有效改善環管人員對院內環境清潔與醫療廢棄物之處理

Improving the process of hospital environment cleaning and medical waste by educating the environmental clean workers

近年來因本院抗藥性菌株有逐漸上升之趨勢，且臨床單位反應：環管人員流動率高，導致對於醫院環境消毒之認知不足而無法正確執行。有鑑於此，感控小組於2004年12月調查環管人員對院內環境清潔興醫療廢棄物處理的認知與執行，其正確率分別為74%與52%。依問卷調查結果及現場觀察法發現；泡出正確濃度與選用適當濃度的漂白水擦拭、正確執行清潔原則與清潔方式、人員對感控認知及硬體設備等未符合標準。據此，我們訂出各種改善方案，如舉辦院內感染之在職教育、設計統一規格的清潔用物、張貼標示語、增設各單位拖布槽、訓練種子成員、建立定期稽查制度、教導正確清潔處理的原則等等，並將此列入環管人員的工作規範中。改善成效追蹤發現認知的正確率明顯進步22%，而執行正確率亦進步34%。由此可證教育訓練及改善清潔設備環境的工具，能提升人員院內環境清潔與消毒的認知、及瞭解醫療廢棄物處理方式，並能正確執行。（感控雜誌 2009; 19: 10-20）。

Since bacterial antibiotic-resistant rate increased gradually and is still rising in our hospital, and it was also noted that the hospital environmental clean workers, due to a high turnover rate, were lack of the concept of infection control, particularly disinfection, we, therefore, conducted a survey in December. 2004, for their cognition and behavior regarding hospital environmental cleaning. The accuracy ratings were 74% and 52%, respectively. According to results of the survey and on-site observation, we identified 4 major problems in their processing: unawareness of how to prepare and choose a correct and appropriate concentration of sodium hypochloride to wipe, unawareness of the principle and way of a correct cleaning process, no cognition of infection control and no appropriate cleaning instruments. As a result, we conducted a variety of improvement strategies for the clean workers, including continued education for hospital infection, providing appropriate cleaning instruments, posting a variety of signage, adding the mop basins in each ward unit, training seed members, setting up an audit system, and guiding the principle of a correct cleaning process etc., and incorporate these strategies into the standard operative procedures of the clean workers. After implementation of these strategies, we found that the accuracy rating for the cognition of infection control had an increment of 22%, and the accuracy rating for the behavior 34%. Apparently, through continued education and training, environmental clean workers can learn about the importance of infection control, a correct process of hospital environmental cleaning, and the handling of medical waste. (Infect Control J 2009; 19:10-20).