醫院環境清潔消毒與COVID-19疫情防治

Hospital Cleaning and Disinfection for COVID-19 Pandemic Control

醫院內的病原體可能透過污染的環境間接交叉傳播，因此環境清潔消毒是維護病人就醫安全和職場安全的重要感染預防和管制要素。醫院環境清潔工作已多年委外處理，在疫病流行時帶來風險和挑戰。本文介紹台灣1家具2600 床之教學醫院，從COVID-19疫情前到流行期的環境清潔管理經驗。因應COVID-19疫災而重新設計環境清潔消毒措施，以4個S（人員、標準作業程序、清潔工具及簡化負荷）面向，進行夥伴系統的專責人員訓練、建立雙人操作之標準作業流程，包括消毒劑配製和具人體工學的清潔實務、提供適當清潔用具、簡化其他工作負荷，亦建立內部檢查和外部確效回饋，運用在確診病例之病室終期清潔消毒。這些努力確保疫情期間的醫院職場安全，以及全院環境終期清潔消毒的徹底性和有效性。

Pathogens may transmit through indirect contact transmission, that is cross transmission through contaminated environment (fomite transmission) at hospitals. Thus, environment cleaning/disinfection is an important element of infection prevention and control program for patient safety and occupation safety in healthcare settings. Environment cleaning has been outsourced in the recent two decades which bring benefits but also risks and challenges particularly in the context of epidemic/pandemic. Here we shared experience of environment cleaning program before and during COVID-19 pandemic at a 2600-bed teaching hospital in Taiwan. Hospitals manage risk of environment contamination through early identification and isolation in dedicated units of patients with COVID-19 and other epidemiological important organisms and risk-based environment cleaning programs. We re-designed environment cleaning policy/practice and emphasized 4S, that is, Staff, Standard, Supplies and Simplify. We establish partnership, educate staffs; establish detailed standard operation procedures including preparing disinfectants, and take into consideration of human factors engineering; design and provide appropriate supplies or tools and emphasize simplify to enhance feasibility. We establish internal checklist and perform external audit and feedback. We further implement the model of dedicated cleaning staffs with buddy system for terminal cleaning of units where COVID-19 confirmed cases stay. All these efforts ensure workplace safety during pandemic as well as the thoroughness and the effectiveness of terminal cleaning and disinfection for the whole hospital.