過程導向和結果導向目測法在醫院環境清潔確效之比較

Comparison of the Process-oriented Assessment and Outcome-oriented Visual Assessment of Hospital Cleanliness

為比較過程導向評估法和結果導向目測法使用於研究醫院的差異性，以及和ATP生物冷光反應檢測結果的相關性，從2016年9月至2017年12月期間，於中部某醫學中心的特殊病房為研究場所，包括成人重症加護單位、負壓隔離病房、急診及整合醫學急診後送病房，針對常被接觸的環境物品，包括床欄、床頭板、床尾板等共收集588個環境表面的樣本，發現清潔過程合格率和ATP檢測合格率僅有極低吻合度（κ＝0.174）；目測結果為清潔的比率和ATP檢測結果不一致（κ＝-0.011）；有確實擦拭清潔和和目測結果為清潔的結果不一致（p＞0.05）。醫療儀器的擦拭比例較低，包括抽痰器、點滴幫浦、監視器及氧氣流量表，其中點滴幫浦、監視器和抽痰器在ATP檢測結果合格率也是最低。各項環境物品目測清潔比例都達九成以上，顯見目測結果高估環境表面的清潔度。因此建議在低感染風險的環境或公共區域，可以結果導向目測法進行清潔確效，在高感染風險的環境則以過程導向目測法搭配ATP檢測方法來確認環境的清潔度。

This study compared the results of the process-oriented assessment and outcome-oriented visual assessment of environment cleanliness, tested using ATP [A3]bioluminescence in a medical center. For this purpose, 588 surfaces in patients' surroundings that were touched very frequently in adult intensive care units, airborne infection isolation rooms, emergency rooms, and emergency backwards were sampled from September to December of 2014. There was slight agreement between the results of the process-oriented assessment and ATP bioluminescence (κ= 0.174). There was no agreement between the results of outcome-oriented visual assessment and ATP bioluminescence (κ= -0.011). The results of the processoriented assessment and outcome-oriented visual assessment were inconsistent with each other (p > 0.05). Medical devices whose surfaces were not cleaned frequently included suction machines, infusion pumps, EKG monitors, and oxygen flowmeters. The pass rates of the ATP bioluminescence of suction machines, infusion pumps, and EKG monitors were lower than those for the other surfaces. The pass rates of the outcome-oriented visual assessment for all surfaces were higher than 90%, and were clearly overestimated. Therefore, we recommend that healthcare facilities evaluate cleanliness by using outcome-oriented visual assessments in low risk environments; however, in high risk environments, we recommend using processoriented visual assessments combined with ATP bioluminescence.