手術室刷手台消毒液設備管理之改善專案

Project of Improving Surgical Hand Antisepsis in Operating Room

長久以來強調手部衛生是防範院內感染最重要的基石，因此大都著重在醫療人員對洗手遵從性及增設洗手設施，但卻少提到手術中每日例行性需執行的刷手作業是否有潛伏危機，引發本專案改善動機。經由安排在職教育課程、增修訂刷手台標準作業規範、刷手台設備改善措施，包括消毒液管路檢討、增設改良式消毒溶液瓶蓋及建立定期稽核機制。刷手台設備採樣檢驗革蘭氏陰性桿菌陽性率由36.4%與40%降至0%。藉由發掘刷手台消毒液更換問題進一步策略改善，建立一套手術室刷手台消毒液設備管理機制，讓醫護人員在完善安全的醫療環境中執行各項醫療業務。建議單位中各項業務雖屬常規性作業模式，仍需察覺相關流程有何疏失並進一步求證，以保障醫療照護品質。

Putting emphasis on hand hygiene has been the most important cornerstone to prevent nosocomial infection for a long time. Most hospitals focus on staff hand washing compliance and the increase of hand washing facilities. However, few of them addressed the existing crisis behind daily routine operation scrubbing assignment. The project included an education training programs and a modification of scrubbing operating standards and reconstruction of scrubbing devices, including examination of the infusion tube, use of new disinfectant solution caps, and a regular evaluation mechanism The positive rate of gram-negative bacilli sampled from the scrubbing device dropped from 36.4-40 % to 0% after this project. By further improving the strategy through problem finding, a new management system of the scrubbing disinfectant solution was established so that staff could operate in a safe environment. Even regular daily routine can be improved through observation to ensure the quality of care.