內科病房MDROs病室清潔改善方案

Medical Ward's MDROs Cleaning Improvement Program

10.29494/LN.201903_20(1).0009

吳秀英(Hsiu-Ying Wu)；湯培欣(Pei-Hsin Tang)；陳素里(Shu-Li Chen)

多重抗藥性微生物 ； 病室清潔 ； 院內感染 ； Multi-Drug Resistant Organisms ； ward's cleaning ； nosocomial infection

領導護理

20卷1期（2019 / 03 / 01）

124 - 140

繁體中文

本專案旨在提升內科病房多重抗藥性微生物（MDROs）病室清潔完整率，調查發現全院MDROs病室清潔完整率僅50.4%，醫院是抗藥性菌種傳播的大本營，深恐內科病房清潔不完整造成院內感染群突發，引發積極改善之動機。確立主要問題為：MDROs病室清潔之作業規範不周詳、清潔人員MDROs病室清潔知能不足、MDROs清潔相關硬體設備不完善、欠缺稽核制度等，經改善對策：修訂感控清潔作業規範及合約、拍攝本院清潔人員專用MDROs病室清潔教學影片製作教育訓練教材、舉辦清潔人員MDROs病室清潔教育訓練並培訓清潔種子教官、增修環境設備（清潔工作車定位及建置專屬清潔設備空間）、定期稽核。內科病房清潔人員MDROs清潔認知正確率由40.3%升至93.1%，內科病房MDROs病室清潔完整率由34.7%升至96.9%，改善期間未發生院內感染群突發。本專案印證清潔人員知能深深影響環境清潔成效，教育訓練與稽核是管理重點。

This project aims to improve the medical ward's completion rate of MDROs cleanse. According to investigations, the completion rate of ward's MDROs cleanliness is merely 50.4% in the whole hospital. The hospitals are the hotbed for multi-drug resistance organism. Therefore, in order to prevent nosocomial cluster infection, to improve relevant quality is essential. The possible fundamental causes could be: MDROs ward cleansing related regulations are not completed; the cleaning faculties for MDROs ward cleansing are not competent; MDROs cleaning facilities are not sufficient; shortage of regular supervision and so on. After management review, the following strategies for improvement was given: adjustment of rules and contract for infectious control as well as cleansing; producing relevant educational materials; holding training courses and seed instructors; augmenting environmental equipment (working vehicle positioning and provide exclusive cleaning equipment space); and periodic inspection. The cleaning faculty's comprehensive rate has hence elevated from 40.3% to 93.1%, medical ward's MDROs cleaning completion rate raises from 34.7% to 96.9%, no more episodes of nosocomial infection occurred during the improvement period. This project confirms that cleansing staff can profoundly influence the effectiveness of environmental cleanse, and educational training as well as auditing are the key points to management.

1. Jean, S. S.,Hsueh, P. R.(2011).Antimicrobial drug resistance in Taiwan.Journal of the Formosan Medical association,110(1),4-13.
2. Michael, S. L.(2010).Patient safety and quality improvement Medical errors and adverse events.Pediatrics in Review,31,151-158.
3. Plipat, N.,Spicknall, I. H.,Koopman, J. S.,Eisenberg, J. N.(2013).The dynamics of methicillin-resistant staphylococcus aureus exposure in a hospital model and the potential for environmental intervention.ВМС Infectious Diseases,13,595.
4. 李怡頡(2011)。多重抗藥性 Acinetobacter baumannii 常汙染醫護人員的手套 、 隔離衣及手。感染控制雜誌，21(3)，204-205。
5. 李聰明(2011)。多重抗藥性問題對臨床的威脅。醫療品質雜誌，5(3)，57-59。
6. 林慧姬,曾意儒,陳明源,盛望徽,陳宜君,張上淳(2013)。多重抗藥性菌株資訊自動化監測與應用。感染控制雜誌，23(6)，290-299。
7. 洪儀珍,陳美伶,田貴蓮,陳美文,黃寶華,黃雅惠,王振泰,盛望徽,陳宜君(2016)。運用不同檢測方式評估某醫學中心環境清潔成效。感控雜誌，26(3)，97-106。
8. 盛望徽(2010)。加護病房內的多重抗藥性細菌感染與控制。重症醫學雜誌，11(1)，32-36。
9. 郭富美,王復德(2013)。鮑氏不動桿菌在乾燥表面形成生物膜後的存活率。感染控制雜誌，23(5)，271-273。
10. 陳瑛瑛,王復德,蘇逸玲(2010)。鮑氏不動桿菌院內感染之相關因素探討。榮總護理，27(2)，109-117。
11. 趙伶惠,蘇麗香,湯雅芬,陳一伶,黃高彬,劉建衛(2011)。推動環境清潔策略降低多重抗藥性鮑氏不動桿菌醫療照護相關感染之成效。感染控制雜誌，21(2)，83-94。
12. 衛生福利部疾管署 ( 2015,11 月 ) . 醫療機構環境清潔感染管制措施指引 . 取自 https://www.cdc.gov.tw/professional/i nfo.aspx?treeid=beac 9c103df952c4&nowtreeid=52E2FAA B2576D7B1&tid=135C4035EJD9F6F7

1. 鄭薏吩,歐依雯,陳亞嵐,郭文英,林麗滿,丁淇平(2022)。提升一般病房病室環境終期清潔之正確率。長庚護理，33(2)，70-83。