臺灣衛生署立醫院院內感染控制作業的集體推動及其檢討

Promotion of Nosocomial Infection Control Functions at 23 Department of Health Hospitals in Taiwan

許清曉(Clement C. S. Hsu) ； 謝國珍(Guo-Jen Hsieh) ； 莊意芬(Yi-Fen Zhuang) ； 劉勝芬(Shen-Fen Liu) ； 馬桂美(Guei-Mei Ma) ； 梁瓊芳(Chuong-Fang Liang) ； 王妙娟(Miau-Juen Wang) ； 劉淑媛(Shu-Yuen Liu) ； 林靜(Jing Lin) ； 簡麗暖(Li-Nuan Jien) ； 王曉慧(Shiaw-Hw)

《院內感染控制雜誌》 12卷3期 (2002/06) Pp. 137-143

摘要

民國八十八年台北、桃園、新竹、豐原、雲林、花蓮等六家前省立醫院由衛生處主持，聯合推動院內感染控制作業。主要方式為感控護理師每月互相訪視、觀摩、討論、改進；結果甚受各家醫院歡迎。民國八十九年度，在衛生署中部辦公室推動下，將院內感染控制作業在全部23家衛生署所屬急性病醫院予以積極的改善與落實。執行主要方式為：1）訂定十一項需要改善之作業；2）將全台灣分為四區，由原六家醫院之較有輔導經驗的感控護理師分別到各區醫院訪視並提出改進意見；3）各區之醫院感控護理師每月互相訪視、觀摩，至少5-6 家醫院；4）在年初及年底各一次，由資深感控護理師對各自所屬區域醫院作業做詳細的評分。結果幾乎每一家醫院感控護理師都對此作業計劃感到獲益良多，實地經驗、知識、信心都大為增加。各醫院之稽核評分也從年初之58分增加為年底之77分。
這項工作能夠順利的在23家醫院內推展兩革，其落實的因素，分析如下：1）以醫院評鑑細節做為作業改善的指標，醫院願意配合；2）感控作業的輔導、建議、稽核、評分，由具有中華民國醫院感染管制學會執照的合格感控護理師執行，格外仔細；3）由多家醫院間互相的觀摩，深入的瞭解其他醫院的優缺點，增加了工作人員的信心；4）一年三次的檢討會上，氣氛友善、討論徹底，促進諮詢管道的暢通；5）中部辦公室推動此項作業的經費充足、決心堅定，更加強了各家醫院人員的改進意願。不過因為有礙於公立醫院人事任用上的限制，各醫院護理人員人手缺乏，兼任感由空護理師的感控作業常成為繁忙的護理業務之外多加的工作，影響所得數據的正確性。此項瓶頸在小型醫院尤甚。為幫助解決這項問題，目前已由中部辦公室規定所有醫院護理長都必須研習，取得院內感染控制學分。如此，希望對減少院內感染、減輕感控護理師監測新個案的工作壓力、及院方對預防院內感染作業的瞭解有所幫助。

關鍵字

署立醫院 ； 感控作業

並列摘要

There are 23 acute care hospitals, varying in size from 12 beds to 536 beds, under the jurisdiction of the Central Office of the Department of Health in Taiwan. In the year 2000, a project was implemented to enhance various nosocomial infection control functions at these hospitals. Several senior infection control nurses (ICN5) were divided into four teams and visited four to six hospitals in each of the four geographic. areas at least twice a year. They inspected each item that was listed as our initial targets for improvement in detail and graded their performance. The items included the following: establishment of appropriate infection control policies; affirmation of the hospital support of hardware, such as computers, desk and space for the workers, proper handwashing facilities, isolation rooms, ventilation systems etc; surveillance of the infections in the intensive care units and the wards; monitoring of drug sensitivities of bacteria isolated; reporting of the contagious diseases to the local authorities; education of hospital employees on the subjects of infection controls; investigation of outbreaks; and periodic checks and recording of sterilization procedures, hemodialysis systems, and employee health, etc. The infection control personnel in each hospital of the four geographic areas visited other hospitals in the area. The result of the grading by the ICNs improved from an average of 58 in the first inspection carried out in the earlier part of the year to 77 in the second inspection during the latter part of the year. The responses of the infection control nurses at these hospitals were also overwhelmingly positive, citing the increase in confidence, friendship among workers, and ready availability of channels to solve problems. A major difficulty remains; the size of the nursing staff of these hospitals has not increased despite the expansion in their bed numbers in recent years. Therefore, at many of these hospitals, the nosocomial infection control procedure is still considered an added extra work for the part time infection control personnel’s daily routine as a nurse. In extreme situations, the validity of their surveillance reports is in doubt. To bypass the problem of the shortage in nursing personnel assigned to the infection control routines, the Central Office has ordered that all present and future head nurses of these 23 hospitals are required to participate in a two-day clinical course of the nosocomial infection control seminars. How this training course for the head nurses is going to affect the quality of the nosocomial infection control functions at hospitals requires further evaluations.

並列關鍵字

DOH hospitals ； nosocomial infection control