提升一般病房病室環境終期清潔之正確率

To Improve the Accuracy of Terminal Disinfection for General Ward Environment

醫療環境清潔是病人安全照護重要的一環，為了避免醫療照護相關感染發生，落實正確的環境清潔是減少醫療院所內感染致病菌的有效方法之一。為了提升本院病房環境清潔作業，由護理部和跨團隊（環管課、感染管制師、清潔廠商）成立工作小組，專案期間為2019 年6 月19 日至9月26日，針對主要問題：1. 環境清潔員缺乏感染管制及醫院清潔概念2. 未正確使用工具、擦拭過程不確實及順序錯誤、未正確泡製漂白水等，經系統性改善如：修訂感染管制相關作業、制定環境清潔流程及查核、整合清潔工具分色管理作業、放置清潔順序提示卡、進行教育訓練及拍攝病室環境終期清潔影片，達到環境清潔員標準作業一致性，以符合感染管制要求，且以螢光標示檢測法做為品質監控清潔標準，經措施介入後病室環境終期清潔正確率由54.1% 提升至86.7%；病室環境終期清潔消毒潔淨度通過率由41.2% 提升至92.6%，有效提升清潔人員環境清潔成效並將標準規範列入常規作業，提供安全的病室照護環境。

The cleanliness of the medical environment is a key to safe patient care. To prevent from health careassociated infections, one of the most effective measures is to assure proper environmental cleanliness in medical facilities. To improve the cleanliness of the general wards, a joint task force composed of the Department of Nursing and a multidisciplinary team (Including the Environmental Management Department, the Infection Control Division, and the janitorial services) was established for a specific project from June 19 to September 26, 2019, focusing on two main issues. First, the lack of knowledge about infection control and correct cleaning and disinfection procedures required in medical facilities among hospital janitors. Second, incorrect use of cleaning tools, inappropriate wiping process and or sequence, and inaccurate bleach preparation. Systematic improvement measures were conducted to achieve a standardized and consistent operation for hospital janitors, and therefore to be in line with requirements for infection control. These include revising infection control protocols, developing procedures and inspections for hospital cleaning and disinfection, creating a colored categorization system for janitorial tools, placing janitorial note cards, organizing educational training programs, and filming videos regarding terminal disinfection in general wards. The level of fluorescence marker, also known as the accuracy endpoint, was used for the detection of residual cells or soiling surfaces. After intervention, the effectiveness of environmental cleanliness in our general ward increased from 54.1% to 86.7%, while the accuracy of terminal disinfection improved from 41.2% to 92.6%. Due to the implementation of effective cleaning and disinfection measures and the inclusion of standardized janitorial procedures as routine operations, our project successfully establishes a safer health care in general wards.