運用多元感染管制策略提升清潔人員環境清消成效

Improving Environmental Cleaning Quality by Implementing Diversified Strategies of Infection Control

避免醫療照護相關感染的發生，落實正確的環境清潔消毒方法、減少環境表面的污染是重要的一環。為了提升本院的環境清潔消毒作業，本研究由感染管制室、總務室、護理部及外包清潔公司成立工作小組，進行為期一年（2014年1月至2014年12月）的跨團隊品質改善研究，依據直接觀察法及第一線工作人員的詢問調查結果，發現主要問題：1.標準作業程序未完善及缺乏確實的稽核制度。2.污物室空間規劃不佳、清潔工具未分類擺放及工作車不整潔。3.清潔人員對環境清潔消毒的重要性認知不足且清潔流程不正確。針對問題擬定環境清潔策略進行改善如下：1.政策面：重新修定環境清潔標準規範、每月環境清潔巡查流程、以及相關的稽核表。2.設備面：建立清潔用具分色管理作業並統一工作車與污物室物品的擺放位置。3.輔導面：辦理清潔人員醫院環境清潔教育訓練課程、製作清潔作業教育訓練影片、海報、及手冊、辦理清潔消毒技術認證活動。本研究亦導入ATP生物冷光法（adenosine triphosphate [ATP] bioluminescence assay）做為另一項環境清消成效的評估標準，多元感染管制措施介入前、後的合格率分別為69.5%及93.8%（進步率為34.9%），p＜0.01；且品管研究結束之次年亦維持九成以上的合格率。本研究運用多元感染管制策略提升清潔人員環境清消成效，達到明顯效果，故將改善策略列為常規作業以利院內環境品質的維持。

Proper environmental cleaning is important in the prevention and control of healthcare associated infections. This study was a multidisciplinary collaboration between the infection control office, general affairs office, nursing department, and the outsourcing cleaning services company, to improve the quality in environmental cleaning from January to December in 2014. Utilizing direct observations and questionnaires from first-line healthcare workers, we identified the main issues regarding cleaning quality improvement, including: 1. lack of standard procedures and monitoring systems for environmental cleaning. 2. wastes and soiled linens rooms were poorly organized and cleaning tools were not well segregated; medical vehicles were unsanitary. 3. hospital cleaning staff lacked knowledge about enviro nmental cleaning and the proficiency of cleaning procedures. According to the above problems, strategies to improve environmental cleaning were implemented in 3 aspects: 1. Policy: Establishing standard procedures and monitoring systems with associated audit tables for environmental cleaning. 2. Equipment: Establishing rules of tool cleaning and segregation with different color codes, and unifying object placement in medical vehicles, as well as wastes and soiled linen rooms. 3. Education: Provide cleaning staff training courses and producing educational materials, including posters, videos, and manuals, as well as granting certification after training. In this study, adenosine triphosphate (ATP) bioluminescence assay was introduced for measurement of surface cleanliness. Significant improvement in the ATP assay pass rate was noted after implementation of the above infection control strategies (from 69.5% to 93.8%, improvement of 34.9%). The pass rates were all above 90% one year after this study. From these diversified quality and infection control strategies, we significantly improved the environmental cleaning quality, leading to these interventions becoming routine practice at our hospital.