某健檢中心內視鏡室使用戊二醛防護措施之改善專案

Strategies to Improve Protection From Glutaraldehyde in Endoscopic Examination

近年來政府及各大醫療院所積極推動「工作環境安全」重要性，期盼提供病患及醫護人員安全的醫療環境；戊二醛屬高揮發性製劑具辛辣刺激味，長時間在密閉不通風的消毒環境中，已造成人員產生身體不適症狀，經分析其主要原因為：（一）護理人員對戊二醛認知不足。（二）戊二醛用量大，加重空氣濃度。（三）環境設備使用不當。（四）自我防護措施不足。經由改善方案：加強護理人員對戊二醛的在職訓練，並且減少戊二醛的使用量，宣導環境設備的正確使用方法，及拆除絨毛地毯，並加強安全防護用具使用。經改善後，護理人員在職訓練，評值結果率達100%，滿意度達97%；每個月戊二醛用量減少為150L；空氣濃度檢測值下降0.0054ppm；護理人員不適自覺率，也由80%至100%降到10%；身體防護率由10%至30%提昇到100%。

Safety of the working environment has emerged as an important issue in recent years. Of safe work place is a prerequisite for the practice of medicine. High level disinfection by glutaraldehyde (GAD) is the usual method for sterilizing endoscopes. But GAD is highly volatile and is an irritant. Prolonged exposure to GAD in a closed unit usually causes discomfort. Our study demonstrated that the main veasons for this are: (1) nursing staff are not sufficiently familiar with GAD, (2) high GAD concentration in the air, (3) insufficient training to use the facilities and disinfectant, (4) lack of safety precautions due to large amount of GAD in examination room. In order to diminish the dangers of unavoidable exposure, the following strategies are recommended: intensify training for the handling of GAD, decrease the amount of GAD, encourage the use of individual precautions and remove fuzzy carpets, and use appropriate disinfection facilities. Many improvements can be achieved with the introduction of these measures as, this article shows. These improvements include: (1) a 100% response rate and a 97% satisfaction rate from trainees, (2) a total reduction of 150 liters of GAD per month with atmospheric GAD markedly reduced, to 0.0054 ppm, (3) reduction in reported discomforts from between 80% and 100% to 10%, (4) a protection rate of 100% compared to the previous 10% - 30%.