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目的：探讨行政干预对I 类切口围术期预防性使用抗菌药物的影响。方法：2011 年4 月～6 月对全院手术科室进行行政干预，具体做法：卫生行政部门与医院一把手、医院与手术科室主任、科室主任与科室执业医生分别签订目标责任状；医院配合全国抗菌药物临床应用专项整治活动方案进行全员培训，并对医师进行抗菌药物临床应用培训并考核合格后，授予其相应级别的抗菌药物处方权，明确各级医师使用抗菌药物的处方权限；由医务科牵头与院感染科、药剂科、质控科联合对I 类切口手术患者预防使用抗菌药物情况进行检查，定期实施目标奖罚，责任到科室主任和临床医生。然后抽取我院2010 年7 月～12 月（行政干预前）和2011 年7 月～12 月（行政干预后）I 类切口手术病历各210 份，参考《抗菌药物临床应用指导原则》、卫办医政发[2009]38 号通知对420 例I 类切口手术患者预防使用抗菌药物情况进行回顾性分析。结果：行政干预前（2010 年7 月～12 月）I 类切口围手术期预防性抗菌药物的使用率达83.81%(176/210)，术后抗菌药物使用时间在2～7 天者占69.52%，大于7 天者占6.67%；行政干预后（2011 年7 月～12 月）210 例患者预防使用抗菌药物使用率为30%(63/210)，显著低于未使用行政干预的Ⅰ类切口术患者（P<0. 05），围术期术后抗菌药物使用时间在2～7 天者占16.67%，没有1 例患者用药超过7 天，抗菌药物的使用时间较未使用行政干预的Ⅰ类切口术患者显著缩短（P<0.05）。结论：有效的行政干预可以强化临床医生合理应用抗菌药物的意识，提高合理用药的水平，明显降低I 类切口预防性抗菌药物的使用率，缩短抗菌药物的使用疗程。

英文摘要:

Objective: To investigate the effect of administrative intervention on prophylactic antibiotic therapy during perioperative period for typeⅠincision operations. Methods: Departments of surgery in our hospital were given administrative intervention from April to June in 2011. The specific approach was to sign the contracts between the public health administration and hospital president, hospital and directors of surgical departments, directors of surgical departments and doctors, respectively. All the doctors were trained with national action plan for the rectifying campaign on clinical application of antibiotics. Doctors who passed the training were awarded with corresponding levels of prescription privileges for antibiotics. The application of prophylactic antibiotic therapy during perioperative period for typeⅠincision operations were examined by the department of hospital infection, department of pharmacy, department of quality control under the leadership of medical department, and periodic goal awards were conducted. Then 210 cases from July to December 2010 (before administrative intervention ) and 210 cases from July to December 2011 (after administrative intervention) were randomly selected, and the applications of prophylactic antibiotic therapy during perioperative period for typeⅠincision operations were retrospectively analyzed according to "Guiding principles for clinical application of antibacterial" and announcement No.[2009]38 by Guardian Office of Medical Administration. Results: Before administrative interference, the rate of prophylactic antibiotic therapy usage during perioperative period for typeⅠincision operations was 83.81%(176/210), and 69.52% patients received 2-7 days of antibiotic treatment postoperation and about 6.67% patients received more than 7 days of antibiotic treatment postoperation. While after administrative interference, the rate of prophylactic antibiotic therapy usage during perioperative period for type Ⅰincision operations was 30%(63/210), which was significantly lower than the patients without administrative intervention(P<0.05). 16.67% patients received 2-7 days of antibiotic treatment postoperation and no patient received more than 7 days of antibiotic treatment postoperation. The treatment duration wasmarkedly shortened than the patients without administrative intervention (P<0.05). Conclusion: Effective administrative intervention was able to improve the consciousness of doctors to prescribe antibiotics reasonably and the level of the rational prescription, significantly reduce the rate of prophylactic antibiotic therapy usage during perioperative period for type Ⅰincision operations, as well as shorten the treatment course of antibiotics.

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