疫情中的暗黑角落 2020-2021年間北部某區域醫院嚴重特殊傳染性肺炎群聚事件之清潔人員歷程探討

Abstract

COVID-19疫情期間，北部某區域醫院於2021年初爆發群聚感染事件，歷經照護分流、隔離及多次大規模清消，直至2021年2月19日恢復營運。在這次重要的防疫戰役，清潔人員肩負重度辛勞的清潔工作，卻被隱沒在角落，期間對清潔人員之身體、心理、家庭及社會關係造成之影響及危害為何，是否獲得良好的職業安全保護，於國內研究資源相當缺乏。因此本研究採探索性研究，以質性研究方法，一對一深度訪談，進行系統性資料分析整理，比較現行因應疫情發展之國家政策、法規及醫院規範，與實際清潔人員執業現象之差異探討。 本研究共訪談10位歷經A醫院群聚感染事件之清潔人員，發現工作內容、清潔工具、清潔頻率和清潔溶液的發生了變更，身體方面發生呼吸道刺激（咳嗽、鼻子過敏）、眼睛刺激疲倦、肌肉骨骼疼痛，疲累等身體健康問題；心理方面擔心影響家人、獲得訊息之不完整、不熟悉防護裝備穿脫、重複之新聞報導、沒有受到篩檢，發生了焦慮、害怕及壓力感受並且影響睡眠品質，另外疫苗的快速施打及完整的防護裝備可降低其心理壓力；家庭方面，因擔心影響同住家人之就醫及就學權益而被迫休假或離職而影響收入；社會關係方面清潔人員經歷被標籤化、社會歧視等感受，且發生社會隔離。研究結果也發現相較醫護人員，醫院清潔人員有五項不平等現象，與其勞動派遣身分相關之包含防疫物資(未獲得足夠及合適防護裝備)、資訊、防疫津貼與相關職業災害補償、休息環境及權力結構的弱勢。 為維護派遣勞工之職業安全及工作權益，建議政策面，政府應盡維持社會公義原則，消弭派遣階級身分相關社會不平等現象之勞動權益侵害，政策應由制定「派遣勞工專法」方向，朝向廢除勞動派遣之非典型勞動方式，使清潔人員獲得完整法規保障工作權益及社會尊重。建議修訂醫療機構群聚感染之清潔消毒規範，禁止使用氣霧或噴霧型的化學清潔用品，由政府部門針對醫療機構及廠商定期稽核及執行相關罰則，另建議提升執行嚴重特殊傳染性肺炎補償津貼金額；醫療機構面，建議直接聘僱清潔人員，其相關權利、福利及教育訓練應等同正式員工，由相關單位分責負責及實施，落實相關教育訓練宣導、執行及稽核機制，醫療機構也應重視清潔人員身心、家庭及社會關係層面需求，重視相關權益維護及福利保障。

During the COVID-19 pandemic, a cluster infection outbreak occurred at a hospital in the northern region in early 2021. After undergoing patient care triage, isolation, and multiple large-scale disinfection efforts, the hospital resumed operations on February 19, 2021. In this critical hospital epidemic prevention battle in Taiwan, the cleaning staff undertook intensive cleaning tasks but were often overlooked. The impact and harm caused to the cleaning staff’s physical, psychological, family, and social environments during this period and whether they received adequate occupational safety protection are under-researched domestically. Therefore, this study aims to explore these aspects using qualitative research methods, such as in-depth one-on-one interviews, and systematically analyzing the narrative data. It also compares current national policies and hospital regulations in response to the pandemic with the actual work conditions of cleaning staff. The findings of this study could potentially influence policy changes to improve the working conditions of the cleaning staff, making it a significant contribution to the field. This study interviewed 10 cleaning staff members who experienced the cluster infection event at Hospital A. It was found that the content of their work, cleaning tools, cleaning frequency, and cleaning solutions had changed. Physically, they experienced health issues such as respiratory irritation (cough, nasal allergies), eye irritation and fatigue, musculoskeletal pain, and exhaustion. Psychologically, they were worried about affecting their families, received incomplete information, were unfamiliar with putting on and taking off protective equipment, were stressed by repeated news reports, and were not tested, leading to anxiety, fear, and stress, which affected their sleep quality. Rapid vaccination and complete protective equipment could reduce their psychological stress. In their family lives, they were forced to take leave or resign due to concerns about affecting their cohabiting family members' medical and educational rights, thereby impacting their income. In their social relationships, cleaning staff experienced labeling, social discrimination, and social isolation. The study also found that, compared to medical personnel, hospital cleaning staff experienced five inequalities related to their status as outsourced labor. These include insufficient and inadequate protective equipment, lack of information, lack of pandemic-related allowances and compensation for related occupational hazards, poor rest environments, and a disadvantaged position within the power structure. To safeguard the occupational safety and work rights of dispatched laborers, it is recommended that the government uphold the principles of social justice to eliminate the social inequalities associated with the status of dispatched laborers and the infringement of their labor rights. The policy should establish a "Special Law for Dispatched Laborers" and move towards abolishing non-standard labor forms such as labor dispatch. This would ensure that cleaning personnel receive comprehensive legal protection for their work rights and social respect. It is recommended that the cleaning and disinfection regulations in medical institutions be revised to prohibit the use of aerosol or spray-type chemical cleaning products during cluster infections. Government departments should conduct regular audits and implement related penalties for medical institutions and manufacturers. Additionally, it is suggested that compensation for the execution of severe infectious disease allowances be increased. From the perspective of medical institutions, it is recommended to hire cleaning personnel directly. Their rights, benefits, and training should be equivalent to regular employees. Relevant units should be responsible for and implement related education and training, execution, and audit mechanisms. Medical institutions should also pay attention to the physical, mental, family, and social relationship needs of cleaning personnel, ensuring the protection of their rights and welfare.