提升麻醉喉頭鏡葉片高層次消毒正確率專案

A Program to Enhance the Correctness of the High-level Sterilization for the Laryngoscope Blades Used in Clinical Anesthesia

10.6386/CGN.201903_30(1).0005

李曉菁(Hsiao-Ching Li)；蔡安琪(An-Chi Tsai)；葉秋嬅(Chiu-Hua Yeh)；余怡珍(I-Chen Yu)

喉頭鏡 ； 高層次消毒 ； laryngoscope blades cross-infection ； high-level sterilization

長庚護理

30卷1期（2019 / 03 / 01）

52 - 65

繁體中文

喉頭鏡葉片為臨床麻醉科重覆使用的物品，文獻提及消毒不正確易造成病患間交叉感染及插管時將病原菌帶入肺部的風險；基於醫院感染「零容忍」的需求，引發執行本專案改善的動機。經調查後發現，本科對於喉頭鏡葉片高層次消毒觀念及步驟仍有改善之處，現況分析後，發現問題為：（1）未制定喉頭鏡葉片消毒規範；（2）缺乏高層次消毒專業知識；（3）無明確查核制度；（4）環境設備不足。因此本專案目的旨在提升喉頭鏡葉片高層次消毒正確率。故針對現有問題擬定改善措施：（1）建立喉頭鏡葉片消毒標準規範；（2）安排教育訓練；（3）建立標準化查核機制；（4）改善消毒環境與設備。經由改善專案實施後，本院之喉頭鏡葉片高層次消毒正確率由31.3%提高至100%，護理人員對高層次消毒的認知正確率由33.3%提升至98.3%，專案改善成效可避免病患間交叉感染的機會及保障病患的就醫安全，同時也提升臨床護理人員感染控制的專業知識技能，進而確保醫療照護品質。

The laryngoscope blade is recycling equipment in clinical anesthesia practice. The literature review indicated that if sterilization of laryngoscope were incomplete it would result in cross-infection among patients, and increases the risk of pulmonary infection during tracheal intubation. Based on the hospital policy of ‘infection zero tolerance', we motivated to implement this improvement project. Through investigation and analysis the situation, the high-level sterilization for laryngoscope blades were incorrect in anesthesia department. And problems were: 1. wouldn't set up procedure of the sterilization, 2. lack of knowledge of the high-level sterilization, 3. there is no check mechanism, 4. equipment are not available adequately. The aims of the improvement project were increased the accuracy of the high-level sterilization for laryngoscope blades. There were including: 1. establishment of standards regulation, 2. educated the staffs in knowledge, 3. establishment of the standardized check-out system, 4. improvement of sterilization the equipment. The improvement project effectively improve the high-level sterilization of laryngoscope blade in the correct rate to increase from 31.3% to 100% elevated and the acknowledge of the high-level sterilization in our nurses staff of the correct rate to increase from 33.3% to 98.3% elevated in order to avoid cross-infection between patients and to ensure medical safety. But also enhance the clinical nursing staff infection control of professional knowledge and skills, and thus to ensure the quality of medical care.

1. 趙婉青、王美華、陳淑芬(2009)。探討台北縣診所護理人員繼續教育需求及課程規劃之期望。亞東學報，29，277-284。
   連結：
2. Joint Commission on Accreditation of Healthcare Organizations. (2017). 2017 National Patient Safety Goals. https://www.jointcommission.org/assets/1/6/NPSG_Chapter_HAP_Jan2017.pdf
3. Negri de Sousa, A. C.,Levy, C. E.,Freitas, M. I. P.(2013).Laryngoscope blades and handles as sources of cross-infection: an integrative review.The Journal of Hospital Infection,83(4),269-275.
4. Rutala, W. A.(1996).APIC guideline for Selection and use of disinfectants.1994, 1995, and 1996 APIC Guidelines Committee. Association for professionals in infection control and epidemiology, Inc..American Journal of Infection Control,24(4),313-342.
5. Stone, P. W.,Braccia, D.,Larson, E.(2005).Systematic review of economic analyses of health care-associated infections.American Journal of Infection Control,33(9),501-509.
6. Walley, S. C.,Berger, S.,Harris, Y.,Gallizzi, G.,Hayes, L.(2013).Decreasing patient identification band errors by standardizing processes.Hospital Pediatrics,3(2),108-117.
7. World Health Organization(2011).Report on the burden of health care-associated infection worldwide.
8. 王淑惠(2007)。從院內感染談病人安全與醫療照護品質。重症醫學雜誌，8(4)，166-174。
9. 朱芳儀(2011)。標準化在醫療產業的應用。亞東品質季刊，3(4)，10-13。
10. 李昭代、余文良、王嘉裕、池麗寬、嚴淑卿、王淑貞、張文翰(2013)。某區域醫院鼻咽鏡Serratia marcescens 污染事件之調查處理。感控雜誌，23，257-67。
11. 邱月璧、廖美南(2011)。從醫院的角度看護理人員在感染控制的角色與功能。護理雜誌，58(4)，16-20。
12. 洪秀蓉、張玉貞、、凌美貝(2004)。某健檢中心內視鏡使用戊二醛防護措施之改善專案。護理雜誌，51(4)，53-58。
13. 張瑛瑛(2015)。器械滅菌之感染管制措施。醫療品質雜誌，9(1)，68-71。
14. 葉秀貞修訂(2011)。實用基本護理學上冊。台北=Taipei City, Taiwan, ROC:華杏=Farseeing。
15. 詹明錦、邱勝康、彭明業(2008)。院內感染成本支出。感控雜誌，18(4)，240-245。
16. 趙雪嵐(2015)。喉鏡葉片和手柄交叉感染源：綜合回顧。感控雜誌，25(3)，144-145。
17. 衛生福利部(2015)‧105-106 年度醫院病人安全工作目標及執行策略‧取自：http://www.patientsafety.mohw.gov.tw/Content/zMessagess/contents.aspx?&SiteID=1&MmmID=621273300317401756&MSID=655635445640513543[Ministry of Health and Welfare. (2015). 105-106 annual on hospital medical quality and patient safety target retrieved from : http://www.patientsafety.mohw.gov.tw/Content/zMessagess/contents.aspx?&SiteID=1&MmmID=621273300317401756&MSID=655635445640513543]
18. 衛生福利部疾病管制署(2013)‧侵入性醫療管制作業基準‧取自：http://www.cdc.gov.tw/uploads/files/ad4490ad-b5bd-40bd-8491-e465f2e144e1.pdf[Centers for Disease Control, D.O.C. (Taiwan) (2013). Invasive medical treatment control for operating standards retrieved from: http://www.cdc.gov.tw/uploads/files/ad4490ad-b5bd-40bd-8491-e465f2e144e1.pdf]
19. 賴雅惠、丁淑美、張鳳儀(2010)。提升急救車喉頭鏡葉高層次消毒完成率之專案。志為護理，9(3)，111-119。
20. 顏旭亨、陳淑惠、黃美麗、林麗珍(2012)。內視鏡高層次消毒液之使用及管理。感控雜誌，22(4)，163-169。