| 摘要: | 台灣洗腎人口約4萬5千人，且每年以7%的幅度增加僅次於日本為全球第二，每位洗腎病患皆使用一套醫療耗材，除人工腎臟為可重複使用外其餘皆是單次使用，造成感染性廢棄物持續增加。尤其在健保實施後，醫院收入不足、成本考量及法令規定之下，醫院推動感染性廢棄物源頭減量更顯得重要，因此如何擬定有效方法推動醫院感染性廢棄物減量工作，並有效降低感染性廢棄物產出為本研究主要目的。本研究運用個案研究法，對大林慈濟醫院相關管理單位主管、醫護人員進行訪談、問卷調查、直接觀察以及文獻分析。 研究結果顯示，經歸納分析出增加感染性廢棄物重量因素為未習慣分類、醫護人員分類觀念混淆、病人及家屬缺乏分類認知、垃圾桶太多、標示不清、人工腎臟含水量高、點滴袋剩水、IV set剩水、獎勵未落實，本研究針對以上因素擬定與實施各項感染性廢棄物減量方案包含：教育訓練、增加稽核次數、成立單位稽核小組、分類宣導、增加相關海報標語以及設計血液透析室專用污水收集桶。在實施各項減量方案後感染性廢棄物95年11月至96年2月產量由原每人每床產出0.9公斤，降低至每人每床產出0.778公斤，平均每人每床減少0.122公斤的感染性廢棄物，降低幅度為14%。處理費用則由平均每月支出54,690元降低至平均每月支出48,395元，平均每月減少支出6,295元。另外，醫護人員在醫療廢棄物認知問卷調查後測結果顯示，經由教育宣導之後醫護人員總回答正確率為98.95﹪，回答錯誤率僅1.05﹪，顯示出醫護人員醫療廢棄物認知有效提升。 本研究減量方案除減少感染性廢棄物外也降低環境的衝擊提升病人服務品質，降低醫護人員感染機會使得醫護人員工作更具有保障。
There are approximately forty-five thousand dialysis patients in Taiwan and the annually increasing rate is 7%, ranked top second in the world. Except artificial kidney which can be reused, other consumption materials are used one time only then discarded. As a result, medically infectious wastes increase continually. After implementing national medical care, the hospital income is significantly reduced. Considering the cost and regulation, it is important for the hospital to carry out infectious wastes reduction. The purpose of this study is to set up infectious wastes reduction program to effectively reduce such wastes. This research is a case study in the Da-Lin Tsuchi Hospital. The associated administrative office director and nursing staff are interviewed and directly observed and asked to write questionnaires. The results show that the increase of infectious wastes can be attributed to the following factors: (1) unbuilt habit of classification, (2) confusion of classification from nursing staff, patients and their family members, (3) operation mistakes, (4) too many trash cans, (4) unclear indication signs on trash cans, (5) high water contents of artificial kidney, and (6) dirty water of IV bags and IV sets. This study focuses on these six factors to propose several infectious wastes reduction programs. The experiment period is performed from November 2006 to January 2007.After increasing times of audit and classified guidance, posters and slogans manufacture, decreasing operation mistakes as well as designing specialized sewage collectors for the hemodialysis room, the weight of infectious wastes is reduced from 0.9 to 0.778kg per person per bed. In the average, the amount of infectious wastes is reduced 0.122 kg per person per bed, about 14% relative to previous amount of infectious wastes. The average monthly processing expense is also reduced, from NT$ 54,690 to NT$ 48,395, which creates the savage of NT$ 6,295 per month. Moreover, after the education training, the achievement test of nursing staff for infectious wastes recognition questionnaire indicates 98.95% of questions can be answered correctly. It implies the efficiency of our wastes reduction program on increasing recognition of infectious wastes for nursing staff. By our wastes reduction program, infectious wastes and environmental impact are both lowered, the service quality for patients is raised, as well as the hospital environment is secured. |
