手術預防性抗生素的使用時間長短與傷口

The Correlation Between the Duration of

邱彥華(ch'iu yen hua)

指導教授 ： 楊漢湶

亞洲大學/健康學院/健康管理研究所/碩士(2007年)

摘要

WHO2000 年「克服抗生素抗藥性」報告指出：全球抗生素濫用或不當使用的情形嚴重，國內每年度住院患者約為269 萬人次至299 萬人次，其使用抗生素之處方率為62%～64.6%，臨床醫療照護過程中預防性抗生素使用時間長短的合理性長期被忽視，造成醫療資 源的過度耗用，因此，推動預防性抗生素正確使用係為提升醫療品質之重要課題，但近年來手術預防性抗生素的相關研究，較缺乏手術預防性抗生素使用時間長短與手術傷口感染率相關性之研究，值得進一步瞭解與重視。目的：爲暸解參與台灣醫療品質指標計畫同一術式因 不同醫院特性使用預防性抗生素時間長短對手術傷口感染率之影響進行分析與探討。方法：本研究以2004 年至2006 年間參加台灣醫療品質指標計畫（TQIP）醫院，其提報II-a、Ⅱ-b 指標之手術預防性抗生素使用時間長短與手術傷口感染率，以冠狀動脈繞道術、腹式子宮切除術、髖關節成形術、膝關節成形術進行其相關性分析。結果：（1）多數醫院皆於手術劃刀前1 小時內使用預防性抗生素（2）術後傷口感染率不因手術預防性抗生素使用時機而有所影響（3）各不同特性醫院在台灣醫療品質指標計畫指標數據接近合理閾值之比率皆有提高的趨勢。討論：適當的預防性抗生素使用可提升醫療品質。其指標監測成效，涉及醫院對預防性抗生素使用流程之組織行為改變，與臨床醫師對預防性抗生素處方行為之改變。TQIP 提供具實證基礎之自發性預防性抗生素使用監測機制，並提供國內、外醫院預防性抗生素使用標竿學習機會，促進醫療品質之改善。本研究建議醫院應持續監測預防性抗生素使用時機和使用期間，並同時監測手術傷口感染率，以營造促成改變之標竿學習環境；有關單位和主管機關應重視各項手術預防性抗生素使用成效，並訂定相關指引及管理規範。

關鍵字

台灣醫療品質指標計畫、預防性抗生素、感染率

並列摘要

In the To Overcome Antibiotic Resistance report, 2000, WHO pointed out that the misuse and abuse of antibiotic throughout the world is severe. There are around 2.69 million to 2.99 million hospitalized patients per year, and 62% to 64.6% of which were prescribed antibiotics.
The duration of the antibiotic prophylaxis application in clinical medical care has long been neglected, which also causes the exploitation of the medical resources. Therefore, promoting the responsible usage of antibiotic prophylaxis has become an important task in elevating the quality of medical services. Nonetheless, there isn’t much research with regards to the correlation between the infection rate and the duration of antibiotic prophylaxis application. Hence, it deserves our further attention and studies.
Objective:
In order to understand the influence of the duration of the antibiotic prophylaxis application on the infection rate in different participating hospitals from the Taiwan Quality Indicator Project (TQIP), through series of analysis and research.
Method:
In this thesis, the infection rates marked II-a and II-b in surgeries such as coronary bypass operation, abdominal hysterectomy, hip arthroplasty, and knee arthroplasty are analyzed in TQIP participating hospitals from 2004 through 2006.
Result:
1) Most hospitals apply antibiotic prophylaxis an hour before the surgery.
2) The post-surgery infection rate does not fluctuate due to the timing of the antibiotic prophylaxis.
3) Hospitals in different categories have all come close to the reasonable TQIP threshold.
Discussion:
Appropriate usage of antibiotic prophylaxis can advance the quality of medical service. The effectiveness of monitoring infection rate index refines the hospital’s organizational behavior, and improves the doctor’s conduct in prescription. In order to promote the quality of medical services, TQIP offers not only a monitoring mechanism which is based on practical foundation, but also a standard for domestic hospitals and foreign ones alike. It is recommended that the hospitals keep monitoring the timing and duration of antibiotic prophylaxis, as well as the infection rate; all related agencies and government authorities should focus on the effectiveness of the antibiotic prophylaxis, and establish a thorough guideline and protocol.

並列關鍵字

word:Taiwan Quality Indicator Project (TQIP).antibiotic prophylaxis.

參考文獻

23、 財團法人醫院評鑑暨醫療品質策進會（ 2007 ）：http://www.tjcha.org.tw.

22、 蘇喜(1996)：醫院評鑑評量指標及分配之適切性研究。中華衛誌。15:228-248。

21、 韓揆(1994)：醫院品質及門診服務品質定量指標。中華衛誌。13（4）:35-53。

19、 蔡素玲（2005）：手術預防性抗生素品質指標監測成效評估–以開腹式子宮切除術為例。台灣大學高階公共管理組碩士論文。

13、 張峰義（2003）：探討外科手術預防性抗生素使用長短與術後傷口感染之關係。合記圖書出版社：167-79。