薬剤供給方法の変更による術中抗菌薬予防投与の適正化  [in Japanese] System for Improved Administration of Antimicrobial Agents for Surgical Site Infection Prophylaxis  [in Japanese]

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Abstract

  手術部位感染予防には抗菌薬の予防投与が重要である.当院感染対策チームでは,手術時のcefazolin(CEZ)およびcefmetazole(CMZ)の3時間毎投与を推奨してきたが,長時間手術では追加投与が適切に行われていないケースがみられた.そこで,抗菌薬供給方法を処方せんによる個人セット払いから手術室への定数配置へ変更し,追加投与実施状況の改善を試みた.併せて術前・術中投与の指示出し用スタンプを各病棟に配置した.供給方法変更前(2005年8月),供給方法変更後(2006年8月),ならびに電子カルテ稼動後(2007年8月)の3期間において,6時間を越える手術での抗菌薬術中追加投与の実施割合を調査した.各期間における対象件数と平均手術時間は2005年45例483分,2006年46例524分,2007年44例510分であった(p=0.46).必要投与回数の総和は各期間でそれぞれ99回,114回,106回であったのに対して,実投与回数の総和(実施率)は20回(20.2%),101回(88.6%),104回(98.1%)と,供給方法変更後に増加した(p<0.001).なお,2007年における前投与からの投与間隔は平均181分であり,210分を超えたのは全104回中2回のみであった.抗菌薬の供給を手術室定数配置に変更するなどの介入によって,抗菌薬術中追加投与の実施率を劇的に改善することができた.<br>

  Antimicrobial agent administration during surgery is important for prophylaxis against surgical site infection. The infection control team of our hospital recommends administration of cefazolin (CEZ) or cefmetazole (CMZ) every 3 hours during surgery. However, appropriate administration was frequently not provided in surgery extending over 6 hours. We changed the supply of an antimicrobial agent from “provided by prescription” to “administered by all staff in the operation area” to improve compliance with the recommendations. In addition, “form stamps” were provided to control administration in each care unit. Administration of antimicrobial agents during surgery extending over 6 hours was retrospectively studied before (August 2005) and after (August 2006) change of the supply system, and after introducing the electronic medical recording system (August 2007). Total surgeries were 45, 46 and 44 cases, and mean operation times were 483, 524 and 510 min (p=0.46), respectively. The recommendations required 99, 114 and 106 doses, whereas the actual provisions were 20 (20.2%), 101 (88.6%) and 104 doses (98.1%), respectively (p<0.001). The mean interval between administrations was 181 min and extended over 210 min in only 2 cases. The change in supply methods including form stamps and other interventions dramatically improved antimicrobial agent administration during extended surgery.<br>

Journal

  • Japanese Journal of Infection Prevention and Control

    Japanese Journal of Infection Prevention and Control 24(6), 395-399, 2009-11-25

    Japanese Society for Infection Prevention and Control

References:  7

Codes

  • NII Article ID (NAID)
    10026902015
  • NII NACSIS-CAT ID (NCID)
    AA12313188
  • Text Lang
    JPN
  • Article Type
    ART
  • ISSN
    1882532X
  • NDL Article ID
    10516321
  • NDL Source Classification
    ZS9(科学技術--医学--病理学・微生物学・寄生虫学・感染・免疫学・血清学・アレルギー)
  • NDL Call No.
    Z19-3650
  • Data Source
    CJP  NDL  J-STAGE 
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