提升血液透析室生物醫療廢棄物之分類正確率方案

Improving the Biomedical Waste Classification Accuracy of Hemodialysis Room

醫療廢棄物若處理不當，不僅讓人員暴露在高風險環境中，亦會造成環境的危害，並提高處理成本。本單位醫療廢棄物分類稽核異常率高達20.7%，引發專案小組改善動機，目的在提升生物醫療廢棄物之分類正確率。
本專案執行期間自2019年1月1日至12月31日，根據現況分析發現問題：醫護人員、病人與陪病者對廢棄物分類認知不足、護理指導工具不足、廢棄物桶標示不清、工作車的分類設備不完善、缺乏考核獎懲制度。經由：安排在職教育訓練、製作標準分類提醒圖表、製作衛教手冊及海報、拍攝宣導短片、製作分類清楚標示圖卡、增加行動護理車分類設備和設計可分類完善收針車、訂定完整稽核制度及獎懲辦法。結果分類行為正確率由57.9%提高至93.3%；分類稽核異常率由26.4%降為5.1%；醫護人員認知由70分提高至100分；民眾認知由52分提高至85分，達到專案目標，有效提高醫療環境的安全及照護品質。

 

Background & Problems: The most significant cause for peritoneal dialysis (PD) patients to drop out is peritonitis. Our PD center is located in a medical center in Northern Taiwan. The peritonitis rate of our center increased from 1.51 episodes per 100 patient-months in 2014 to 2.37 episodes per 100 patient-months in 2015.

Purposes: To (1) understand the causes of peritonitis among peritoneal dialysis patients, and (2) further implemented an effective retraining program to reduce peritonitis rate.

Resolution: We developed a checklist including peritonitis prevention cognition and exchange technique. Retraining program was refined with continuous adjustment. Holding group education, setting up educational posters and delivering leaflets to convey information about peritonitis prevention were also applied.

Results: After initiating the refined retraining program, infectious episodes decrease to 4 times/month form 8 times/month on average in the last 3 months. Peritonitis rate significantly went down to 0.94 episodes per 100 patient-months from 2.37 in 2015.

Conclusion: The refined retraining program showed that a coherent procedure assessing system and a comprehensive cognition/ technique evaluation could lower the peritonitis rate.