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Systematic review of interventions on antibiotic prophylaxis in surgery in Chinese hospitals during 2000–2012
Author(s) -
Sun Jing
Publication year - 2013
Publication title -
journal of evidence‐based medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.885
H-Index - 22
ISSN - 1756-5391
DOI - 10.1111/jebm.12048
Subject(s) - psychological intervention , medicine , medline , intervention (counseling) , incentive , enforcement , christian ministry , infection control , family medicine , nursing , surgery , political science , law , microeconomics , economics
Objective To systematically review intervention studies on antibiotic prophylaxis in clean or clean‐contaminated surgery in Chinese hospitals from 2000 to 2012. Methods Published peer reviewed articles, unpublished documents and reports, and gray literature were identified through searching CNKI, CBM, VIP, PubMed (MEDLINE), WHO database, and the official websites of the Ministry of Health of China, provincial health authorities and medical university internal publications. Results Eighty‐two studies were identified. Circulation and localization of central rules, regulations and guidelines; clinical pharmacists’ involvement; technical, administrative, and managerial strategies were the mostly adopted interventions. Except one study, all claimed effectiveness of interventions. Limited effects were observed for non‐indicated clean surgery. Huge gaps still existed between the international agreed guidelines and the claimed best performance following interventions. The following were critical to have more effective interventions: recognition, acceptance, and enforcement strategies of rules, regulations, and guidelines; intervention persistence and intensity; health information system; removal of health system perverse incentives; patient–doctor relationship; public education; and access to unbiased medicines information. A total 4 of 82 studies were pre–post studies with control; all others were simple pre–post studies without control. Simple measurement of the outcome indicators as an average for pre–post intervention groups and changes in between failed to distinguish the real intervention effect from confounding factors, and failed to adjust underlying trends. Conclusions Interventions on surgical antibiotic prophylaxis in Chinese hospitals during 2000–2012 brought limited positive effects. There are still huge gaps between the Chinese situation and internationally agreed standards. More advanced study methodologies are needed to have better documentation of evidence of the most effective interventions.