運用多項感染管制策略提升清潔人員環境清潔成效

Applying a Multi-faceted Infection Control Strategy to Improve Environmental Cleaning Quality

林信安(Lin Hsin-An)

指導教授 ： 郭鐘隆

國立臺灣師範大學/教育學院/健康促進與衛生教育學系/博士(2022年)

https://doi.org/10.6345/NTNU202200792

摘要

背景：通過清潔組合式照護，減少醫院環境的整體生物負載，通過打破傳播鏈，為感染預防和管制建立了強大的平台。通過實施包括對環境清潔人員進行教育介入在內的政策，來維持環境清潔績效的顯著改善。基於提高環境清潔人員的知識和行為的介入措施，旨在支持他們在日常清潔實踐中的整體合規性。
目的：本研究旨在確定使用環境清潔組合式照護的教育介入是否可以改善環境清潔人員的行為、健康素養、醫院清潔績效和減少醫院獲得性感染。
材料和方法：共納入28名環境清潔人員，他們接受了環境清潔組合式照護的教育介入（兩小時長的課程）。在介入前、介入後和3個月的隨訪中，評估了環境清潔人員的知識、感知的利益和障礙、自我效能、健康素養和清潔績效。
結果：與介入前的分數相比，參與者的ATP分數在介入後或3個月的隨訪中顯著下降（p<0.05）。然而，介入前後醫院相關感染的知識、感知益處、感知障礙、自我效能和健康素養得分沒有顯著差異（均 p>0.05）。與第1次環境清潔後的評分相比，第2次環境清潔後的ATP評分顯著降低（p<0.05）。特別是在第2次環境清潔後，ATP 評分達到了標準。雙向ANOVA分析顯示，與基線自我效能感、健康素養或ATP得分低的參與者相比，基線自我效能感、健康素養或 ATP得分高的參與者在介入後的ATP得分顯著降低（所有p<0.05)。在多元廣義估計方程式 (GEE) 分析中，年齡 < 65 歲 (β=0.508, p=0.025)，高基線知識 (β=1.012, p<0.001)，高基線感知收益 (β=1.034, p=0.003) , 高基線自我效能 (β=0.870, p=0.049) 或高基線 ATP (β=0.790, p=0.001) 與教育介入後健康素養的提高呈正相關。此外，高基線ATP分數（OR=4.195，p<0.001）是預測介入後ATP分數依從性的積極因素，而低教育（OR=0.480，p=0.009）和高基線知識分數(OR=0.481, p=0.023) 是預測教育介入後，ATP得分達標的負面因素。高基線感知利益分數也是預測教育介入後，遵守ATP分數的負面因素，但沒有統計學意義（OR=0.556，p=0.071）。
結論：本研究的結果為探索環境清潔人員的感染管制原則和相關清潔實踐提供了新的見解。使用環境清潔組合式照護的教育介入，表明環境清潔人員的環境清潔性能有所改善。接受教育介入後，清潔性能的改善導致具有較高教育、低基線醫院相關感染的知識或低基線感知利益的環境清潔人員的醫院相關感染知識和環境清潔感知收益增加。研究結果表明，有興趣通過提高醫院清潔績效來減少醫院相關感染的環境清潔人員和政策制定者，應考慮實施環境清潔組合式照護和所描述的介入方法。

關鍵字

醫院相關感染 ； 環境清潔人員 ； 多項感染管制策略 ； 知識 ； 感知收益 ； 感知障礙 ； 自我效能 ； 健康素養 ； 清潔績效

並列摘要

Background: Efforts made routinely to reduce the overall bioburden of the hospital environment through cleaning builds a strong platform for infection and prevention control (IPC), by breaking the chain of transmission. Significant improvements can be achieved in the performance of environmental cleaning, which can be sustained by implementing policies that include educational interventions for environmental service workers. Interventions based on improving workers’ knowledge and behavior are targeted to support their overall compliance within their day-to-day cleaning practices.
Purpose: This study aimed to determine whether educational intervention using an environmental cleaning bundle can improve the behaviors of environmental service workers, their health literacy, hospital cleaning performance and reduce hospital-acquired infection (HAI).
Materials and methods: A total of 28 environmental service workers who received an educational intervention (two hour-long sessions) with an environmental cleaning bundle were included. The environmental service workers’ knowledge, perceived benefits and barriers, self-efficacy, health literacy, and cleaning performance were evaluated at pre-intervention, post-intervention, and 3-month follow-up.
Results: Participants’ ATP scores decreased significantly at post-intervention or 3-month follow-up compared with scores at pre-intervention (p<0.05). However, no significant differences were found in scores for HAI knowledge, perceived benefits, perceived barriers, self-efficacy, and health literacy between pre-intervention and post-intervention (all p>0.05). ATP scores were significantly decreased at post-2nd environmental cleaning compared with scores at post-1st environmental cleaning (p<0.05). In particular, ATP scores met the standard criterion after the 2nd environmental cleaning, with a median ATP score of 267 (range, 71-386). Two-way ANOVA analysis showed that participants with high baseline self-efficacy, health literacy, or ATP scores had significantly decreased ATP scores at post-intervention compared with scores of participants with low baseline self-efficacy, health literacy, or ATP scores (all p<0.05). In multivariate generalized estimating equations (GEE) analysis, age < 65 years (β=0.508, p=0.025), high baseline knowledge (β=1.012, p<0.001), high baseline perceived benefit (β=1.034, p=0.003), high baseline self-efficacy (β=0.870, p=0.049), or high baseline ATP (β=0.790, p=0.001) was positively associated with health literacy improvement after the educational intervention. In addition, high baseline ATP scores (OR=4.195, p<0.001) were a positive factor for the prediction of compliance with ATP scores after the intervention, while low education (OR=0.480, p=0.009) and high baseline knowledge scores (OR=0.481, p=0.023) were negative factors for prediction of up to the standard of ATP score after the educational intervention. High baseline perceived benefit scores were also a negative factor for the prediction of compliance with ATP scores after educational intervention, but without statistical significance (OR=0.556, p=0.071).
Conclusions: Results of this study present new insights into the exploration of infection control principles and related cleaning practices among environmental service workers. The use of an educational intervention with an environmental cleaning bundle revealed improvements in environmental cleaning performance by environmental service workers. Improvement of cleaning performance after receiving an educational intervention resulted in increased HAI knowledge and perceived benefits of environmental cleaning in environmental service workers with high education, low baseline HAI knowledge, or low baseline perceived benefits. Study findings indicate that health services personnel and policy-makers who are interested in reducing HAI by improving hospital cleaning performance should consider implementing both the environmental cleaning bundle and the described interventional approach.

並列關鍵字

Hospital acquired infection ； environmental service worker ； Multi-faceted Infection Control Strategy ； knowledge ； perceived benefits ； perceived barriers ； self-efficacy ； health literacy ； cleaning performance

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