspite of the fact that all alcoholics were male. 39% of all chronic obstructive pulmonary disease （COPD） patients were suffering from depression in comparison to 65% for pulmonary tuberculosis and 44% for other chronic respiratory illness. 54% of patients suffering from depression are 〈 30 yrs of age, 53% are between 30-60 yrs of age and 52% are 〉 60 yrs of age, suggesting that age has no relation with depression. No association was seen between alcoholism and depression. Conclusion： Prevalence of depression in patients of chronic respiratory illness is very high, like in cases of diabetes and hypertension. Further community and hospital based studies are needed to find out exact prevalence of depression in chronic respiratory illnesses.