拋棄式呼吸防護具認知與密合度調查－以某中型地區綜合醫院為例

Abstract

近年來H7N9、H5N1以及SARS等疾病崛起。醫療從業人員因工作特性，必須暴露於此類危害環境。但由於汙染物發生源之不確定性以及分布的不固定性，除特定疾病之隔離病房外，欲使用通風換氣等手段達到控制的目的在實務上並不可行，使用個人防護具成為不得已的手段。呼吸防護具(Respirator)由於成本低廉、取得容易，往往在第一時間作為危害控制的選擇。但呼吸防護具之保護仰賴兩方面，濾材效率以及呼吸防護具之正確使用及管理。在呼吸防護具濾材效率部分，其QA�QC機制已相對成熟，可藉著檢測標準的制定與執行來加以規範；但在正確使用及管理方面，國內相較於歐美各國，相關機制尚未成熟。 本實務實習研究主要採用三款醫療院所常使用之N95呼吸防護具，利用TSI PortAccount量化密合度測試儀搭配呼吸防護具認知問卷以及羅吉斯迴歸分析、McNemar相依樣本卡方檢定等統計方法，針對北部某地區醫院43名醫療從業人員進行密合度檢點、密合度測試以及呼吸防護具認知研究。冀從中了解現行醫院感染管制機制中醫療從業人員對於呼吸防護具之使用狀況及認知情形、找出醫療從業人員正確使用呼吸防護具的主要因子。 研究結果發現，僅有極少數(2.3%)之使用者能夠正確回答出自己過去使用之呼吸防護具廠牌與型號者；有接近八成(79.1%)之受試者表示呼吸防護具在使用上有不舒適感。在呼吸防護具穿戴方面，僅有1名受試者能夠完全依照呼吸防護具廠商所提供之穿戴方式進行穿戴與檢點，若以單獨步驟來看，正壓密合度檢點動作是最多人遺忘的步驟(79.1%)。而在使用單一型號之呼吸防護具方面，僅有39.5%之人員能夠通過密合度測試。但若搭配多個型號之呼吸防護具使用，整體通過率則可達96.6%。 從統計檢定的結果發現，過去一年有接受呼吸防護具教育訓練者，與正確穿戴呼吸防護具方面有顯著相關。此外在執行呼吸防護具穿戴教育訓練前與教育訓練後，人員在正確穿戴呼吸防護具方面有顯著的改善。顯見教育訓練的重要性。而人員正確穿戴呼吸防護具，對於呼吸防護具的密合係數之間有顯著的正相關，但是對於通過與否方面，則無達到統計上的顯著。

The threats of H7N9, H5N1, SARS and other emerging diseases rise in recent years. Owing to the job characteristic, the Health Care Workers (HCWs) have to expose to such hazards. However, the sources of the contamination and the distribution, with uncertainty attribute, so ordinary control measures, such as ventilation, is impractical. Personnel Protective Equipment (PPE) is one of the last alternative methods. Respirator is not merely have the advantage of cost, but easy to obtain, thus, it been choosed as one of the hazards control countermeasures. The efficiency of respirators relies on two aspects – filtration performance and good respirator management/usage practices. Concerning filtration performance, the QA/QC standards were mature. Yet, compare with filtration performance, the respirator management/usage practices in Taiwan is farer behind than developed countries. This practicum research uses three of most common N95 respirators among healthcare industries as research material, aim at 43 subjects in one of district hospitals in northern Taiwan to conduct fit-check, fit-test and respirator perception survey via TSI PortAccount quantitative fit-tester, questionnaire and statistics methods (i.e. Logestic Regresion, McNemar Test and T-Test etc.) to realize and to find the key factors of respirator usage and perception. In accordance with study, we found that very few of the users (approximately 2.3 %) could answer the manufacturer and model of respirator correctly. Second, near four-fifth subjects reflect they have uncomfortable experiences when they worn respirators. Next, regarding respirator wearing procedures, only one attendee could wear respirator following manufacturer recommendation. Postive pressure test was the step that most of attendee got missed (approximately 79.1%). On the other hand, the study found that only 39.5% attendee could pass quantitative fit-test with single model respirator. Nevertheless, the overall pass rate could reach 96.6% if we collocate with several different respirator models during fit-testing phase. According to the statistical tests result, the personnel who accepted respirator training in the past year, with correct use respirator have significant corelation. In addition, at training aspect, the study found that the attendee improved significantly their respirator wearing after they accepted respirator training. It obviously expresses the importance of respirator training. Lastly, the correlation between the subjects wearing respirator with correct procedure and fit-test factor have postive siginificant relation, but the result of fit-test and subjects wearing respirator with correct procedure didn't have significant corelation between each other.