組合式環境清潔策略可提升加護病房執行環境清潔作業之品質改善

Environmental Cleaning Bundle Strategy to Improve the Quality of Environmental Cleaning in the ICU

醫療環境清潔成效為照護品質要素之一，當執行環境清潔正確率低時，將影響清潔成效，進而增加感染風險。藉由事件分析發現某兒科加護病房中，清潔人員及護理師執行環境清潔正確率低的原因為：對環境清潔流程及重要性認知不足、缺乏使用中醫療儀器清潔作業程序及環境清潔作業細則、清潔細項繁瑣及用物設備多，不易清潔。此次品質改善活動期望提升加護病房執行環境清潔作業之正確率，改善策略為建立以人因工程為原則之組合式環境清潔策略，包含教育訓練、建置清潔作業程序與細則、設置清潔點及提醒圖卡、簡化環境增加清潔可行性、稽核成效及溝通回饋。清潔人員及護理師執行環境清潔正確率由46.3%及48.2%，提升至92.5%及93.6%，進而提升環境清潔成效及醫療照護品質。

The effectiveness of medical environmental cleaning is an indicator of care quality. When the accuracy rate of environmental cleaning is low, it will increase the infection risk. According to event analysis and quality improvement process in a pediatric intensive care unit(ICU), we found the cause of the low accuracy rate of environmental cleaning by cleaning staffs and nurses include: insufficient understanding of the process and importance of environmental cleaning, the lack of cleaning procedures for medical equipment in use and detailed operating procedures for environmental cleaning, cumbersome cleaning details, the amount of materials and equipment, and the difficulty to clean. The program was designed to improve the accuracy rate of environmental cleaning in the intensive care unit. The improvement strategy is to establish an environmental cleaning bundle based on the principle of human factor’s engineering, which includes personal educating and training, establishment of cleaning operation procedures and rules, formulating cleaning points and setting reminder charts, simplifying the environment to increase the feasibility of cleaning, auditing effectiveness, and communicating feedback to improve environmental cleaning accuracy rate. After the improvement strategies, the accuracy rate of cleaning staffs and nurses on environmental cleaning increased from 46.3% and 48.2% to 92.5% and 93.6%, respectively. It can further improve the effectiveness of environmental cleaning and the quality of medical care.