某醫學中心加護病房環境清潔成效探討

Evaluation of the appropriateness of the standard operating procedure and propose amendments to ensure of the cleaning/disinfection in Intensive Care Unit

醫療環境表面的微生物有可能是醫療照護相關感染的來源。因此，不論是例行性的環境清潔或終期消毒，其清潔消毒的程序及清潔人員的遵從度非常重要。但環境清潔後能降低多少數量的微生物，目前則無具體之數字。本研究目的在清楚瞭解現行環境清潔作業流程對病原體降低的效果及作業過程有否修改的必要。參與計畫之清潔人員皆為台灣籍女性員工，平均年齡57歲。計畫分兩階段進行，第一階段為現況環境清潔前後採檢，經感染管制師實地觀察第一階段清潔過程，將缺失以課室教育回饋清潔人員後，在相同的清潔人員，相同的床位再次進行環境清潔前後採檢。第一階段清潔前及清潔後總菌落顆數各為454 cfu/cm^2及40 cfu/cm^2，清潔度的合格率從73.8%上升至94.4%（p=0.34）。第二階段清潔前及清潔後總菌落顆數各為2,441 cfu/cm^2及15 cfu/cm^2，合格率從74.8%上升至99.1%。教育訓練提醒後，環境清潔改善率與教育訓練提醒前的改善率相較，有顯著意義（配對t檢定p＜0.001）。兩階段清潔前後菌落數減少最多的採檢點為洗手台，門把清潔後的菌落數減少最少。本研究結果證實病房環境經清潔後，其表面的細菌數量是有明顯減少，因此本院所設計的環境清潔標準化作業流程，是確實可行且有效的。

Environmental contamination is the important source for bacterial spread causing hospital-acquired infections. Environmental cleaning with an established standard operation procedure (SOP) and cleaners' strict adherence to the SOP are therefore extremely important. However, evaluation of the effects of environmental cleaning in general has not been fully reported in the literature. The aim of this study is to elucidate the effects of environmental cleaning with the established SOP and by the well trained cleaners in Kaohsiung Chang Gung Memorial Hospital. Environmental cleaning was based on the SOP which followed the principle of cleaning from higher locations to lower ones, and from the contaminated areas to the comparatively cleaner ones in rooms where patients were staying. Before and after daily environmental cleaning routine, environmental surfaces were swabbed for sampling specimens for bacterial culture and for bacterial count evaluation in case of culture positive. Effects of environmental cleaning in intensive care units significantly improved in terms of further lowering environmental bacterial burdens after giving feedback to cleaners on how to avoid cleaning mistakes found at observations of their routine cleaning process (p ＜ 0.001).