Pharmacy Department, CHU Caen, Caen, France.
Maxillofacial Surgery Department, CHU Caen, Caen, France.
Eur J Hosp Pharm. 2023 Mar;30(e1):e61-e65. doi: 10.1136/ejhpharm-2021-003100. Epub 2022 May 2.
Medicinal leech therapy - known as hirudotherapy (HT) - is an empirical medical technique that has become popular again in reconstructive surgery. However, at each step of leech management there are risks for blood contamination of the caregivers and severe infections for patients. This reduces the success of the treatment. The aim of this study was to improve the management of leeches from ordering to disposal to improve patient care.
First, a review of the literature was performed. Second, we conducted a retrospective study of patients' antibiotic prophylaxis from January 2018 to December 2019. The data we collected were patient characteristics, the specific care unit at the hospital, indication, contra-indication, posology, duration of HT, number of leeches delivered, antibiotic prophylaxis prescribed and microbial organism, if identified. Third, an interdisciplinary meeting was organised to review the entire leech circuit: ordering, maintenance, prescription, dispensing, application and disposal.
At the end of the literature review, six articles based on practices implemented in France were selected for inclusion. These articles discussed antibiotic prophylaxis, iron supplementation, and leech storage, application and disposal. On the retrospective study performed, antibiotic prophylaxis for HT was performed for 60% (30/50) of patients, 77% (23/30) of the prescriptions followed the recommendations for antibiotic prophylaxis, and 20 patients did not receive antibiotic prophylaxis. The interdisciplinary meeting made it possible to define a collegially validated protocol, containing a computerised antibiotic prophylaxis prescription, including ciprofloxacin antibiotic prophylaxis, intravenous iron supplementation and biological monitoring. A leech application protocol was created, and the method of leech disposal was revised.
Despite the absence of clear guidelines and heterogeneous practices, this study reveals the importance of a standard procedure including leech management practices before use, antibiotic prophylaxis and application and disposal guides. The interdisciplinary protocol allows improved patient care management and makes leech management safer for caregivers.
医学水蛭疗法，又称水蛭疗法（HT），是一种经验性的医学技术，在重建手术中再次流行。然而，在管理水蛭的每一个步骤中，护理人员都有血液污染的风险，患者有严重感染的风险。这降低了治疗的成功率。本研究旨在通过改进从订购到处理的水蛭管理，以改善患者的护理。
首先，对文献进行了回顾。其次，我们对 2018 年 1 月至 2019 年 12 月期间接受抗生素预防治疗的患者进行了回顾性研究。我们收集的数据包括患者特征、医院特定护理单元、适应证、禁忌证、剂量、HT 持续时间、交付的水蛭数量、开具的抗生素预防处方和微生物，如果鉴定。第三，组织了一次跨学科会议，以审查整个水蛭循环：订购、维护、处方、分发、应用和处理。
在文献综述结束时，选择了六篇基于法国实施实践的文章进行纳入。这些文章讨论了抗生素预防、铁补充剂以及水蛭的储存、应用和处理。在进行的回顾性研究中，60%（30/50）的患者接受了 HT 的抗生素预防治疗，77%（23/30）的处方遵循了抗生素预防治疗的建议，20 名患者未接受抗生素预防治疗。跨学科会议制定了一个经同行验证的方案，包括计算机化的抗生素预防处方，包括环丙沙星抗生素预防、静脉内铁补充和生物监测。制定了水蛭应用方案，并修订了水蛭处理方法。
尽管缺乏明确的指南和异质的实践，但这项研究揭示了在使用前包括水蛭管理实践、抗生素预防治疗以及应用和处理指南在内的标准程序的重要性。跨学科方案可改善患者护理管理，并使医护人员在管理水蛭时更安全。
