- 學位論文
新冠肺炎疫情衝擊下醫院環境作業安全影響分析及改進措施
Hospital working environment safety under the COVID-19 pandemic：impact analysis and improvement measures
摘要
研究背景與目的： 醫院環境空間規劃複雜，工作環境中潛藏著許多危害因子。2020年新冠肺炎(COVID-19) 疫情爆發，防疫管制措施改變原本醫院空間規劃及動線安排，與環境安全管理可能有衝突，造成危害問題更嚴重。疫情肆虐全球，國際間也陸續發生多起收置新冠肺炎醫院發生嚴重火災傷亡事件，疫情衝擊下醫院環境安全面臨威脅。藉此研究探討疫情期間醫院有那些危害因子可能造成醫院環境作業安全之影響。 研究方法： 本研究蒐集新冠肺炎疫情前後(2019年5月~2022年2月)北部某大型醫學中心醫院環境安全聯合巡檢查核結果，觀察環境安全巡檢缺失率變化情形。研究資料分析方式使用ANOVA檢定及廣義估計式(Generalized estimating equations, GEE)，利用重複測量GEE model分析，進一步探討不同疫情期間、院區及醫療作業場所等在安全巡檢項目的表現差異，並將巡檢發現的缺失樣態羅列整理，找出系統性缺失問題，經專家諮詢會議進行討論，以尋求合適的改善作法。 研究結果： 本研究結果發現，隨著國內COVID-19疫情警戒分級升高，醫院環境安全管理在用電安全及設施、易燃物管理巡檢缺失率呈現上升趨勢，緊急應變缺失率呈現下降趨勢。依ANOVA檢定結果顯示，用電安全及設施缺失率在疫情警戒1級比0級增加0.33%，2級比1級增加0.05%。易燃物管理缺失率在疫情警戒1級比0級增加0.9%，2級比1級增加0.85%。緊急應變缺失率在疫情警戒1級比0級減少1.71%，2級比1級減少0.22%。進一步以GEE分析，其中在用電安全及設施、緊急應變方面GEE分析結果達顯著差異。 此外，各醫療作業場所與一般病房相較，以急診部管理較不理想，加護病房及開刀房則表現較佳，顯見醫院內場所的安全管理成效，易受到不同醫療作業型態而有所差異。綜合本研究數據分析結果及專家會議建議的重點，新冠肺炎相關防疫措施對醫院環境安全的影響，建議要特別重視易燃性酒精乾洗手液的管理、用電安全管理、出入口管制、避難動線及變更管理等的重要性。 研究結論： 新冠肺炎疫情期間火災危害因子多，藉由執行醫院環境安全巡檢有助於監測醫院潛在危害因子，可避免重大危害之發生。未來新興傳染病發生，醫院的環境安全管理也可能會面臨類似的挑戰，以期本研究結果可以提供醫院防疫環境安全管理更精進的改善參考。唯有不斷追求更高標準的安全環境，才能提供最高品質的醫療服務。
並列摘要
Background and Aim: Demanding highly complex spatial planning for meeting specific needs, hospital environments house a plethora of hidden hazard factors. The problem has been aggravated since the outbreak of the novel coronavirus pneumonia (COVID-19) in 2020 as pandemic prevention and control measures trigger changes in existing traffic flow and space plan that may be in conflict with environmental safety management. Serious fires and other workplace accidents in hospitals treating epidemic COVID-19 patients have been reported around the world, highlighting the impacts of the epidemic on the environmental safety of hospitals. The study accordingly aims at exploring the hazard factors threatening the safety of the hospital working environment during the epidemic. Methods: The outcomes of the regular joint inspections of environmental safety at a medical center in northern Taiwan conducted before and after the COVID-19 outbreak (May 2019 to February 2022) were collected for comparing and examining the identified defects. The research data analysis method uses ANOVA test and GEE (generalized estimating equation) model analysis. The GEE model was adopted for repeated measure analysis to trace the changes in the performance of inspected items at different hospital campus and facilities, under different healthcare environments, and during the pre- and post-outbreak periods. The defects were examined to help identify patterns for locating problems of systematic deficiencies. A meeting with experts was then held to discuss and develop appropriate improvement measures. Results: As the study results indicate, the rise in the domestic COVID-19 epidemic alert level was associated with a corresponding growth in the defect rate of “electricity and facilities safety” and “management of flammable substances” in hospital environmental safety management, and the “emergency response” defect rate showed a downward trend. According to the ANOVA test results, the “electricity and facilities safety” defect rate increased by 0.33% in epidemic grade 1 compared with previous condition grade 0, and increased by 0.05% in grade 2 compared with grade 1. The defect rate of “management of flammable substances” in epidemic grade 1 increased by 0.9% compared with previous condition grade 0, and grade 2 increased by 0.85% compared with grade 1. The emergency response defect rate was reduced by 1.71% in grade 1 compared with grade 0, and reduced by 0.22% in grade 2 compared with grade 1. Through GEE analysis, we found a significant difference in “electricity and facilities safety” and “emergency response” before and after the outbreak. In addition, compared to that of the general ward, the performance of the emergency department in environmental safety management appears to be poorer, while the intensive care unit and operating room report better performance, a finding suggesting that the effectiveness of environmental safety management in a hospital is susceptible to the type of department or facility. Based on the analysis of study results and the key recommendations of the consulted experts, COVID-19-related prevention and control measures do exert significant impacts on several aspects of hospital environmental safety. Special attention should be directed to monitoring the use of flammable alcohol-based hand sanitizer, electricity safety, access control and evacuation routes and implementing responsive change management. Conclusions: During the COVID-19 epidemic, there are many fire hazards. Inspection of workplace environmental safety can help monitor potential hazards in hospitals, avoid major hazards. The challenges confronting hospitals in their environmental safety management during the time of COVID-19 are likely to resurface with the outbreak of new infectious diseases in the future. It is hoped that the findings of this study can help improve environmental safety management of hospital to assist epidemic prevention and expedite continuous pursuit of better quality of healthcare.
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