運用ATP檢測及擬定清潔流程改善血腫病房工作車清潔暨感染控制成效

Application of Adenosine Triphosphate Bioluminescence Assay and the Cleaning Procedures to Improve the Nursing Carts’Cleaning and Infection Control in a Hemato-Oncology Ward

血腫病人因免疫低下，以致感染發生率高，嚴重感染會提高敗血症發生。經調查分析發現，護理師未落實手部衛生及洗手時機、缺乏護理師清潔規範、客觀清潔成效查核工具及即時回饋機制，且清潔人員整理工作車程序不確實，並缺乏提醒機制，以上導因成為菌株傳播媒介，故引發改善動機，期望提升手部衛生及工作車清潔成效，以有效控制院內感染。經制定作業程序、製作精簡教學影片、運用螢光標示法及ATP查核即时回饋、加强教育訓練等改善措施推動，專案改善後護理師手部衛生正確率由53.8%提升至87.5%，上班備藥前工作車清潔執行率由70%提升至90.4%。我們以ATP檢測達到專案目標，藉有效緩解及維持單位感染密度，已正向成效回饋於感控護理師，且進行院內平行推展。

Abstract: The infection incidence is relatively high in patients with hematological diseases, the major population admitted to our unit. Severe infection will increase the incidence of sepsis. Our initial investigation revealed four problems. First, the nurses failed to perform hand hygiene and its optimal timing. Second, the standardized cleansing protocol for nurses was not established. Third, the evaluation objectives of cleansing process and the instant feedback system were also not available. At last, the protocol for cleaning staff to clean the trolleys was not well standardized and there is no warning system currently. The possible routes of infection transmission may be related to the above four problems. This observation leads us to improve the hand hygiene and trolleys to prevent transmission of hospital-acquired infection. By creating standard protocol, producing teaching videos, applying fluorescent marker and adenosine triphosphate bioluminescence assay, instant feedback system, and reinforcing training program, the accuracy rate of nurses' hand hygiene increased from 53.8% to 87.5%, and the rate of implementation of trolleys cleaning before medication preparation also improved from 70% to 90.4%o. We reach the preset goal with using adenosine triphosphate bioluminescence assay. Therefore, the infection rate in our unit was successfully reduced and sustained. We feedback this achievement to infection control nurses and will promote to other ward units in our hospital.