抽血櫃檯環境清消頻率評估

The Assessment of Environmental Cleaning and Disinfection Frequency at Blood Collection Counter

目的：醫療機構定期清潔消毒為感染防治之重要措施，現行醫療機構感染管制指引僅依區域汙染風險、人員可能接觸風險及危害程度概略建議不同區域適合的清消頻率，無明確的環境監測數據佐證，本研究擬監測抽血櫃檯清消後每小時之環境生物汙染程度，並分析適合之清消頻率及探討影響櫃檯生物汙染程度的重要因子。方法：本研究採用ATP生物冷光法監測櫃檯桌面(醫檢師端、病人端)、觸控螢幕、鍵盤、滑鼠、抽血枕、止血帶等表面於使用75%乙醇擦拭完成後，執行日常抽血業務1至4小時後之生物汙染程度。結果：病人易接觸之位置如抽血枕、止血帶、病人端桌面等，於清消後1小時ATP檢驗中間值均大於安全值250 RLU(Relative Light Unit)，其餘監測點於清消後4小時僅鍵盤稍超過安全值(289 RLU)。多變項Cox regression分析指出，病人易接觸與否、清消後表面殘餘生物汙染、櫃檯抽血頻率為影響環境表面生物汙染度之重要因子(p<0.05)。結論：研究結果建議，抽血枕、止血帶、病人端桌面清消時間間隔應小於1小時，醫檢師端桌面、觸控螢幕、鍵盤、滑鼠則可採用較長的清消間隔。

Objectives. Regularly cleaning and disinfecting the environments of medical institutions are pivotal in infection prevention and control. Currently, the cleaning frequency recommended in the infection control guidelines is based on the pollution level, infection exposure level, and health risk. Clear data supporting environmental monitoring are unavailable. This study evaluated the degree of biological pollution on the blood collection counter every hour after disinfection. We estimated the suitable cleaning frequency and explored factors affecting degree of biological pollution.
Methods. We used the adenosine tri-phosphate (ATP) bio-luminescence assay to monitor the degree of biological pollution on the counter top (medical examiner side and patient side), touch screens, keyboards, mouses, blood pumping pillows, and tourniquets an hour after disinfection with 75% ethanol.
Results. The median ATP test values at locations that were frequently in contact with patients, such as blood pumping pillows, tourniquets, and patient side of the counter top, exceeded the safe value of >250 RLU 1 hour after disinfection. For the remaining monitoring points, only the keyboard slightly exceeded the safe value at 4 hours after disinfection (289 RLU). Multivariable Cox regression indicated that patient accessibility, residual biological pollution on the surface after disinfection, and frequency of visitors to the counter were independent factors affecting the degree of biological pollution (p<0.05).
Conclusion. This study suggests that blood pumping pillows, tourniquets, and patient side of the counter top should be disinfected at intervals of <1 hour. Touch screens, keyboards, mouses, and medical examiner side of the counter top may be disinfected at longer time intervals.