運用螢光標示檢測法及改善策略提升醫院環境清潔度

Improving Environmental Cleanliness by Fluorescent Marker Method and Strategy in Hospital

醫院環境中存在著多樣性微生物及抗藥性菌株，會藉由醫療工作人員未落實手部衛生五時機的雙手或受污染之醫療環境、儀器設備等，接觸傳播移生至病人身上甚至進一步造成感染；因此醫療機構的環境清消品質是影響醫療照護相關感染及多重抗藥性細菌傳播的重要關鍵之一。如何有效降低環境表面之污染程度，目前醫療院所多數採用漂白水等消毒溶液進行擦拭為主，即使近年因應Coronavirus Disease 2019（COVID-19）疫情大為推廣之ultraviolet-C也僅作為輔助加強消毒之用並不能完全取代傳統之人工擦拭，因此選擇一個簡單客觀的檢測方式，如螢光標示檢測法，可具體反映清潔消毒品質，並能進一步透過回饋、檢討、再教育等方式提升環境清潔度。本院於2021年9月進行環境品質改善專案，由感管中心、總務室及護理部共同擬定採用客觀、成本較低又可即時回饋之螢光標示檢測法，並配合改善策略以期增進環境清潔成效。由稽核人員以螢光標示檢測法，每月至加護病房及一般病房，針對10處高接觸頻率之環境表面進行終期消毒品質稽核，將檢測結果即時回饋給清潔人員及樓層主管，並進行教育訓練。統計2021年9月1日至2022年7月31日，檢測一般病房共1487點、加護病房區共732點，監測結果由最初合格率分別為41.7%及73.2%改善進步至2022年7月合格率可達89.2%及98.6%，以Cochran-Armitage trend test檢定2021年9月至2022年7月一般病房、加護病房之通過率，p值均<.0001。因此螢光標示檢測法是一個簡單便宜客觀的檢測方式，可以即時回饋並用於提升醫院環境清潔品質。

Multiple microbes with highly antibiotic-resistant characteristics are present in the hospital environment. These pathogens can be transmitted via the hands of staff by touching the surfaces of the environment and medical instruments that were contaminated, followed by cross-infection among other inpatients. Currently, most medical institutions use bleach and other disinfection solutions for wiping. Even in recent years, ultraviolet-C, which has been widely promoted in response to the Coronavirus Disease 2019 (COVID-19) epidemic, has only been used to strengthen disinfection and cannot completely replace traditional manual wiping. Therefore, selecting an effective detection method that reflects the quality of cleaning and disinfection can further improve environmental cleanliness through feedback, review, and re-education. Taipei Tzu-chi General Hospital has executed a project of fluorescent mark method monitoring, which was formulated by the Infection Control Center, General Affairs, and Nursing Department, to improve the quality of the hospital environment cleanliness since September 2021. The fluorescent mark method evaluated 10 high-touch points on the environmental surface before and after terminal cleaning of rooms in general and intensive care wards each month. The results were returned to the cleansing staff and their supervisors, and cleaning education was provided. Using this method, from September 1, 2021, to July 31, 2022, 1487 and 732 high-tough points of the environment surface were evaluated in the general and intensive care wards, respectively. After the comprehensive education program of cleansing staff and result feedback, the complete cleaning rates of the general ward and intensive care ward increased from 41.7% and 73.2% (Sep 2021) to 89.2% and 98.6% (Jul 2022), respectively (Cochran-Armitage trend test, p<0.0001). In conclusion, the fluorescent mark method is a simple, objective, real-time, and inexpensive method to evaluate the effectiveness of environmental cleansing, and the application of this method could contribute to the improvement of cleansing quality in hospitals.