利用品管手法提升放射師執行移動式X光檢查之洗手執行率

Using Quality Control Circle to Improve Hand-washing Rate of Radiological Technologist in Portable Radiography

錢信德(Hsin-Te Chian) ； 粟文治(Wen-Chih Su) ； 陳億達(Yi-Ta Chen) ； 黃逸楹(Yi-Ying Huang) ； 葉小琪(Hsiao-Chi Yeh) ； 林佳誼(Chia-I Lin) ； 張永強(Wing-Keung Cheung) ； 曾旭明(Ah-Ming Tsang)

《臺灣醫事放射期刊》 2卷2期 (2014/07) Pp. 57-61

https://doi.org/10.6717/JTMRT.201407_2(2).0007

摘要

手部衛生是近年來世界衛生組織持續宣導之主題，也是各醫療機構努力推行之目標。美國疾病管制中心明確指出洗手是預防院內感染最簡單與重要的方法。藉由洗手不但可以降低感染並且提升病人安全，經文獻查證以新生兒院內感染率為例，在開發中國家如巴西或印尼，超過50 %的新生兒會在新生兒病房得到院內感染，致死率大約在12-52%。相較之下，在已開發國家，新生兒的院內感染率降低了12倍之多，分析原因可歸功於手部衛生的落實。本院2012年上半年度全院性洗手稽核結果，影醫科洗手執行率為38.9%，而分析院內洗手稽核結果後發現主要執行病床邊X光檢查工作同仁佔大多數，因此本部決議推行改善專案：提高病床邊X光檢查洗手執行率。參考2011年及2012年洗手稽核結果，本科過去二年洗手執行率平均為45.7%，經由討論訂定目標將洗手執行率提升改善至75%以上。期望藉由品管圈手法進行資料蒐集與分析，採用魚骨圖進行原因分析，經由小組同仁討論並確立問題，可分為人為、時間、環境三項因素。利用實證醫學的精神，參考文獻中的改善方法，修正執行病床邊照相工作無法落實洗手的可能原因進行矯正措施。經由矯正措施推行後，由2012年洗手執行率38.9%提升至2013年度上半年執行率82%，洗手執行率有效提升並達成預定目標，故專案結案並持續監測。透過本專案能更暸解影響工作人員洗手之因素，提升工作人員洗手執行率，實施之對策可提供臨床參考。

關鍵字

手部衛生 ； 品管圈 ； 魚骨圖

並列摘要

The hygiene of hands, one of the propagating topics of the World Health Organization, has been being promoted in recent years and is a goal that each medical institute endeavors to advocate. The Center for Diseases Control and Prevention in the United States definitely indicates that washing hands is the simplest and significant method in prevention of nosocomial infection. Washing hands can reduce infection and increase safeties of patients. Literature shows that nosocomial infection rate of newborns at newborn wards in developing countries, such as Brazil and Indonesia, is over 50 % and its fatal rate is about 12-52 %. In developed countries, nosocomial infection rate of newborns has declined to one-twelfth of that in developing countries. The main factor is attributed to the fulfillment of the hygiene of hands. According to the result of auditing hand washing of healthcare-givers of our hospital in the early half of 2012, the execution rate of hand washing of radiologic technicians during radiographic procedure was 38.9 % that was analyzed to likely reflect the result of hand washing rate of technicians in performing bed-side portable X-ray. Hence, our department decided to promote a specific program for improving the execution rate of hand washing of technicians during the bedside portable radiography. According to the record of auditing the hand washing in 2011 and 2012, the average execution rate of hand washing of radiologic technicians in the past two years is 45.7 %. After discussion, the goal of execution rate of hand washing of technicians during the bedside portable radiography would be elevated up to 75 %. We decided to achieve this improvement by means of Quality Control Circle (QCC). We did the root cause analysis using Fishbone Chart. The factors affecting the hand washing rate were classified into three factors: human factors, time and environments. Under the spirit of evidence-based medicine, we applied the methods of improvement recommended in literature in order to correct the reasons causing low hand washing rate. The execution rate of hand washing of our technicians was elevated from 38.9 % in 2012 to 82 % in the early half of 2013, which achieved the goal. The specific program finished but the audit of hand washing rate has been being continued. By using this QCC method, the factors affecting the incentive of hand washing of health-care givers can be confirmed and thus an appropriate policy is established to increase the hand washing rate. The example can be a reference for other institutes.

並列關鍵字

Hygiene of hands ； Quality control circle ； Fishbone Chart