運用拋棄式擦拭巾導入醫院環境清潔之成效

病人安全是醫療照護品質的重要一環，而降低醫療照護相關感染事件能提升醫療品質。若能落實院內環境的清潔與消毒和手部衛生，就可減少病菌傳播、微生物移生與預防醫療照護相關感染及預防群突發事件的發生。環境清潔中使用的抹布為重要工具之一，但抹布有時反而成為傳播媒介，改使用拋棄式濕紙巾進行環境清潔，縮短環境清潔的時間，節省人力成本，提高清潔度，減少病原體藉由汙染環境導致醫療照護相關感染發生。本院於2015年下半年度導入拋棄式擦拭巾，以目視觀察法、使用ATP冷光儀檢測法、統計病人分離出VRE（vancomycin-resistant Enterococci）及MRSA（methicillin-resistant Staphylococcus aureus）分離率、感染密度、及成本效益來評估此導入措施（2015-2017年）的結果，並追蹤效果至2022年。此研究結果目視觀察法的清潔流程由84.66分進步到90.28分，ATP採檢清潔度由50%上升到89%，VRE分離率維持在31.11-31.47%，MRSA由69.57%下降至50.84%，有顯著統計差異。感染密度由6.98‰，下降至6.08‰，減少了138個感染個案。
本研究藉由教育訓練及擦拭巾的導入，亦改善了本院清潔間空間限制，而清潔用具不易適當存放的問題，除了原先目視觀察法，也增加客觀的ATP生物發光法採檢，以評估環境清潔成效的方式。提升了醫療環境的執行及清潔度，降低了感染密度及抗藥性細菌的分離率，使醫療環境清潔品質有良好的改善。

Patient safety is a crucial aspect of medical care quality, and reducing healthcare-associated infection events can significantly enhance the quality of medical services. Implementing effective measures such as thorough cleaning and disinfection of the hospital environment and promoting hand hygiene can reduce the spread of germs, minimize microbial colonization, prevent healthcare-associated infections, and decrease the occurrence of cluster emergencies. Although the cleaning rag is an essential tool in environmental cleaning, it can act as a transmission medium for pathogens. Therefore, using disposable wet wipes for environmental cleaning can expedite the cleaning process, save on labor costs, improve cleanliness, and mitigate the risk of pathogens contaminating the environment, thereby ultimately reducing healthcare-related infections.
Our hospital introduced disposable wipes in the second half of 2015. This introduction measure was evaluated through visual observation, adenosine triphosphate (ATP) luminescence detection, statistical analysis of vancomycin-resistant Enterococcus (VRE) and methicillin-resistant Staphylococcus aureus (MRSA) isolation rates of patients, infection density, and cost-effectiveness (2015–2018) and followed up until 2022. The results of this study showed that the cleaning process of the visual observation method improved from 82.3 to 90.1 points, the cleanliness of ATP inspection increased from 50% to 86%, the VRE separation rate decreased from 36.7% to 32.1%, and the MRSA detection decreased from 69.8% to 39.7%, all with statistically significant differences. The infection density decreased from 6.98% to 5.27%, which is a decrease of 124 infection cases.
Through education, training, and the introduction of disposable wipes, this study addressed the issue of space constraints in the clean rooms of our hospital and the challenge of adequately storing cleaning tools. In addition to the visual observation-based cleaning checklist, we incorporated the objective ATP bioluminescence method as a means of inspecting and evaluating the effectiveness of environmental cleaning. The implementation of the cleaning quality improvements resulted in enhanced execution of tasks and cleanliness within the medical environment, leading to a decrease in infection density and isolation rates of drug-resistant bacteria, thereby ultimately elevating the overall quality of cleanliness in the medical environment.