探討手部衛生時機在不同醫療區之執行原則

The Time and Space Relationship of “My Five Moments for Hand Hygiene”

醫療照護活動執行手部衛生主要目的為避免病菌於病人間造成傳播，同時保護照護人員工作安全及維護環境清潔品質。世界衛生組織除了提倡手部衛生五時 機，同時以當下所照護的病人為主體，將該病人與周遭環境視為「病人區」；其他病人及其他所有環境視為「照護區」，以進一步說明各時機的重點，與如何避免不必要的手部衛生。以國內目前醫療現況，「照護區」包括使用中的治療工作車、住院病人與家屬日常使用的公共設備，若未及時清潔可能造成病菌之散播，因此使用者除須遵守使用規定，並定時清潔。為維護安全之工作環境，建議「照護區」應再劃分出「乾淨區」，包含護理站、庫房、會議室、工作人員用餐區等，工作人員進入此區應先執行手部衛生，治療工作車使用後應進行清潔消毒，方推回護理站。

In clinical practice, the goal of hand hygiene is to prevent the transmission of pathogens and related hospital-associated infections in order to protect the health of both patients and health-care workers. The World Health Organization launched a global, multimodal hand hygiene program in 2004, that focused on the use of an alcohol-based hand rub located at the point of care and “my five moments for hand hygiene”, which was developed under the mode of pathogen transmission and conceptualization of the risk of the transition between patient zone and health-care zone. However, in the current medical environment in Taiwan, patients may move between the patient zone and the health-care zone, and medical and non-medical equipment is shared in the health-care zone. Thus, in addition to the “patient zone” and “health-care zone”, we recommend adding the concept of a “clean zone”. We recommend hand hygiene before entering the “clean zone” from either the “patient zone” or the “health-care zone”.