抽痰設備與亞急性呼吸照護病房醫療照護相關感染相關性初探

Analysis of the association between suction equipment disinfection and healthcare-associated infection in respiratory care units: An experience from a medical center in central Taiwan

抽痰設備壓力表抽吸控制開關因臨床高度接觸及清消問題，常有致病菌移生的風險，在中部某醫學中心針對全院抽痰設備壓力表抽吸控制開關以腺苷三磷酸（ATP）及微生物培養進行調查。第一次全院ATP檢測合格率46％，合格率較低的是第一及第二亞急性呼吸照護病房（RCC1及RCC2），ATP檢測合格率分別為28％及29％。發現合格率低的原因是洗手時機不正確及清潔消毒易被忽略，因此在兩個RCC宣導正確抽痰技術洗手時機，另外將RCC1的清消頻次由每日清消增加至每次使用完後清消，RCC2仍維持每日清消。第二次採檢，ATP檢測合格率RCC1為10％、RCC2為40％，探究原因發現正確的抽痰技術洗手時機仍不易掌握，因此拍攝標準抽痰技術洗手時機的影片進行臨床人員的教育，並為了增加清潔消毒的方便性，導入PDI清潔消毒濕巾。第三次採檢，ATP檢測合格率RCC1為80％、RCC2為50％，RCC1已明顯改善（p＝0.006）。在RCC1的ATP合格率改善後，平均感染密度也由第一期的8.8‰，下降至第三期的2.9‰（P trend＝0.003）。本實驗探討了抽痰設備壓力表抽吸控制開關在醫療照護相關感染所扮演的角色，感染管制策略首重正確抽痰技術洗手時機以降低移生率，其次增加環境的擦拭頻率以及使用便利的清消工具。維持醫療環境的清潔是改善醫療照護相關感染的重要議題，尤其針對許多臨床易汙染的區域更需加強管理。

Life-threatening pathogens are frequently isolated from switches of suction facilities. We used an adenosine triphosphate (ATP) bacterial detection meter to analyze samples obtained from surfaces of switches to evaluate the efficacy of cleaning. The baseline qualification rate of cleaning was 46%. We observed lower qualification rates for respiratory care centers RCC1 and RCC2 (28% and 29%, respectively). The promotion of environmental cleaning, hand hygiene, improved suction techniques, and higher frequency of environmental cleaning (cleaning after each suction in RCC1; daily cleaning in RCC2) resulted in the qualification rate of 10% and 40% in RCC1 and RCC2, respectively. Hence, we introduced PDI to increase the convenience of cleaning. The frequency of cleaning remained the same for these two wards. Consequently, the qualification rate of cleaning in RCC1 significantly improved to 80% (p = 0.006), whereas that in RCC2 improved to 50%. The infection density in RCC1 decreased from 8.8 in period 1 to 2.9 in period 3 (p = 0.003 for trend test). Thus, nosocomial infection density may positively correlate with the extent of environmental disinfection. To maintain clean environment around patients, it is imperative to enforce correct suction techniques, increase the frequency of environmental disinfection, use convenient cleaning methods, and follow proper hand hygiene. It is critical to clean hospital environment to decrease the incidence of nosocomial infections.