Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi, India.
Obstetrics and Gynaecology, Lady Hardinge Medical College, New Delhi, India
BMJ Open Qual. 2022 May;11(Suppl 1). doi: 10.1136/bmjoq-2021-001438.
Antibiotic resistance is a global problem. Irrational use of antibiotics is rampant. Guidelines recommend administration of single dose of antibiotic for surgical antimicrobial prophylaxis (SSAP) for elective obstetrical and gynaecological surgeries. However, it is not usually adhered to in practice. Majority of women undergoing elective major gynaecological surgeries and caesarean sections in the department of obstetrics and gynaecology of our tertiary level heavy case load public health facility were receiving therapeutic antibiotics (for 7-10 days) instead of recommended SSAP. Our aim was to increase the SSAP in our setting from a baseline 2.1% to more than 60% within 6 months.
After root cause analysis, we formulated the departmental antimicrobial policy, spread awareness and sensitised doctors and nursing officers regarding antimicrobial resistance and asepsis through lectures, group discussions and workshops. We initiated SSAP policy for elective major surgeries and formed an antimicrobial stewardship team to ensure adherence to policy and follow processes and outcomes. The point of care quality improvement (QI) methodology was used. Percentage of patients receiving SSAP out of all low-risk women undergoing elective surgery was the process indicator and percentage of patients developing surgical site infection (SSI) of all patients receiving SSAP was the outcome indicator. The impact of various interventions on these indicators was followed over time with run charts.
SSAP increased from a baseline 2.1%-67.7% within 6 months of initiation of this QI initiative and has since been sustained at 80%-90% for more than 2 years without any increase in SSI rate.
QI methods can rapidly improve the acceptance and adherence to evidence-based guidelines in a busy public healthcare setting to prevent injudicious use of antibiotics.
抗生素耐药性是一个全球性问题。抗生素的不合理使用非常普遍。指南建议对择期妇产科手术采用单剂量抗生素进行外科预防抗菌治疗（SSAP）。然而，在实践中通常无法遵循。在我们三级大容量公共卫生设施的妇产科部门，大多数接受择期大型妇科手术和剖宫产的女性接受的是治疗性抗生素（7-10 天），而不是推荐的 SSAP。我们的目标是在 6 个月内将我们设定的 SSAP 从基线的 2.1%提高到 60%以上。
在根本原因分析后，我们制定了部门抗菌药物政策，通过讲座、小组讨论和研讨会，提高医生和护理人员对抗生素耐药性和无菌操作的认识和敏感性。我们为择期大型手术制定了 SSAP 政策，并成立了抗菌药物管理团队，以确保政策的遵守以及遵循流程和结果。使用即时护理质量改进（QI）方法。接受 SSAP 的低危女性患者的比例是过程指标，接受 SSAP 的所有患者中发生手术部位感染（SSI）的比例是结果指标。随着时间的推移，使用运行图跟踪各种干预措施对这些指标的影响。
SSAP 从开始这项 QI 举措时的基线 2.1%-67.7%在 6 个月内增加，并在此后持续保持在 80%-90%以上，超过 2 年没有 SSI 率增加。
QI 方法可以在繁忙的公共医疗保健环境中迅速提高对基于证据的指南的接受度和遵循度，以防止不合理使用抗生素。
