運用不同檢測方式評估某醫學中心環境清潔成效

Assessment of the Utility of Diverse Strategies to Improve the Environmental Cleaning Quality

提升醫院清潔度是減少易感宿主感染致病菌的有效方法，本文為運用ATP冷光反應檢測法（adenosine triphosphate [ATP] bioluminescence assay）、總菌落數法（aerobic colony count, ACC）、目視觀察評量法等三種方法，評估在實施多元策略後改善環境清潔品質之成效。評估方法為方便取樣選擇6個不同屬性的病室，在病室清潔前後立即採檢已選定之12個手經常會觸摸處。研究結果顯示在清潔後，目視觀察評量法、總菌落數法和ATP冷光反應檢測法等檢測法的不合格率均有顯著下降，分別從14.3%、21.4%、45.7%降至5.7%、7.1%、20.0%。ATP冷光反應檢測法測得之平均相對光單位（relative light unit, RLU）從清潔前的1,313降至419（下降68.1%），總菌落數法測得從清潔前的1.9 cfu／cm2 降至0.4 cfu／cm2 （下降78.9%），顯示本院推動的環境清潔政策和多元策略改善措施是確實可行且有成效。然而外科病房清潔前後之未達乾淨比例較內科病房高，可能是與每天入出院人數較多，清潔人員無法短時間落實清潔工作所致。因此如何在有限時間內簡化清潔流程並強調清潔重點，是往後可以再改善的方向。

Enhancing patient zone cleanliness is an effective way to reduce pathogen cross-transmission. This study used adenosine triphosphate (ATP) bioluminescence assays, aerobic colony counts (ACCs), and visual observations to assess the utility of diverse strategies that are employed to improve environmental cleaning quality. Environmental samples were obtained from 12 high-touch surfaces before and after ward terminal disinfection. After cleaning, the failure rate, tested by using ATP bioluminescence assay, ACC, and visual observations, decreased significantly from 14.3%, 21.4%, and 58.6% to 5.7%, 7.1%, and 28.6%. The mean ATP value decreased from 1313 relative light units (RLU) before cleaning to 419 RLU after cleaning. The mean ACC value decreased from 1.9 colony forming units (CFU)/cm2 before cleaning to 0.4 CFU/cm2 after cleaning. The results indicate that these strategies are effective in improving the environmental cleaning quality. However, the high failure rates in the surgical ward may be attributed to lack of implementation by the cleaning staff due to time constraints. Therefore, simplifying the cleaning process and focusing on high-touch surfaces are the next steps to improving cleaning quality in a limited time.