急诊科抗菌药物耐药性控制：需要具体改进。
Antimicrobial resistance control in the emergency department: a need for concrete improvement.
机构信息
Florence-Nightingale-Hospital, Kaiserswerther Diakonie, Department of Emergency Medicine, Düsseldorf, Germany.
German Association for Emergency Medicine, (Deutsche Gesellschaft Interdisziplinäre Notfall- und Akutmedizin e.V., DGINA), Berlin, Germany.
出版信息
Antimicrob Resist Infect Control. 2022 Jul 8;11(1):94. doi: 10.1186/s13756-022-01135-6.
BACKGROUND
Rational use of antibiotics (AB) and infection prevention and control (IPC) are key measures for reducing antimicrobial resistance (AMR) in healthcare. Nonetheless, transferring evidence into clinical practice in emergency medicine has proven difficult. The extent to which structural requirements for implementing AMR control exist in German emergency departments (ED) was determined in a survey.
METHODS
Aspects of antimicrobial stewardship (AMS) and IPC implementation were surveyed within the German Association for Emergency Medicine (Deutsche Gesellschaft interdisziplinäre Notfall- und Akutmedizin e.V, DGINA) in 2018. Data were collected using an anonymous online questionnaire on ED characteristics, ED-based-link personnel for IPC and AMS, education and training, process monitoring and specific requirements for AMS and IPC as availability of AMR data and alcohol-based hand rub (AHR) consumption data. Data were analysed descriptively.
RESULTS
66 EDs with in median [interquartile range (IQR)] of 30,900 [23,000; 40,000] patient visits participated in the survey. EDs' healthcare worker (HCW) received regular training on hand hygiene (HH) in 67% and on AMS in 20% of EDs. Surveillance of AHR consumption was performed by 73% EDs, surveillance of AB consumption by 64%. Regular audits on HH were performed in 39%. Training and audit activities, showed no significant variations according to EDs' organizational characteristics. HCWs received immediate feedback of HH performance in 29%, in 23% a regular structured feedback of HH was provided. ED-based physicians with (1) specific IPC responsibilities and training were available in 61%, with (2) AMS training and responsibility in 15%. 83% had ED based IPC link nurses with precise ICP responsibilities in place. Essentially resistance data existed at the hospital level (74%) rather than at ED- or regional level (15% and 14% respectively).
CONCLUSIONS
Management of AMR varies in German EDs, especially in accordance to hospital size and level of emergency care. IPC seems to receive more attention than AMS. Our data indicate the need for more implementation of regular IPC and AMS training in connection with monitoring and feedback in German EDs.
背景
合理使用抗生素（AB）和感染预防与控制（IPC）是减少医疗保健中抗微生物药物耐药性（AMR）的关键措施。然而，将证据转化为急诊医学中的临床实践已被证明具有挑战性。本研究通过调查确定了德国急诊科（ED）实施 AMR 控制的结构要求的程度。
方法
2018 年，德国急诊医学协会（Deutsche Gesellschaft interdisziplinäre Notfall- und Akutmedizin e.V，DGINA）对抗菌药物管理（AMS）和 IPC 实施情况进行了调查。使用匿名在线问卷收集 ED 特征、ED 中负责 IPC 和 AMS 的人员、教育和培训、流程监测以及 AMS 和 IPC 的具体要求的数据，具体要求包括 AMR 数据和酒精基手消毒剂（AHR）消耗数据的可用性。数据采用描述性统计分析。
结果
共有 66 家 ED 参与了调查，中位数（IQR）为 30900 [23000；40000] 名患者就诊。67%的 ED 医护人员定期接受手卫生（HH）培训，20%的 ED 医护人员接受 AMS 培训。73%的 ED 监测 AHR 消耗，64%的 ED 监测 AB 消耗。39%的 ED 定期进行 HH 审核。培训和审核活动并未因 ED 的组织特征而存在显著差异。29%的 ED 医护人员能即时获得 HH 表现的反馈，23%的 ED 医护人员定期接受 HH 表现的结构化反馈。61%的 ED 配备有（1）特定 IPC 职责和培训的 ED 医生，15%的 ED 配备有（2）AMS 培训和职责的 ED 医生。83%的 ED 配备有 ED 基础 IPC 联络护士，具有明确的 ICP 职责。基本上，耐药数据仅存在于医院层面（74%），而不是 ED 或地区层面（分别为 15%和 14%）。
结论
德国 ED 对抗微生物药物耐药性的管理存在差异，尤其是根据医院规模和急诊护理水平的不同而存在差异。IPC 似乎比 AMS 更受关注。我们的数据表明，德国 ED 应更频繁地开展 IPC 和 AMS 培训，同时进行监测和反馈。
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