School of Medicine and Health Management, Tongji Medical College of Huazhong University of Science and Technology, Wuhan, 430030, Hubei, China.
School of Nursing, Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR.
BMC Health Serv Res. 2023 Mar 25;23(1):283. doi: 10.1186/s12913-023-09243-8.
The results of laboratory testing are crucial basis for clinicians to prescribe antimicrobial. Laboratory testing is a highly complex process, and increasing evidence suggests that errors and obstacles in the pre-analytical process (PP) will affect reasonable antimicrobial use. However, PP was an easily neglected link in hospital infection management and the current situation of it and the influencing factors of management are not clear.
A cross-sectional survey was conducted in the department of clinical, specimen collection, transportation, and inspection in 109 secondary and tertiary hospitals in Central China. The rate of antimicrobial susceptibility test request (AST) and related indexes of above departments were calculated to describe the situation. Management characteristics (frequency of training etc.) were described as proportions and fractional probit regression analysis was used to determine the influencing factors.
The average rate of non restricted-use antimicrobial was 63%, the restricted-use was 86%, the special-use was 95%. The zero obstacle rate of specimen collection was 27.3%, of specimen transportation was 19.4% and of inspection feedback was 61.7%. There was a difference between the secondary and tertiary hospitals on non restricted-use (X = 22.968, P < 0.001); restricted-use (X = 29.466, P < 0.001); special-use (X = 27.317, P < 0.001). Taking non restricted-use as an example, training (OR = 0.312, 95%CI: 0.148,0.429), low-frequency appraisal (OR = 0.153, 95%CI: 0.082,0.224), guidance (OR = 0.32, 95%CI: 0.237,0.403) and information technology (OR = 0.104, 95%CI: 0.009,0.199) were positive factors.
There were substantial differences in the rate of AST request in clinical department between secondary and tertiary hospitals. The zero obstacle rate in collection, transportation and inspection department were still low. In most departments, training and performance appraisal were positive factors, guidance and information technology were positive supporting factors.
实验室检测结果是临床医生开具抗菌药物的重要依据。实验室检测是一个高度复杂的过程，越来越多的证据表明，分析前过程（PP）中的错误和障碍会影响合理使用抗菌药物。然而，PP 是医院感染管理中容易被忽视的环节，目前其现状及管理的影响因素尚不清楚。
采用横断面调查方法，对华中地区 109 家二级和三级医院的临床科室、标本采集、运输和检验部门进行调查。计算各科室抗菌药物敏感性试验申请（AST）率及相关指标，描述现状。以培训频率等管理特征为例，描述比例，并采用分数概率回归分析确定影响因素。
非限制使用抗菌药物的平均使用率为 63%，限制使用抗菌药物的使用率为 86%，特殊使用抗菌药物的使用率为 95%。标本采集零障碍率为 27.3%，标本运输零障碍率为 19.4%，检验反馈零障碍率为 61.7%。二级和三级医院在非限制使用（X²=22.968，P<0.001）、限制使用（X²=29.466，P<0.001）、特殊使用（X²=27.317，P<0.001）方面存在差异。以非限制使用为例，培训（OR=0.312，95%CI：0.148，0.429）、低频率评估（OR=0.153，95%CI：0.082，0.224）、指导（OR=0.32，95%CI：0.237，0.403）和信息技术（OR=0.104，95%CI：0.009，0.199）是正相关因素。
临床科室 AST 请求率在二级和三级医院之间存在较大差异。采集、运输和检验部门的零障碍率仍较低。在大多数科室，培训和绩效考核是正相关因素，指导和信息技术是正相关的支持因素。
