臺灣博碩士論文加值系統

由於內視鏡檢查具有一定侵入性，即使已配戴基礎防護措施，仍可能碰觸到病患唾液或糞水，使致病原可藉此污染醫療設備表面或醫療人員手部接觸，造成交叉散播及抗藥性微生物流行等危險產生。良好的清潔措施是減少傳染病傳播的關鍵，因此本研究以南部某醫學中心之內視鏡室，選定「電子式內視鏡轉接頭」為試驗區域，採五組比較設計，以便利取樣方式，於2018年5月至7月間，透過ATP生物冷光反應技術進行清潔前後採樣，比較漂白水、Klorsept消毒錠、75%酒精、Cavicide複方消毒液與清水擦拭環境的成效差異，期望最終研究結果能夠有效提供輔助調整院內環境清潔方式，落實院內零感染及保護病人受檢安全。
本研究結果顯示不論是使用清水或四種消毒溶液效果彼此之間並無差異，然僅就比較四種消毒液結果，則顯示漂白水與Klorsept消毒錠效果均較75%酒精與Cavicide複方消毒液效果更佳（χ2=33.78, p=0.00）；本研究結果使用清水進行環境擦拭效果不劣於使用消毒溶液，確立先以清水進行初次擦拭環境的有效性與重要性，應去除大部分髒汙與微生物後再行二次消毒，方可確保達到有效清潔及殺菌的效果。

Endoscopic examination is an invasive procedure. With current basic protective measures, there is still some risk of contamination by contacting patient’s saliva or stool. Pathogens may contaminate the surface of medical instruments or the hands of medical personnel and result in cross-spreading and drug-resistant microbial endemics. Choosing proper cleaning regimens are the key to reduce the contamination. Finding the most effective method to disinfect the working environment can reduce the nosocomial infection transmitted by endoscopy and the medical cost for treating it, and moreover, to ensure the medical quality and patient safety.
From May 2018 to July 2018, this study was conducted in the endoscopic room of a medical center in southern Taiwan. We compared the disinfection efficacy of bleach, Klorsept disinfection tablet, 75% alcohol, Cavicide surface disinfectants with water. We selected the site-electronic endoscope adapter where the endoscopy was plugged into the light source as the test region according to our preliminary results testing contamination level in different sites of examination room. Samples were taken before and after cleaning using ATP bioluminescence technique to evaluate the levels of contamination.
Our study revealed there were no difference in disinfection capability between water and other four disinfectants. Whereas, among the 4 disinfectants, bleach or Klorsept disinfection tablet showed better efficacy than 75% alcohol or Cavicide surface disinfectants (χ2=33.78, p=0.00).
In conclusion, wiping the potential contaminated site with water is as good as using current commonly used disinfectant in removing the pathogens reside on the surface of objects. However, we would suggest to use water cleaning as the first step, followed by other disinfectants to clean endoscopy room or other potential contaminated environment in hospital.

中文摘要........................................................ I
Abstract........................................................II
目錄............................................................IV
圖目錄..........................................................V
表目錄..........................................................VI
致謝............................................................VII
第一章 緒論.....................................................1
第一節、研究背景與動機.............................................1
第二節、研究目的..................................................3
第三節、縮寫之中英文名詞對照.......................................4
第二章 文獻探討 .................................................5
第一節、內視鏡室環境及其相關感染....................................5
第二節、環境終期清潔與消毒.........................................8
第三節、國內常用環境化學消毒滅菌劑種類及其化學特性..................10
第四節、ATP生物冷光反應技術.......................................15
第三章 研究方法及材料...........................................19
第一節、研究架構與研究假設........................................19
第二節、實驗操作流程..............................................21
第三節、實驗消毒方式規劃..........................................23
第四節、實驗測定點規劃............................................24
第五節、實驗測定方法及實驗器材介紹.................................26
第六節、資料處理與分析方法........................................29
第四章 研究結果.................................................30
第一節、成效比較..................................................35
第二節、檢查室環境特性變項與內視鏡電子轉接頭清潔前ATP之相關性.........37
第五章 討論.....................................................38
第一節、內視鏡電子轉接頭使用四種消毒溶液擦拭與清水擦拭之效果探討.......38
第二節、檢查室環境特性變項與內視鏡電子轉接頭清潔前ATP之相關性探討.....40
第六章 結論.....................................................41
第一節、總結......................................................41
第二節、研究限制及建議.............................................42
參考文獻..........................................................43
中文文獻..........................................................43
英文文獻..........................................................45
附錄..............................................................51
附錄1、IRB免審證明.................................................51

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