運用多面向感染管制策略提升醫院環境清潔成效

Applying a Multi-faceted Infection Control Strategy to Improve the Environmental Cleanliness of Hospitals

醫療機構環境清潔是病人安全照護重要的一環，和醫院感染有密切相關。在面對多種抗藥性感染危機下，抗生素管理及環境清潔工作就更顯得重要。本文的研究時程為2014年5月至2015年12月，分為政策宣導前期、政策推行期及政策穩定期。針對環境清潔的主要問題：清潔環境作業流程、清潔工具、人員、報表管理及稽核制度等，進行系統性的改善。本研究以ATP生物冷光反應法（adenosine triphosphate bioluminescence technique）為環境清潔稽核工具，配合制定標準作業程序、清潔用具管理作業、人員管理及教育訓練、內外稽核等工作來進行改善。在多面向感染管制策略實施後，環境清潔成效有明顯進步。政策宣導期的清潔不合格率達40.0%，在政策推行期教育宣導後的四週及八週降至20.0%及18.3%。政策穩定期的第一至第四季的環境清潔不合格率也可維持在13.0～23.5%之間。其中一個加護病房感染密度由3.8‰降至2.4‰。多重抗藥性細菌年度培養菌種總數有明顯減少，由計畫推行前一年2013年的1,757株，推行第一年為1,462株，推行第二年則減少到969株。多重抗藥性細菌所導致的醫療照護相關感染人次，由最高年度總計達30人次降至計畫實施期間年度分別為18及9人次，尤其是methicillin-resistant Staphylococcus aureus（MRSA）由年度16人次逐年降為4人次，vancomycin-resistant Enterococcus（VRE）則由年度4人次降為1人次。

Environmental cleanliness of medical institutions is a very important part of patient safety and hospital infection control. In the face of crisis by drug-resistant bacterial infections, antibiotic management and environmental cleanliness have become more important. This study was conducted from May 2014 to December 2015 and was divided into a pre-intervention period, policy implementation period, and policy stability period. The main issues of environmental cleanliness are clean operating procedures, cleaning tools, personnel training, report management, and audit systems. We used the ATP bioluminescence assay to assess environmental cleanness. Efficiency was used as the core tool of the reengineering project of the hospital environmental cleanliness work system. We cooperated in the formulation of the standard operating procedures, management of cleaning appliances, personnel management, education and training, and internal and external audits. After the multi-faceted infection control strategy was implemented, significant progress was observed. During the pre-intervention period, the unqualified rate of clean up was 40.0%, which dropped to 20.0% and 18.3% during the four and eight weeks of policy implementation period, respectively, after the educational campaign was launched. In the first, second, third, and fourth quarters of the policy stability period, the unqualified rate was maintained at 13.0%-23.5%. The intensive care unit infection rate dropped from 3.8‰ to 2.4‰. The annual frequency of medical-carerelated infections caused by multiple drug-resistant strains dropped significantly from a peak of 30 to 18 and 9.