長期照護機構手部衛生及感染管制推行之重要性

The Importance of Implementation of Hand Hygiene and Infection Control Programs in Long-term Care Facilities

多篇研究證實醫療工作人員的雙手會藉由醫療照護活動受到微生物污染，而抗藥性菌株也可能經由工作人員雙手，散播到環境、其他病人，甚至造成醫療相關感染。護理之家的住民常常會使用侵入性導管留置（如導尿管和鼻胃管），如果缺乏適當的照護，則容易導致多重抗藥性微生物和導管相關的感染率增高。顯示手部衛生應該要投與更多的關注。建議應透過嚴謹的方法學，收集長期照護相關機構工作人員與手部衛生執行狀況，透過手部衛生設備建置、手部衛生的知能教育訓練（如手部衛生方式，執行手部衛生之步驟及臨床照護之手部衛生5時機等）等方式導入、來研擬適用於長期照護相關機構可供量化的手部衛生稽核指標等，同時經由實際導入後的結果彙整分析，如此可更進一步暸解機構內推行手部衛生最需改善的部分；另一方面亦可建構手部衛生認知問卷，來了解機構人員對手部衛生的意向及認知，相關結果可作為機構內推行手部衛生實務之參考。透過手部衛生的執行對於防止長照機構住民的感染（傳染）是很重要的一環，且需被重視的。

The hands of healthcare workers are contaminated by microorganisms during routine medical care, and multidrug-resistant pathogens can be transmitted to the environment or other patients via these hands and cause healthcare-associated infections. Indwelling catheters, such as urinary catheters or nasogastric tubes, are commonly used in the residents of long-term care facilities (LTCFs), and without proper precautions can result in catheter-related infections and predispose to development of multidrug resistance in microorganisms. Therefore, hand hygiene merits more concern and attention. Before implementation of quantified audit indexes of a hand hygiene program (HHP) in LTCFs, it is essential to establish compliance among staff, build hand-washing devices in working place, and formulate a training program (such as methods, standard procedures, and the knowledge of hand-washing schedules). After implementation, systematic review of program performance can reveal the application feasibility and deficiencies of the HHP. Furthermore the development of appropriate questionnaires to promote understanding of the critical role of the HHP is essential in LTCFs. In conclusion, to prevent healthcare-associated infections in LTCF residents, universal compliance to a customized HHP should be emphasized and encouraged.