醫療照護人員，脫除個人防護裝備污染程度調查

Assessment of Healthcare Workers' Self-Contamination During Removal of Personal Protective Equipment

"個人防護裝備（Personal Protective Equipment, PPE）在人類與傳染病戰爭中，是保護醫療人員最佳利器。但值得注意的是，脫除防護裝備過程存在風險，可能造成工作人員皮膚或工作服受污染。本研究藉由PPE穿脫訓練中加入螢光乳模擬污染物質附著情境，以了解脫除PPE後人員皮膚及工作服污染狀況。2017～2021年共499人參與螢光檢測（傳染病防治醫療網205人、PGY訓練醫師294人），其中192人至少發生1處（含）以上部位污染，污染率38.5%。比較醫療網支援人員與PGY訓練醫師PPE脫除後結果，PGY訓練醫師污染率顯著低於醫療網支援人員（p＜0.001）。醫療網支援人員工作年資6～10年發生污染最高（72.7%），進一步比較有污染組及無污染組，無污染組中有負壓隔離病室工作經驗（21.4%）及曾接受雙層PPE穿脫訓練（72.7%）比例較高，但未達顯著差異（p＞0.05）。2020～2021年COVID-19疫情爆發期間，PGY訓練醫師脫除PPE污染率明顯較疫情前降低（p＜0.001）。污染部位前三位為手部38.4%、頭髮19.7%、頸部（含下巴）17.5%。脫除過程中至少出現1次（含）以上錯誤動作佔29.1%，其中以脫除外層隔離衣及外層手套出現錯誤佔最多（27.3%）。因此定期且持續提供教育訓練熟練技術，透過有效檢測工具將原本看不見的「污染」視覺化呈現，以提升穿脫正確性；本研究可提供教學者作為課程設計安排及學習者重要參考。"

"To prevent disease transmission in healthcare settings, personal protective equipment (PPE) must be used correctly by healthcare workers (HCWs) to prevent exposure and the transport of pathogens to their skin and clothing. PPE reduces but does not eliminate the risk of skin and clothing contamination with pathogens. In this study, we examined the frequency and sites of contamination of the skin and clothing of HCWs. They performed simulations of contaminated PPE removal with fluorescent lotion on the gloves. During the simulations, 192 of the 499 (38.5%) HCWs contaminated their skin or clothing with fluorescent lotion, and 145 (29.1%) had one or more lapses during doffing. Among them, most of the lapses occurred when removing the outer layer gown and outer layer gloves (27.3%). The hands (38.4%) were most frequently contaminated during PPE doffing simulations, followed by hair (19.7%) and neck including the chin (17.5%). Senior staff (6~10 or＞10 years of experience) had more significant contamination than junior staff (＜1 year of experience) (p＜.05). Our findings have implications for designing PPE education and implementing PPE training protocols."