Assessing the antimicrobial prescription request process in a teaching hospital in Brazil: Regulations and training

It is kmown that antimicrobials are often prescribed inappropriately. One method used to deal with problem is to regulate antimicrobial use by monitoring prescriptions. We report a study of physician compliance with the request for antibiotic process which was prepared and reviewed by a special infection control committee in our hospital - the Nosocomial Infection Prevention Service (SCHI). The objective of this study was to identify the profile of inappropriate requests for restricted therapeutic antimicrobials used at Nossa Senhora da Conceiçäo (HNSC), in Porto Alegre, Brazil. All 3,389 requests for therapeutic antimicrobials made between May 20, and October 31, 1996, were assesed ans classified as appropriate and inappropriate. We determined that 17.8 percent of the requests were innapropriate (a total of 720 errors). These were categorized according to 12 reasons for inappropriateness. Of these, the 3 most frequent inappropriate requests were deviation from standard use (26.73 percent), inappropriate length of treatment (23.19 percent), and unfounded justification (13.61 percent). The reasons for inappropriateness were also arranged in three categories considering the following aspects:I.technical (59 percent);II.compability with the institucional program (32.36 percent), and III.administrative (8.61 percent). The 720 requests that were initially rejected were evaluated to see how antibiotic use was affected. In approximately 400 (55 percent), the forms could be appropriately modified after discussion with physician. We conclude from this study that most of the inappropriate requests for antimicrobials in our hospital can be remedied by educating the staff since the errors were largely technical in nature. Thus, the SCIH should focus more on its role as an educational rather than as a regulatory body. By expanding this educational role, we antecipate improved physician compliance with our guidelines, and more appropriate antimicrobial prescribing and and usage.

Incidência dos marcadores virais para a hepatite B e resposta a vacinaçäo em uma unidade de hemodiálise / Prevalence of viral markers for hepatitis B and response to vaccination in a hemodialysis init

O presente estudo avalia, em uma unidade de hemodiálise, a prevalência dos marcadores virais da hepatite pelo virus B e a taxa de seroconversäo após vacinaçäo. Para tanto, foram avaliados 397 pacientes. Em todos foi determinado o HBsAg e em 201 também foi realizado o anti-HBs, o anti-HBc IgG e o anti-HBc IgM.Sessenta e quatro pacientes sem marcadores virais, foram imunizados com vacina recombinante. A presença de algum marcador viral foi obsevada em 68,5 por cento dos casos, sendo que em 14,1 por cento o HBsAg foi positivo. Por outro lado, a taxa global de seroconversäo, após vacina, foi de 58 por cento. Conclui-se ser elevada a prevalência de marcadores do virus da hepatite B em pacientes hemodialisados, bem como ser baixa, nesta populaçäo de pacientes, a taxa de seroconvbersäo após vacinaçäo