Goldmann D A, Weinstein R A, Wenzel R P, Tablan O C, Duma R J, Gaynes R P, Schlosser J, Martone W J
Department of Medicine, Children's Hospital, Boston, Mass 02115, USA.
JAMA. 1996 Jan 17;275(3):234-40.
To provide hospital leaders with strategic goals or actions likely to have a significant impact on antimicrobial resistance, outline outcome and process measures for evaluating progress toward each goal, describe potential barriers to success, and suggest countermeasures and novel improvement strategies.
A multidisciplinary group of experts was drawn from the following areas: hospital epidemiology and infection control, infectious diseases (including graduate training programs), clinical practice (including nursing, surgery, internal medicine, and pediatrics), pharmacy, administration, quality improvement, appropriateness evaluation, behavior modification, practice guideline development, medical informatics, and outcomes research. Representatives from appropriate federal agencies, the Joint Commission on Accreditation of Healthcare Organizations, and the pharmaceutical industry also participated.
Published literature, guidelines, expert opinion, and practical experience regarding efforts to improve antibiotic utilization and prevent and control the emergence and dissemination of antimicrobial-resistant microorganisms in hospitals.
Participants were divided into two quality improvement teams: one focusing on improving antimicrobial usage and the other on preventing and controlling transmission of resistant microorganisms. The teams modeled the process a hospital might use to develop and implement a strategic plan to combat antimicrobial resistance.
Ten strategic goals and related process and outcome measures were agreed on. The five strategic goals to optimize antimicrobial use were as follows: optimizing antimicrobial prophylaxis for operative procedures; optimizing choice and duration of empiric therapy; improving antimicrobial prescribing by educational and administrative means; monitoring and providing feedback regarding antibiotic resistance; and defining and implementing health care delivery system guidelines for important types of antimicrobial use. The five strategic goals to detect, report, and prevent transmission of antimicrobial resistant organisms were as follows: to develop a system to recognize and report trends in antimicrobial resistance within the institution; develop a system to rapidly detect and report resistant microorganisms in individual patients and ensure a rapid response by caregivers; increase adherence to basic infection control policies and procedures; incorporate the detection, prevention, and control of antimicrobial resistance into institutional strategic goals and provide the required resources; and develop a plan for identifying, transferring, discharging, and readmitting patients colonized with specific antimicrobial-resistant pathogens.
为医院领导提供可能对抗菌药物耐药性产生重大影响的战略目标或行动，概述评估各目标进展情况的结果和过程指标，描述成功的潜在障碍，并提出对策和新颖的改进策略。
一个多学科专家小组来自以下领域：医院流行病学与感染控制、传染病（包括研究生培训项目）、临床实践（包括护理、外科、内科和儿科）、药学、行政管理、质量改进、适宜性评估、行为改变、实践指南制定、医学信息学和结果研究。来自相关联邦机构、医疗保健组织认证联合委员会和制药行业的代表也参与其中。
关于改善抗生素使用以及预防和控制医院内抗菌药物耐药微生物的出现和传播的已发表文献、指南、专家意见和实践经验。
参与者被分为两个质量改进小组：一个专注于改善抗菌药物使用，另一个专注于预防和控制耐药微生物的传播。小组模拟了医院可能用于制定和实施对抗抗菌药物耐药性战略计划的过程。
商定了十个战略目标以及相关的过程和结果指标。优化抗菌药物使用的五个战略目标如下：优化手术操作的抗菌药物预防；优化经验性治疗的选择和持续时间；通过教育和行政手段改善抗菌药物处方；监测并提供有关抗生素耐药性的反馈；为重要类型的抗菌药物使用定义并实施医疗保健提供系统指南。检测、报告和预防抗菌药物耐药生物体传播的五个战略目标如下：建立一个系统以识别和报告机构内抗菌药物耐药性的趋势；建立一个系统以快速检测和报告个体患者中的耐药微生物，并确保医护人员迅速做出反应；提高对基本感染控制政策和程序的依从性；将抗菌药物耐药性的检测、预防和控制纳入机构战略目标并提供所需资源；制定一个计划，用于识别、转移、出院和重新收治携带特定抗菌药物耐药病原体的患者。
