運用螢光檢測與手部衛生教育改善加護病房感染密度的研究

The use of Fluorescence Detection and Hand Hygiene Education to Reduce Infection Density in Intensive Care Units

加護病房（Intensive Care Units，ICU）是醫院內照護重症病人的核心單位，亦是醫院醫療資源耗費且感染風險最高的區域。文獻顯示60%的ICU病人合併感染症，進一步提高1.5倍的死亡風險。本研究起源為醫學中心某外科加護病房（Surgical Intensive Care Unit，SICU）於2022年11月感染密度攀升至15.6‰，相較2021年平均8‰有明顯增幅。經分析發現手部衛生未落實為主要原因之一。因此導入標準化手部衛生教育訓練並採用創新高解析度螢光檢測技術，以高對比影像清晰顯示洗手盲點。研究目的是探討導入手部衛生與螢光檢測介入措施，是否與降低外科加護病房的感染密度及醫療人員的手部衛生清潔度改善有關。
本研究共納入276名參與者，組別A（外科加護病房群組（於2022年12月至2023年2月，共55人醫療人員參與教育訓練後初次檢測（以下簡稱初測）數據分析，其中38人有完成的初測、教育訓練後第二次檢測（以下簡稱複測），此數據分析為組別A-paired（組別A前後配對子樣本）。另外組別B（新進員工群組）於2023年7月至2024年12月共221人參與初測數據分析，透過職前訓練與螢光洗手檢測，評估教育成效。組別A（n=55）與組別B（n=221）初測的橫斷面比較結果顯示，在性別、職業別、指甲修飾、螢光殘留、螢光殘留區及6部位螢光殘留數有統計差異（p<0.05）。其中，指甲修飾與螢光殘留之差異，提示臨床人員手部衛生教育除正確洗手步驟外，亦應將指甲照護規範及高風險殘留部位列為後續衛教與管理重點。針對組別A-paired（n=38）進行分析，結果顯示在教育訓練後的兩次追蹤中，整體螢光殘留率由初測的65.8%（25／38）顯著降至複測的28.9%（11／38）（p<0.05）。其中，指甲／指尖部位的殘留率亦從44.7%（17／38）降至18.4%（7／38）（p<0.05）。顯示在教育介入後，並透過再次測試與回饋，能有效提升手部清潔表現。
此外，外科加護病房感染密度由2022年8.7‰降至2023年7.1‰（p=0.216），雖呈下降趨勢但未達統計顯著；持續監測至2024年感染密度下降至6.1‰，與2022年相比達統計顯著差異（p<0.05）。
本研究顯示螢光檢測結合手部衛生教育措施，有助於提升醫療人員的手部清潔行為及加護病房感染密度下降呈現正向關聯。研究結果亦提示，指甲照護規範與指甲／尖等高風險殘留部位，可列為臨床人員手部衛生教育與感染管制管理之重要改善重點。

Intensive care units (ICUs) are core hospital facilities for the care of critically ill patients and are also among the areas with the highest medical resource utilization and risk of infection. Previous studies have shown that approximately 60% of ICU patients develop infections, which contributes to a further 1.5-fold increase in the risk of mortality. This study was initiated in November 2022, when the infection density in a surgical intensive care unit (SICU) of a medical center rose to 15.6‰—markedly higher than the 2021 average of 8.0‰. Following analysis, inadequate hand hygiene was identified as one of the major contributory factors. Accordingly, standardized hand hygiene education and training were introduced, along with an innovative high-resolution fluorescence detection technique that uses highcontrast images to clearly identify areas missed during handwashing. Our aim in this study was to determine whether the implementation of hand hygiene education combined with fluorescence detection was associated with a reduction in the infection density within the SICU and an improvement in the hand cleanliness of healthcare workers.
A total of 276 participants were included in this study, who were divided into two groups. Group A, the SICU group, consisted of 55 healthcare workers who participated in initial post-education testing between December 2022 and February 2023. Among these individuals, 38 completed both the initial and subsequent post-education tests and were classified as Group A-paired. Group B, the newly employed staff group, consisted of 221 participants who received initial post-education testing between July 2023 and December 2024 through pre-employment training and fluorescence-based handwashing assessment. Cross-sectional comparison between the two groups after the initial education test revealed statistically significant differences in sex, occupational category, nail decoration, fluorescence residue, fluorescence residue area, and the number of fluorescence-positive hand areas among the six assessed regions (p < 0.05). The differences in nail decoration and fluorescence residue suggest that in addition to teaching correct handwashing techniques, nail care regulations and high-risk residual areas should be included as key focal areas in future hand hygiene education and clinical management.
In Group A-paired (n = 38), comparison of fluorescence residue before and after the educational intervention revealed that the overall proportion of fluorescence residue declined from 65.8% (25/38) at the initial post-education test to 28.9% (11/38) at the second post-education test, reaching statistical significance (p < 0.05). In particular, the proportion of fluorescence residue in the nail/fingertip area declined from 44.7% (17/38) at the initial post-education test to 18.4% (7/38) at the second post-education test, which similarly reached a level of statistical significance (p < 0.05). These findings indicate that hand cleanliness improved after the educational intervention. In addition, within the SICU, there was a reduction in infection density from 8.7‰in 2022 to 7.1‰in 2023 (p = 0.216), revealing a non-significant downward trend. Continued monitoring revealed a further reduction in infection density to 6.1‰in 2024, which was significantly lower than that recorded in 2022 (p < 0.05).
The findings of this study revealed that fluorescence detection combined with hand hygiene education may contribute to improving the hand cleanliness of healthcare workers and that these measures are positively associated with a reduction in ICU infection density. These findings also indicate that nail care regulations and high-risk residual areas, such as the nails and fingertips, should be considered important targets for hand hygiene education and infection control management.