運用生物螢光反應檢測法稽核醫院環境清潔之成果

Application of ATP luminometer to monitor the efficacy of environmental cleaning at a medical center in southern Taiwan

醫院環境清潔為維護病人安全之基石，落實醫院環境清潔可降低照護環境中的微生物與抗藥性菌株，藉此減少醫療照顧相關感染之發生。本院於2015年由感染管制中心、總務室環境管理組及護理部共同成立環境清潔管理小組，建立分色管理制度與共同稽核環境清潔成效。2016年起以Adenosine triphosphate（ATP）冷光儀（ATP luminometer）進行醫院環境清潔稽核，每月於病房及加護病房常用儀器設備與環境常規進行清潔稽核。2016年1月到2018年12月間，檢測加護病房區266點、一般病房區216點，共482點。環境清潔及格（＜200 relative light unit [RLU]）率由79.7％進步至92.5％，優良（＜100 RLU）率由62.1％增至82.9％（p＜0.001）。因2018年環境清潔採檢結果已達院內自訂之閾值（90％為＜200 RLU），預計於2019年將環境清潔標準下修至＜100 RLU，故針對ATP檢測數據＞100 RLU之採檢點作為異常進行分析改善，而異常率較高的採檢點依序為檢體運送條碼機器（62.5％），其次為護理站護理鈴（61.5％）、抽痰流量表（56.3％）、加護工作檯面（40％）、動脈血液氣體分析儀（35.7％）、監視器面板（32.5％）、呼吸器（30.4％）、氧氣流量表（24.4％）與床欄（17％）。由此研究結果得出不易清潔點多為易沾染體液血液之設備與環境，及抽痰流量表及氧氣設備，此類設備多具滾輪或齒輪溝槽，易為清潔死角。藉此稽核可立即回饋環管員，相互討論改善清潔方式，互助合作提升工作效能。

Cleanliness in the hospital environment is imperative for patient safety. Optimization of hospital environment cleaning may help decrease the bioburden of various microorganisms, including multidrug-resistant organisms, from surfaces of medical equipments and instruments and consequently reduce the incidence of healthcare-associated infections. An environmental cleaning management team comprising the representatives from the Infection Control Center, Department of General Business, and Department of Nursing conducted evidence-based interventions to assess the cleaning process in our hospital in 2015. Since 2016, adenosine triphosphate (ATP) luminometer has been used for monthly audits to evaluate the environmental cleaning process in general wards and intensive care units (ICUs). Between January 2016 and December 2018, 266 points in ICUs and 216 points in general wards have been checked using ATP luminometer. The passing rate for environmental cleaning, defined as relative light unit (RLU) < 100/cm2 as assessed with ATP luminometer, improved from 79.7% to 92.5% (p < 0.001) over the study period. The highest failure rate was observed among barcode recorders for medical samples (62.5%), followed by the nursing call system in nursing stations (61.5%), suction flow meters (56.3%), workbench of clinical staff in ICUs (40%), arterial blood gas analyzers (35.7%), bedside monitoring panels (32.5%), ventilators (30.4%), airflow meters (24.4%), and bed rails (17%). According to this study, medical devices with a high cleanliness failure rate after standard cleaning procedures mostly comprised rollers or grooves. With this method, the infection control nurses could provide immediate feedback to the cleaning staff and further improve the mutual cooperation and discussion on the effectiveness of hospital environmental cleaning procedures.