醫院清潔規範

1. 醫院清潔規範 衛生署 疾病管制局 中區傳染病防治醫療網 王任賢 指揮官

2. 課程重點 • 醫院清潔消毒之重要性 • 醫院清潔消毒之一般原則 • 如何準備清潔劑？ • 低風險及高風險區域如何實行清潔消毒？ • 血液或體液外溢之處理 • 清潔消毒用具該如何儲存？

3. 醫院清潔消毒之重要性 “環境中堆積的灰塵、泥土、 及微生物不但會讓人覺得不美觀，而且也是產生院內感染的潛在危險因子。醫療機構內有必要定期執行有效的清潔以保持乾淨的環境。 (Chou 2002)

4. 一般清潔原則: I • 用力刷(Scrubbing)是最有效的去污及減菌方法. • 任何消毒程序前必須先做清潔工作 • 清潔用具必須依用途、效果、安全性、及價錢進行選擇 • 清潔順序必須由較不髒的地方清到較髒的地方，由高處向低處清潔 • 乾掃把、乾抹布、及打掃都是不允許的

5. 一般清潔原則: II • 消毒劑之使用必須依建議的方法調配 • 清潔方法及頻率必須依清潔表面之特性及用途，塵埃的成分及量來決定 • 例行清潔是必要的，清潔的行程均必須事先固定

6. 清潔消毒劑之配製 • 首選為0.5% chlorine solution(5000 PPM漂白水) ，次選為1–2% phenols或5% carbolic acid • 可在0.5% chlorine solution中加入清潔劑使具有清潔功能

7. Cleaning Methods • 濕拖(Wet mopping)是地板清潔之首選: • Single-bucket (basin) technique; • The solution must be changed when dirty. The killing power of the cleaning product decreased with the increased load of soil and organic material present • Double-bucket technique; • can extends the life of the cleaning solution • Triple-bucket technique • 手術室建議洗地(Flooding) • This process eliminates mopping and increase contact time of the disinfectant

8. Cleaning Methods…Cont’d • Dustingis the most used method for cleaning walls, ceilings, doors, windows, furniture, and other surfaces: • Wet clean cloths or mops • The double-bucket (basin) system is recommended. • Use a starting point as a reference. • Dry vacuumingis only recommended for cleaning carpets

9. 醫院環境表面 • 可能受病原菌汙染 • 但不會直接致病 • 不需使用高階的消毒劑

10. 醫院環境表面之分類 • Clinical contact surfaces • 極有可能經由醫護人員之手套接觸而散播病原菌 • Housekeeping surfaces • 不會接觸病患或儀器之環境表面 • 傳播疾病之機會極低

11. Clinical Contact Surfaces

12. Housekeeping Surfaces

13. 環境清潔之一般原則 • 清潔人員必須穿戴防護 (例如., 橡膠手套, 外科口罩, 眼罩) • 物理方法清洗有與消毒同等之去菌功能 • 消毒劑之調配必須依標示辦理 • 不要在環境中使用滅菌劑或高階消毒劑

14. Cleaning Clinical Contact Surfaces • Risk of transmitting infections greater than for housekeeping surfaces • Surface barriers can be used and changed between patients OR • Clean then disinfect using an EPA-registered low- (HIV/HBV claim) to intermediate-level (tuberculocidal claim) hospital disinfectant

15. Cleaning Housekeeping Surfaces • Routinely clean with soap and water or an EPA-registered detergent/hospital disinfectant routinely • Clean mops and cloths and allow to dry thoroughly before re-using • Prepare fresh cleaning and disinfecting solutions daily and per manufacturer recommendations

16. Handling disinfectants Cleaning patient care areas Cleaning heavily contaminated areas Handling soiled linen Handling soiled items and instruments Handling or disposing of waste When spills or splashes are expected Use of PPE

17. Cleaning

20. Poorly Handled Stretcher

21. How to Clean Spills of Blood and Other Body Fluids • Small spills: • Wearing gloves, remove visible material using a cloth soaked with 0.5% chlorine solution. • Then wipe clean with a disinfectant cleaning solution. • Large spills: • Wearing gloves, flood the area with 0.5% chlorine solution. • Mop up the solution and then clean as usual with detergent and water.

22. Bloodborne Pathogen Spill Kit All medical facilities must have a spill kit. All employees should know where the spill kit is located. It must contain the following items: • Absorbent material to manage ten gallons of fluid • One gallon hospital grade disinfectant and a spray bottle • Many large biohazard bags • 2 sets of disposable coveralls, boots, caps • 2 pair of heavy neoprene gloves • 2 pair of eye and respiratory protection devices • 100 yards of boundary marking tape, 1 roll of packing tape • First aid kit (facilities with an emergency room exempt)

24. How to Clean Soiled and Contaminated Cleaning Equipment • Decontaminate cleaning equipment by soaking it for 10 minutes in a 0.5% chlorine solution. • Wash cleaning buckets, cloths, brushes, and mops with detergent and water daily, or sooner if visibly dirty. • Dry completely before reuse (wet cloths and mop heads are heavily contaminated with microorganisms).

25. Fumigation and the use of UV light • Are common housekeeping practice in many health facilities, • These practices are time consuming, waste valuable resources, and do not decrease the risk of infection in your facility

26. Fumigation (Disinfectant fogging) • Fumigation with formalin or formaldehyde is an ineffective method of reducing the risk of infection, • It is perfect example of a practice that is not based on scientific findings, • Besides being ineffective, these agents are • toxic and irritating to the eyes and mucus membranes • Potential carcinogen

27. Fumigation…Cont’d. • Fumigation is time consuming and makes rooms unavailable for use, • Thorough cleaning with a disinfectant cleaning solution and scrubbing should be used instead of fumigation, • Can safely be used on surgical endoscopes (laparoscopes) because 8% formaldehyde will not corrode metal or damage lensed instruments, plastics or rubber.

28. Ultraviolet (UV) light • In general, this is neither practical nor cost-effective, • In the largest and best-designed scientific study on this topic, no decrease was shown in the wound –infection rate when UV light was used, • UV light is unsatisfactory for general use in health care facilities because:

29. UV light…Cont’d • The killing ability of UV light decreases sharply: • If relative humidity is greater than 60-70% • If dust is present (in the air, on surfaces or on the bulb itself) • UV light doesn’t penetrate most substances (including fluids and organic matter such as mucus)

30. UV light…Cont’d • The intensity of UV light needed to effectively kill microorganisms is damaging to humans. Prolonged exposure can lead to reddened skin and irritated eyes. • UV light fixtures are expensive to install and maintain. • Regular servicing, including dust from the bulbs, is required.

31. Take Home Messages Don’t: • Dry mop or dust • Sweep Do: • Wet mop and dust • Terminal cleaning of the surgical unit every 24 hours • Clean the OR and procedure rooms between patients • Decontaminate, wash, and dry cleaning equipment before reuse

32. 懇請賜教