於醫學中心成人加護病房應用實務觀察監測環境清潔之效能

Performance of Practical Observation for Monitoring Environmental Cleanliness

加強環境清潔可以減少多重抗藥性微生物的移生及醫療照護相關感染，本研究為前瞻性研究，於2021年5月至2022年11月在內科加護病房，以實務觀察清潔人員是否遵從標準作業流程，並以菌落總數小於2.5CFU/cm2判讀為通過視為黃金標準，採檢病室高頻率被接觸的環境表面。共採檢569個樣本，菌落總數之平均值、中位數和四分位距分別為1.29, 0.08及0.56-0.00 CFU/cm2。實務觀察遵從率為47.1%，菌落總數通過率為90.5%，310個樣本（54.5%）在實務觀察與菌落總數有一致的判讀結果，實務觀察遵從與否和菌落總數通過與否有顯著關係（p<0.01）。實務觀察遵從組的菌落總數中位數（四分位距數）：0.00（0.08-0.00）CFU/cm2，顯著低於不遵從組的菌落總數中位數（四分位距數）：0.40（1.28-0.08）CFU/cm2（p<0.01）。實務觀察的優點有容易操作、便宜、可以立即回饋及發現教育訓練和工作改善的落差，在臨床應用部分建議除了固定觀察者、標準化觀察的內容、隱密觀察外，醫療機構可以針對新進清潔人員，為確認其操作是否符合標準作業流程時，或群聚事件發生時，或於高風險區域定期採用實務觀察並結合其他方法進行環境清潔評估。

Improvements in environmental hygiene have resulted in reductions in colonization with multidrug-resistant microorganisms and healthcare-associated infections. This study aimed to evaluate the effectiveness of practical observation using aerobic colony counts (ACC) as a gold standard comparator to verify environmental cleanliness. A prospective study was conducted at a medical intensive care unit from May 2021 to November 2022. High-touch surfaces were assessed by practical observation and aerobic colony counts. A total of 569 samples were collected. The detection rates were 47.1% for practical observation and 90.5% for ACC. The concordance rate was 54.5% (310 surfaces) between the two methods. There was a significant relationship between the results of practical observation and ACC (p < 0.01). The median ACC values were 0.00 CFU/cm2 for the“compliant”group and 0.40 CFU/cm2 for the“non-compliant”group (p < 0.01). The advantages of practical observation are its ease of operation, low cost, immediate feedback, and ability to identify gaps in education, training, and work conditions. With respect to clinical application, it is recommended that in addition to standardized observations and surveillance measures, medical facilities can use practical observation to monitor the performance of new cleaning personnel, particularly during the periods of clustered incidents or in high-risk areas, combined with other methods.