提升醫院終期環境清潔成效

Improvement Program to Enhance Effectiveness of Terminal Room Cleaning in Hospital Environments

為落實終期環境清潔、減少物體表面細菌汙染，運用多元策略方法導入螢光劑檢測法提升醫院終期環境清潔成效。組成跨單位小組，運用多元策略方法，為期 8 個月 (2018 年 1 月開始進行至 8 月)，採用螢光劑標示法輔助進行終期環境清潔改善之研究，除進行一系列之課室教育訓練外，更強調學員實際操作的重要性，藉由清潔過程中立即的指導，與每位清潔人員進行雙向溝通，以發現個別性問題提供正確的清潔流程，並以圖示法環境清潔確效表提供人員了解重點清潔之方向，讓清潔工作能夠更有效率的執行，利用 30 位出院病患終期清潔後再以ATP (adenosine triphosphate) 生物冷光反映法進行檢測作為前後比較。結果發現 ATP 環境清潔合格率由前測 54% 上升至 92% (進步率 70.4%)；利用空病房以螢光劑進行 30 位人員清潔檢測，環境清潔合格率由 42.5% 提升至 58.9% (進步率為 38%)，p < 0.01，顯示研究具有成效。
運用多元策略方法導入螢光劑檢測法進行環境清潔確效評估，不僅成本低、對每一位清潔人員進行終期清潔的測驗後，可以立即的回饋並指導，此方式建議納入新進人員訓練，讓人員都能完成測驗後再至臨床工作，以確保環境清潔的成效。

We executed multidisciplinary strategies using fluorescent marking gel to improve the effectiveness of terminal room cleaning and decontamination of surface environments following patient discharges for preventing healthcare-associated infections.
The program lasted for 8 months (from January to August 2018), was implemented through cross-department collaboration and multidisciplinary strategies, assisted by the use of fluorescent marking gel for improving terminal cleaning in our hospital. The training course for all cleaning staff included not only classroom lectures, but also interactive teaching methods where the staff performed environmental cleaning and disinfection procedures according to the standard operation procedures (SOP) and then teach-back. This immediate feedback mechanism enabled us to directly observe individual problems for each staff member and provide different solutions to improve their work. To assist with efficient cleaning procedures, we designed checklists in the form of schematic diagrams to ensure that all steps of the SOP were completed. We applied adenosine triphosphate (ATP) bioluminescence assays to assess the level of cleanliness before and after implementing the program to evaluate the effectiveness of our intervention.
ATP bioluminescence assays after terminal cleaning of 30 discharge rooms found that the rate of qualified cleanliness after terminal room cleaning increased from 54% to 92% (improvement percentage 70.4%). We used fluorescent marking gel to conduct cleaning tests for 30 cleaning staff members. Adherence to cleaning procedures assessed by fluorescent marking gel was also significantly improved: The qualified rate increased from 42.5% to 58.9% (improvement percentage 38%, p < 0.001).
Multidisciplinary strategies combined with the use of fluorescent marking gel for environmental cleaning validation evaluations is not only cost effective, but also able to provide immediate feedback to each staff member after cleaning tests. It is recommended to incorporate this program into the training of new cleaning staff. New staff should be required to complete tests before starting clinical work to ensure the effectiveness of environmental cleaning.