醫學中心之室內空氣品質管理現況探討

An Investigation on the Current Status of Indoor Air Quality Management of Medical Centers in Taiwan

林靜華(Ching-Hua Lin)

指導教授 ： 胡憲倫

國立臺北科技大學/工程學院/環境規劃與管理研究所/碩士(2007年)

摘要

醫院因醫療與照護需要所使用的設備、器械、藥劑及化學物質種類繁多，並且病人複雜，因而存在著各種可能造成人體危害之風險。有鑑於此，消基會曾於2005年3月針對台北市二十五家醫院進行室內空氣品質檢測。檢測結果發現，有十家醫院二氧化碳濃度、空氣中懸浮微粒或總細菌數超過參考標準。且行政院環境保護署也於2005年12月30日公告「室內空氣品質建議值」，其適用範圍包含醫療場所。在室內空氣品質日趨重要及國內對於醫學中心之室內空氣品質研究有限之下，維持醫院良好的室內空氣品質，以確保就醫病患、家屬、訪客及醫院工作人員的健康與就醫醫療品質，乃一刻不容緩的課題。
緣此，本研究之目的有二：一、透過問卷調查之方式，對國內醫學中心進行室內空氣品質管理之重要性認知及其因應做法的普查，以實際瞭解國內各大醫學中心對於此一議題的重視程度及其因應的做法策略；並探討不同因子與各項室內空氣品質管理的重要性認知與實際執行情況之差異性為何？二、透過問卷調查之方式，對國內醫學中心進行環保署公告之「室內空氣品質建議值」看法的普查，以實際瞭解國內各大醫學中心對於未來我國在室內空氣品質推動策略、室內空氣品質檢測項目時間及室內空氣品質檢測項目建議值之看法；並探討不同因子與其之差異性，以提供未來我國制定室內空氣品質標準與管制措施之參酌。
本研究分別從二個層面對國內醫學中心進行問卷調查：一、透過「環境政策與規劃」、「環境管理系統之運作」、「檢查與矯正措施」三個構面，探究各醫學中心對於室內空氣品質管理之認知與實際執行情況。二、透過「室內空氣品質推動策略」、「室內空氣品質檢測項目時間」及「室內空氣品質檢測項目建議值」三個面向，探討各醫學中心對此之看法。
本研究主要結果為：一、醫學中心室內空氣品質管理現況：(1)以「環境管理系統之運作」構面認知程度最高(平均數5.389)；在「檢查與矯正措施」構面之執行情況最好(平均數4.226)。(2)對於「醫院應設置環境保護專責單位或人員，統籌建立醫院環境管理業務」之認知程度最高。(3)對於ISO 14000、ISO 9000及OHSAS 18000系列等之國際標準驗證之認知程度最低。(4)以預防退伍軍人菌之執行情況最好。(5)有88.9%的醫學中心贊同「為能有效推動管理室內空氣品質，醫院應對各部門或人員之權責加以界定」。(6)有72.3%的醫學中心認為應擬定「室內空氣品質維護管理措施計畫書」，使其室內空氣品質管理系統更有組織、更完善。(7)行政院環境保護署公告之室內空氣品質檢測項目中，僅二氧化碳(88.8%)、溫度(72.2%)與甲醛(61.1%)等三種檢測項目之執行情況較好。(8)整體而言，國內醫學中心對於室內空氣品質管理的整體重要性認知之總平均數4.953，遠高於整體實際執行情況之總平均數4.084，顯示國內醫學中心對於室內空氣品質管理工作之執行仍顯不足。二、醫學中心對環保署公告室內空氣品質建議值看法：(1)有77.8%的醫學中心贊同應「正式立法規範室內空氣品質管理」。(2)國內醫學中心均認為室內空氣品質建議值應分階段推動管理。(3)有超過五成醫學中心對於粒徑小於等於10微米與粒徑小於等於2.5微米之懸浮微粒檢測時間24小時，均一致表示檢測時間長。(4)有61.1%的醫學中心普遍認為二氧化碳8小時值600ppm之建議值偏低，有趨於嚴格之情勢。
本研究之建議事項為：一、政府層面：(1)進行醫院室內空氣品質評估調查，以訂定適合醫院之室內空氣品質指標值。(2)現行室內空氣品質建議值應正式立法或納入醫院評鑑之規範。(3)應建置醫院室內空氣品質技術指引手冊或相關之資訊網站。(4)應成立室內空氣品質聯合查核小組，對各醫院進行輔導。二、醫學中心層面：(1)應設置專責單位或人員，並確立各部門或人員之室內空氣品質權責。(2)應規劃實施室內空氣品質檢測，以充分掌握醫院室內空氣品質現況。

關鍵字

醫院 ； 醫學中心 ； 室內空氣品質 ； 環境管理

並列摘要

Due to many equipments, machines, drugs and chemical substances used to provide medical and nursing cares, as well as the presence of patients of complicated backgrounds, the hospitals contain various factors that may place human bodies in a harmful situation. In view of these risks, Consumers’ Foundation had inspected indoor air quality of 25 hospitals in Taipei City in March 2005. The findings indicated the carbon dioxide concentration, the number of suspended particles or bacteria of 10 hospitals exceeded the standard. Meanwhile, Executive Yuan Environmental Protection Administration (EPA) on December 30, 2005 promulgated “Recommended Indoor Air Quality Value”, of which the scope of application encompasses hospitals. As the importance of indoor air quality is becoming more and more appreciated, however, there is only limited domestic research on indoor air quality of the medical centers which highlights the urgency of this issue.
Accordingly, this study has two purposes: 1.Through the approach of questionnaire survey, to comprehensively investigate domestic medical centers’ understanding of the significance of indoor air quality management, as well as the corresponding measures they take, in order to identify the degree to which they appreciate the importance of indoor air quality management and the strategies they employ to tackle the problem. It also looks into various factors, as well as the discrepancy between appreciation of the significance of indoor air quality management and the actual implementation. 2. Through the approach of questionnaire survey, to comprehensively examine domestic medical centers’ view of the “Recommended Indoor Air Quality Value” promulgated by EPA in order to understand their perspectives on indoor air quality management strategies, indoor air quality inspection items and schedule, and recommended values for indoor air quality inspection items. It also delves into different factors and their discrepancies in order to provide reference for the government for formulating indoor air quality standard and control measures.
From two perspectives, this study conducts questionnaire survey of domestic medical centers: 1.Through three dimensions – “environmental policy and planning,” “operation of the environmental management system” and “inspection and rectification measures” – it explores the understanding and implementation of the medical centers pertinent to indoor air quality management. 2.Through three aspects – “indoor air quality management strategies,” “indoor air quality inspection items and schedule” and “recommended values for indoor air quality inspection items” – it examines the view of the medical centers on this issue.
Primary findings of this study are as follows: I. Current indoor air quality management of the medical centers: (1) The degree of understanding of “operation of the environmental management system” is highest (average 5.389); implementation in “inspection and rectification measures” is the best (average 4.226). (2) The degree of understanding of the statement that “the hospital ought to establish environmental protection unit or staff to handle its environmental management” is highest. (3) The degree of understanding of international certification standards such as ISO 14000, ISO 9000 and OHSAS 18000 is the lowest. (4) Implementation pertaining to prevention of Legionella pneumophila is most effective. (5) 88.9% of the medical centers agree with the statement that “for effective indoor air quality management the hospital ought to define the responsibility of its departments or staff.” (6) 72.3% of the medical centers believe they should formulate the “indoor air quality management and maintenance plan” to organize and perfect the indoor air quality management system. (7) Among the indoor air quality inspection items published by EPA, only carbon dioxide (88.8%), temperature (72.2%) and formaldehyde (61.1%) are noted for acceptable implementation. (8) In general, the average score of domestic medical centers’ understanding of the significance of indoor air quality management is 4.953, which is far higher than the average score of their overall implementation (4.084). The fact indicates domestic medical centers’ implementation in indoor air quality management requires improvement. II. The medical centers’ view of the recommended indoor air quality value published by EPA: (1) 77.8% of the medical centers agree that we should “formulate law to regulate indoor air quality management.” (2) Domestic medical centers all agree that recommended values for indoor air quality management should be established and implemented stage by stage. (3) Over 50% of the medical centers indicate that the 24-hour inspection time for suspended particles of diameter that is ≤10μm or ≤2.5μm is too long. (4) 61.1% of the medical centers indicate the recommended value of 600ppm per 8 hours for carbon dioxide is too low. There is a trend toward stricter requirement.
Recommendations of this study include: I. Government level: (1) Conduct survey of hospitals on indoor air quality in order to establish appropriate indoor air quality indicators for hospitals. (2) Current recommended values for indoor air quality should be included in the law or in the guidelines for hospital evaluation. (3) Hospital indoor air quality technical manuals or related information websites need to be established. (4) Joint indoor air quality inspection unit needs to be formed to provide assistance for the hospitals. II. Medical centers: (1) Need to establish responsible department or staff and define indoor air quality responsibility of different departments or staffs. (2) Need to plan and conduct indoor air quality inspections in order to control current indoor air quality.

並列關鍵字

Hospital ； medical center ； indoor air quality ； environment management

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