- 學位論文
醫院負壓隔離病房感染管控之調查與評估
Investigation and evaluation of infection management and control in hospital-- Negative Pressure Isolation Wards--
摘要
本研究係實地調查高雄地區，設有呼吸道傳染隔離病房之大型綜合醫院，目的在探討其執行院內感染管控可能發生之問題癥結，並提出具體改善之對策，以為衛生單位及醫院建築設計上之參考。另一方面，比較不同層級醫院間，感染控制管理之差異性。 研究方法上，利用調查問卷，實地訪視各院負壓隔離病房之各區域設備與空間配置、區塊分級與防護具使用、清潔與污物處置情形、感染動線設計以及室內外空調規劃。環境監測上，並以FTIR 和溫濕度計，測量連續24 小時各院的空氣品質(溫度、濕度、CO、CO2)。以及使用安德森一階生物氣膠衝擊器，採集培養生物氣膠(真菌、細菌)；而且藉SF6 示蹤氣體技術，評估負壓隔離病房之換氣率和污染物逸散情形。 本研究實地調查7 所具有負壓隔離病房之大型綜合醫院。結果發現在對於負壓隔離病房的設置與規劃上，並非由等級最高之醫學中心居冠；反而是地區級之教學醫院，在各方面有較妥善的規劃與設計。而動線規劃方面，則發現各院皆未能確實區分乾淨與污染通道動線。 各院負壓隔離病房空氣品質之監測結果，在溫度、濕度、CO 以及CO2 平均值上，分別介於19.55-23.51℃、50.25-67.68%、0-151.69ppb 以及1.45-22.19ppm間，其中只有一家醫院之病房溫度略低於建議值。而各院細菌和真菌生物氣膠濃度則均符合標準，其值介於91.87-312.72 和40.64-240.28CFU/m3 之間，也發現生物氣膠濃度與環境清潔因子間呈現顯著高度相關。換氣率實驗檢測值則介於8.61~21.99 ACH，皆符合我國法規標準。另外，在污染物逸散檢測方面，發現有2 家醫院有污染區氣體逸散至乾淨區之現象，而且其病房，皆有密閉性與換氣率不足之虞。
並列摘要
The goal of this research is to investigate the problem of infection management and control in Kaohsiung general hospitals which have negative pressure isolation wards (NPIW), and bring up the counterplot to health organization and architectural designs in hospitals. Furthermore, the research also compared the difference of infection management and control between different grade hospitals. The structural questionnaire is used to investigate NPIW of each hospital, about the equipment and spatial arrangement , the area classification and personal protective equipment, the dealing with clean and dirt, the planning of infection routes and outdoor/indoor air conditioner. Besides, FTIR and temperature/ relative humidity detector are used continuously to monitor for 24 hours(including temperature, relative humidity, CO and CO2 ). And single-stage bioaerosol impactor is used to collect/ cultivate bioaerosols (including bacteria and fungi). And the SF6 tracer gas technique is also taken to estimate air changes per hour/ diffuse of SF6 in NPIW of 7 general hospitals. The result shows that the medical center is not the champion of setting up and planning the NPIW, on the contrary the district hospital takes the best one. However the infection routes have cross infection on passageway. The air quality monitoring, concluding temperature, relative humidity, CO and CO2 means are showed between 19.55 to 23.51 , ℃ 50.25 to 67.68 %, 0 to 151.69 ppb and 1.45-22.19 ppm in the research hospitals, almost in standard level. The bacteria, fungi concentrations and air changes per hour in NPIW are all in normal range, moreover, bacteria concentration has a high relationship with the degree of clean environment. Two hospitals have detected SF6 in clean areas, and both of them with the problems in airtight function and air changes per hour.