探討北部某醫學中心心臟內科加護病房執行病室終期清潔之效果

The Effects of Terminal Room Clean Rate in Intensive Care Units

醫療機構的環境清潔是提供安全照護的要素，亦與感染有密切的相關。本加護病房2011年總感染率為16.3‰較醫學中心加護病房9.4‰為高，於2012年抽查本單位清潔服務員在執行三間病室終期之清潔率為39.7%，較Carling等（2006）的研究結果47%為低，經現況分析發現原因為：執行環境清潔標準不一致、未規範環境清潔之項目及順序、缺乏對清潔服務員之監測機制。本專案結果在於提升加護病房清潔服務員病室終期清潔率由39.7%提升為85%。其解決方案為專案小組經由擬定清潔服務員教育訓練、病室設備之清潔標準化及監測機制，並以生物發光法做為清潔成效之客觀指標。2012年2月至12月共執行及監測21間病室之終期清潔，清潔率由39.7%提升為86.1%，單位之總感染率由16.3‰降至6.1‰。環境的清潔為降低加護病房感染最經濟的方法，本專案之成效及所訂定之策略可做為加護單位推廣之參考。

Sanitation of medical institutions is an important element of safe health care; providing a clean environment also affects health care infection rates. The 2011 healthcare-associated infection rate was higher in our intensive care unit (ICU) than the average rate among medical centers in Taiwan (16.3% vs. 9.4%). In 2012, we found that the terminal three-room clean rate by cleaners was 39.7%, significantly lower than the 47% rate reported in a study by Carling. Our investigation found that inconsistent sanitation standards, lack of cleaning protocol and priority, and no monitoring of cleaner efficiency to be the most likely explanations for the low clean rate. We designed a project to increase the clean rate from 39.7% to 85% among cleaners in the ICU. We developed education and training programs for cleaners and established cleaning standards for apparatus and equipment. We also used bioluminescence methods to evaluate cleaning effectiveness in an effort to decrease healthcare-associated infection rates. After implementation of this project from February to December 2012, we monitored 21 terminal clean rooms and found the clean rate had improved from 39.7% to 86.1%. The infection rate also decreased from 16.3% to 6.1%. Environment sanitary management in ICUs is an economical and reliable method to reduce the healthcare-associated infection rates and should be promoted as daily practice in ICUs.