感染性廢棄物暴露之醫療院所人員身心健康調查

The investigation of health status among health care workers exposed to infectious medical wastes.

林豐乾(Feng-Chien Lin)

指導教授 ： 蒲永仁

長榮大學/健康科學學院/職業安全與衛生研究所/碩士(2006年)

https://doi.org/10.6833/CJCU.2006.00040

摘要

醫療保健服務業是照顧全民健康的必要行業。在實施醫療過程中一定會產出廢棄物，這些廢棄物中有些是屬於對人體具有傳染及危害性的感染性廢棄物，所以從來自門診或病房的感染性廢棄物的產出、感染性廢棄物的妥善儲存、到清運路線的規劃及運送、感染性廢棄物的中間處理及最終處理，都有嚴格的規定與控管；但是對於直接與病人接觸的廢棄物產出的醫護人員、接觸到來自病患檢體的醫檢人員及負責廢棄物處理的環保清潔人員卻鮮少有研究探討，本研究目的即在探討醫療院所人員感染性廢棄物的暴露及相關的身心健康狀況。
本研究採橫斷研究法進行，研究樣本為來自分雲林、嘉義、台南地區的七家地區醫院內的員工，以及參加九十三年全國醫療環境衛生與安全污染防制技術訓練研習的醫院人員，總計調查495位醫療院所人員。在這七家醫院中，編制內的病房護理人員、感染科人員、醫護助理、檢驗科人員、廢水處理人員、廢棄物處理人員、醫院工友、行政人員及藥劑師等人員均做抽樣調查。研究資料之收集以結構式問卷進行，調查內容包括參與調查者最近一年來的工作暴露狀況、工作防護、教育訓練、工作壓力感受情形、健康狀況及個人基本資料。在調查過程中，研究者先至醫院實地走訪醫療院所產出、清運及處理感染性廢棄物的情形，再進行問卷設計及抽樣調查。資料分析以SAS統計軟體進行，除了進行描述分析及相關分析外，另外以邏輯迴歸（Logistic Regression）計算危險指標OR(Odds Ratio)值，並進行多因子分析，以控制可能的干擾因子。
研究結果發現，在多因子分析中，控制了暴露量及手套的使用後，每週接觸感染性廢棄物接觸時間與皮膚發紅、皮膚發癢、皮膚起疹或水泡、皮膚乾燥龜裂、脫皮等症狀具劑量效應關係，且與診斷過的接觸性皮膚炎具相關性。此外，在控制了暴露量後，暴露時間和眼睛的酸痛及紅腫等症狀間也具劑量效應關係。由感染性廢棄物接觸時間看來，依暴露類型區分，接觸時間較長的人員依次為檢驗人員、感染廢棄物產出人員及感染廢棄物收集處理人員。
在呼吸症狀及疾病的多因子分析中，在控制了暴露時間、抽煙及口罩的使用後，感染廢棄物的接觸量與呼吸喘鳴、呼吸快且急、聞到臭味及打噴嚏等症狀及慢性支管炎和氣喘等疾病有明顯相關。由感染性廢棄物接觸量看來，依暴露類型區分，接觸量較大的人員依次為感染廢棄物處理人員、檢驗人員及感染廢棄物產出人員。
我們期望醫療院所行政主管能利用妥善人力規劃來減少醫療人員的感染性廢棄物接觸時間，並藉由環境的改善及加強醫療人員個人防護來減少人員對感染性廢棄物的暴露量，以期有效的降低醫療人員皮膚、眼睛及呼吸方面的不適症狀及疾病。

關鍵字

感染性癈棄物 ； 醫療人員 ； 手套 ； 口罩 ； 安全防護

並列摘要

Health care industry is essential for taking care of people’s health welfare. During the process of medical treatments, medical wastes, including the infectious ones, are produced. Regulations and rules have been set not only for managing the infectious wastes produced from OPD (out patient department) and medical wards, but also for storing, planning, transporting, intermediate processing and final processing of these wastes. There are little researches discussing the health conditions of personnel who generate the infectious wastes, such as doctors and nurses, who contact and process the infectious specimen, such as medical technicians, and who dispose the waste such as environmental cleaners or janitors. The goal of this research focuses on the health conditions of the above mentioned health care personnel under exposure of infectious medical wastes.
This is a cross-sectional study that samples staffs from seven local hospitals located in Yunlin, ChiaYi and Tainan counties as well as the attendants of the 2004 Training Conference of National Health Care Environmental Health and Safety Technique of Pollution Controls. There were total 495 health care personnel participating in this study. Among these medical institutes, we randomly sampled the organizational personnel including nurses, infection control personnel, medical/nursing assistants, medical technicians, waste water process personnel, solid waste process personnel, janitors, administrators and pharmacists. A structured questionnaire was developed and distributed to the participants for data analysis. Contents of the investigation include the participant’s workplace exposures, personal protections, trainings, perception of stress, physical health and related personal information. During the inquiry, the author started from walking through some of the hospitals to inspect how the infectious wastes were produced, transported and processed. Afterward, the questionnaire was designed and administered to the selected samples. Data analysis was carried out by SAS. In addition to descriptive analysis and correlation analysis, we use Logistic Regression to calculate Odds Ratios. Moreover, we also proceed with the multivariable analysis by controlling for the potential confounders.
After controlling for the quantity of each contact to the medical infectious wastes and the usage of glove protection, the result of multivariate analysis showed that there were dose-response relationship between hour of weekly contact with the infectious medical wastes and skin symptoms of reddish, itching, rash or blisters, and skin dry or cracking. Also, hour of weekly contact was also associated with contact dermatitis. In addition, after controlling for the quantity of each contact, there was also a dose-response relationship between hour of weekly contact and soreness or reddish swollen of the eye. Examining the weekly hour of contact, according to the type of exposure, medical technicians and infectious control personnel were having the highest hour of weekly contact, followed by infectious waste generation personnel and infectious medical waste collection and process personnel.
For the respiratory related symptoms and diseases, after controlling for the hour of weekly contract, smoking status, and usage of protection mask, quantity of each contact was associated with respiratory symptoms of wheeze and shortness of breath, odor smelling and coughing while contact with the infectious medical wastes, and respiratory diseases of chronic bronchitis and asthma. Examining quantity of each contact, according to the type of exposure, infectious medical waste collection and process personnel were having the highest quantity of each contact, followed by medical technicians and infectious control personnel and, then, infectious waste generation personnel.
We hope that, due to our study, the administrators of the health care industry are able to protect their personnel to shorten the contact time of the infectious medical wastes. They can also design the work to reduce their workers’ exposure to the infectious wastes via improvement of environmental conditions and personal protection enforcement. In so doing, it is expected that the discomfort and illness at skin, eyes and respiratory system among the medical personnel can be greatly decreased.

並列關鍵字

Infectious medical waste ； health care workers ； gloves ； masks ； safety protection

參考文獻

行政院環保署（民93）：有害事業廢棄物認定標準。

張錦標、祝年豐、顏瓊姿（民89）：台灣地區某系統醫院醫事檢驗人員工作壓力及其因應之研究。中華職業醫學雜誌，7輯2卷，77-83頁。

張耀雄(民85)：生物性危害。中華職業醫學雜誌，3輯4卷，147-155頁。

馮兆康、黃建財（民88）：護理人員背部及腿部及肩部肌肉骨骼傷害之相關因子研究。中華職業醫學雜誌，6輯4卷，249-260頁。

毛義方、黃如瑋、陳美蓮、劉珍芳（民91）：環境衛生服務業人員健康評估。行政院勞工委員會勞工安全衛生研究所。