跳到主要內容

臺灣博碩士論文加值系統

(100.28.2.72) 您好!臺灣時間:2024/06/22 21:21
字體大小: 字級放大   字級縮小   預設字形  
回查詢結果 :::

詳目顯示

: 
twitterline
研究生:吳兆偉
研究生(外文):Chao-Wei Wu
論文名稱:醫院工作人員與環保人員對感染性廢棄物之風險認知研究
論文名稱(外文):Risk perceptions of hospital infectious waste from health-care workers and government inspectors
指導教授:謝賢書謝賢書引用關係
學位類別:碩士
校院名稱:長榮大學
系所名稱:職業安全與衛生研究所
學門:醫藥衛生學門
學類:公共衛生學類
論文種類:學術論文
論文出版年:2006
畢業學年度:94
語文別:中文
論文頁數:78
中文關鍵詞:醫院工作人員感染性廢棄物風險認知
外文關鍵詞:health-care workersinfectious wasterisk perception
相關次數:
  • 被引用被引用:0
  • 點閱點閱:230
  • 評分評分:
  • 下載下載:9
  • 收藏至我的研究室書目清單書目收藏:1
摘要
我國醫療廢棄物的管制主要由行政院環保署所負責,規範的法規為同屬環保署主管的:「事業廢棄物貯存清除處理方法及設施標準」及「有害事業廢棄物認定標準」,然而兩個法令在感染性廢棄物定義上不盡相同。廢棄物管理於院內,可因醫院工作人員對感染性廢棄物的危害認知不同,產生不同的分類行為;於院外,執法人員對其危害認知不同會影響稽核的標準。醫院工作人員的危害認知可能取決於教育訓練,但除非教育訓練的內容使其明瞭法規,否則對感染性廢棄物的認定將會與環保人員有所差異;環保人員的危害認知可能取決於法規,但依據哪一個則不清楚。
本研究以問卷調查方式針對(1)護生;(2)護理人員;(3)廢棄物專責人員;(4)縣市環保局人員;(5) 環保署督察大隊等族群,做不同種類感染性廢棄物的危害認知與分類行為調查。
問卷結果顯示:(1)大多數護生(63.5%)及護理人員(65%)未聽過或不了解感染性廢棄物法規,但這個現象並未見於廢棄物管理人員(20.4%);(2)對於醫院中某些廢棄物是否屬於感染性,醫護人員、管理人員與法規顯然有不同之定義;(3)環保人員對於判定醫院廢棄物件是否屬於感染性廢棄物的認定依據,似是依循「事業廢棄物貯存清除處理方法及設施標準」;(4)環保局人員與督察大隊在判定口罩、尿片與一般用過安瓶(ampoule)是否屬於感染性廢棄物之認定上較不一致。
醫護人員的感染性廢棄物分類行為趨於危害認知原則,環保人員則趨向預防保護原則。
關鍵字:醫院工作人員、感染性廢棄物、風險認知
The two regulations related to the management of hospital infectious wastes are “Standards for Defining Hazardous Industrial Waste” and “Methods and Facilities Standards for the Storage, Clearance and Disposal of Industrial Waste”. However, the definitions of infectious waste described in the above two regulations are not consistent. The segregation behaviors of health-care workers wastes are more or less dependent on the personal risk perception of infectious waste. Environmental inspectors of regulated agencies may adapt different criteria of auditing on the management of infectious waste based on the selective interpretation between two related regulations as well as the personal risk perception of infectious wastes.
The purposes of this study were to investigate the risk perception and the segregation behavior among different groups, namely, nurse students, nurses, on-site waste management staffs, and environmental inspectors in the regulated agencies. The questionnaires were designed and distributed to these four groups.
The results indicated that: (1) most of nurse students (63.5%) and nurses (65%) have never heard of or not familiar with the regulations related to infectious waste management; (2) Some disputes about defining infectious wastes exist between nurses and waste management staffs in the hospital; (3) most of the environmental inspectors in the regulated agencies take a stricter stand which is reflected in the interpretation of “Methods and Facilities Standards for the Storage, Clearance and Disposal of Industrial Waste ”; (4) when categorizing which is infectious waste, masks, diapers and disposed ampoules are the items that induce the largest discrepancy between environmental inspectors of the local government agencies and auditors of the central government agency.
Keyword:health-care workers、infectious waste、risk perception
目錄
目錄 4
表目錄 5
圖目錄 6
一、前言 7
二、文獻探討 9
2-1各國感染性廢棄物之認定 9
2-2 WHO感染性廢棄物之認定 11
2-3感染性廢棄物之比例 12
2-4一般城市廢棄物與感染性廢棄物之微生物危害 13
2-4-1一般廢棄物與感染性廢棄物中病原體的研究 13
2-4-2一般廢棄物產生空氣傳播之微生物研究 14
2-4-3一般廢棄物與感染性廢棄物潛在性之健康危害研究 14
2-5感染性廢棄物對環境、人體的影響 15
三、研究目的 18
四、研究方法與架構 20
4-1問卷設計 20
4-1-1問卷調查內容 21
4-1-2 問卷信度 22
4-2分析方法 22
4-3危害風險分析 24
五、問卷調查結果 28
5-1醫院工作人員結果 28
5-1-1基本資料 28
5-1-2問卷調查結果 29
5-2 環保人員結果 35
5-2-1基本資料 35
5-2-2問卷調查結果 36
六、討論 39
七、結論 45
參考文獻 46
附錄ㄧ 各國感染性廢棄物定義之比較 52
附錄二 護生問卷 57
附錄二 護理人員問卷 62
附錄三 管理人員問卷 67
附錄四 環保人員問卷 72

表目錄
表ㄧ、文獻中感染性廢棄物(HCW)對環境人體危害之資料 15
表二、護理人員與環保人員問卷之信度計算值 21
表三、問卷發放與回收 22
表四、危害風險評估 23
表五、40項感染性廢棄物選項危害風險之推估 23
表六、護生、護理人員與管理人員基本資料 26
表七、護理人員與管理人員年資概況 27
表八、護生/護理人員/管理人員對法規的認知 28
表九、護理人員及管理人員對六種職業危害認知之比較 30
表十、護理人員對廢棄物中所含病原體之風險危害認知 31
表十一、環保人員與督察大隊基本資料 34
表十二、縣市環保人員與環保署督查大隊人員對不同推估風險之醫療廢棄物
的風險認知程度一致性比較 37

圖目錄
圖一、感染性廢棄物管理之概念模式 17
圖二、研究方法與架構 19
圖三、護生、護理人員、管理人員對感染性廢棄物之認定比較 29
行政院環保署,有害事業廢棄物認定標準,http://www.epa.gov.tw/
行政院環保署,事業廢棄物貯存清除處理方法及設施標準,http://www.epa.gov.tw/
行政院環保署,有害事業廢棄物認定標準修正草案,http://atftp.epa.gov.tw/announce/095/H0/02400/095H002400.htm
行政院環保署,事業廢棄物貯存清除處理方法及設施標準修正草案,http://atftp.epa.gov.tw/announce/095/H0/01987/095H001987.htm
行政院環境保護署(2003)清除處理機構清理SARS感染性事業廢棄物加強防疫消毒作業規定
林漢龍,林莉玲,陳國帝,董時堅,謝長良,簡正雄,蔡瑞夫(2003)醫院廢棄物廢水處理技術實地技術輔導期末報告。財團法人工業技術研究院。
財團法人環境資源研究發展基金會(2004).醫療院所訪查成果報告,行政院環境保護署。
勞工委員會勞工安全衛生研究所(1997),勞工安全衛生技術叢書 IOSH86-T-017.安全專有名詞辭典。
勞工委員會勞工安全衛生研究所(1997),勞工安全衛生技術叢書 IOSH86-H-307.醫療院所職業衛生狀況調查。
Australia The Department Environment and Heritage, Hazardous Waste Act, http://www.deh.gov.au/
Hong Kong Environement Protection Department, Waste Disposal Ordiance, http://www.epd.gov.hk/epd/eindex.html
Japan Ministry of the Environment, Watse Management and Public Cleaning Law, http://www.env.go.jp/en/
NIOSH, Infectious Waste, http://www.cdc.gov /niosh/homepage.html
Singapore National Environmental Agency, Environmental Pollution Control Act, http://app.nea.gov.sg/
The Environment Agency, UK.(1992). Controlled Waste Regulaitons, http://www.environment-agency.gov.uk/?lang=_e
US EPA, Medical Waste Tracking Act, http://www.epa.gov/
Almuneef, M., Memish, ZA. (2003). Effective medical waste management: it can be done. American J Infection Control. 31:188-192.
Althuas, H., Sauerwald, M., Schrammeck, E. (1983). Waste from hospitals and sanatoria. Zentralblatt fur Bakteriologie und Hugiene I Abt. Orig. B178: 1-29.
Anon. (1990). The Public Health Implications of Medical Waste. A report to Congress by the US agency for toxic substances and disease registry. Washington DC: Department of Health and Human Services.
Ayliffe, GAJ., Fraise, AP., Geddes, AM. (2000). Laundry, kitchen hygiene and clinical waste disposal. Control of Hospital Infection: A Practical Handbook. (4th ed., pp. 253-256). New York: Oxford University Press Inc.
Barrie, D. (2000). Laundry, kitchen hygiene and clinical waste disposal. Ayliffe, GA., Fraise, AP., Geddes, AM. Control of Hospital Infection. (pp. 239-262). London: Arnold and Oxford University Press.
Belani, A., Dutta, D., Rosen, S., Berg, R., Sigelman, S., Dunning, R., Jiji, V., Levin, ML., Glasser, D., Baker, S. (1984). AIDS in a hospital worker. Lancet, London 1, 676.
Birchard, K. (2002). Out of sight, out of mind…the medical waste problem. The lancet. 359: 56.
Bond, WW. Peterson, ML., Favero, MS. (1981). Survival of hepatitis B virus after drying and storage for one week. Lancet, London i, 550-551.
Bond, WW. (1984). Survival of hepatitis B virus in the environment. Journal of the American Medical Association. 252: 397-398.
Cimino, JA., Mamtami, A. (1987). Occupaitonal hazards for New York City sanitary workers. Journal of Environmental Health. 50:8-12.
Clark, CS., Van, Meers, GL., Bjornsen, AB., Linneman, CC., Schiff, GM., Gartside, PS. (1979). Incidence of viral infection among waste collection workers. Cincinnati: University of Cincinnati Medical Center Institute of Environmental Health.
Cocchiarella, L., Deitchman, SD., Young, DC. (2000). Report of the Council on Scientific Affairs: Biohazardous waste management: what the physician needs to know. Archives of Family Medicine. 9(1): 26-29.
Collins, CH., Kennedy, DA. (1992). The microbiological hazards of municipal and clinical wastes. Journal of Applied Bacteriology. 73: 1-6.
Cook, HA., Cromwell, L., Wilson, HA. (1967). Microorganisms in household wastes and seepage waster from sanitary landfills. Proceedings of the West Virginia Academy of Science. 39: 107-114.
Cooper, RC., Potter, JL., Leong, C. (1975). Virus survival in solid waste leachates. Water Research. 9: 733-739.
Donnelly, FA., Scappino, PV., Brunner, D. (1981). Recovery of faecal indicator and pathogenic microbes from landfill leachate. In Land Disposal: Municipal Solid Waste. EPA 600/9-81-002a. pp37-54. Washington DC: Government Printing Office.
Edward, GC., Richard, AZ. (1979). Assessing reliability. Reliability and validity assessment. (pp. 37-51). Sage Publications.
Ferreira, JA., Tambellini, AT., da Silva, CL., Guimarães, MA. (1999). Hepatitis B morbidity in municipal and hospital waste collection workers in the city of Rio de Janeiro. Infect Control Hosp Epidemiol. 20:591-2.
Gaby, WL. (1972). Evaluation of health hazards associated with solid waste sewage sludge mixtures. Final report on environment protection agency contract No. 68-03-0128. Washington DC: Government Printing Office.
Garner, JS., Favero, MS. (1985). Guidelines for handwashing and hospital environement control. US Public Health Service, Centers for Disease Control HHS No. 99-117. Washington DC: Government Printing Office.
Garvin, ML. (1994). Medical waste management: The problem and solutions. Charney, W., Schirmer, J. Essentials of modern hospital safety. (pp. 427-443). Florida: CRC Press, Inc.
Hagen, DL., Al-Humaidi, F., Blake, MA. (2001). Infectious waste surveys in a Saudi arabian hospital: an important quality improvement tool. American Journal Infection Control. 29: 198-202.
Jagger, J., Hunt, EM., Brand-Elnaggar, J., Pearson, RD. (1988). Rates of needlestick injury caused by various devices in a university hospital. New England Journal of Medicine. 319: 284-288.
Johnson, KR., Braden, CR., Cairns, KL., et al. (2000). Transmission of mycobacterium tuberculosis from medical waste. JAMA. vol 284, no 13:1683-1688.
Kalnowski, G., Wiegand, H., Henning, R. (1983). The microbial contamination of hospital waste. Zentralblatt fur Bakteriologie und Hygiene I Abt. Orig. B178: 364-379.
Kuhn, HB., Peters E. (1991). Emerging trends in infectious waste management. Charney, W., Schirmer, J. Essentials of modern hospital safety. (pp. 185-200). Michigan: Lewis Publishers, Inc.
Kuo, HW., Shu, SL., Wu, CC., Lai, JS. (1999). Characteristics of medical waste in Taiwan. Water, Air, and Soil Pollution. 114: 413-421.
Lundholm, M., Rylander, P. (1980). Occupational symptoms among compost workers. Journal of Occupational Health. 22: 256-257.
Meers, PD., Ayliffe, G., Emmerson AM., Leigh, DA., Mayonwhite, RT. Mackintosh, CA. Stronge, JL. (1988). Report on the national survey of infection in hospitals. Journal of Hospital Infection. (Suppl.).
Miller, G., Fournier, GD., Rugg, B., Frei, A. (1990). Hospital waste management: Where we are. Hospital Material Management Quarterly. 11: 72-81.
Mose, JR., Reinthaler, F. (1985). Microbial contamination of hospital waste and household refuse. Zentralblatt fur Bakteriologie und Hygiene I Abt. Org. B181: 98-110.
Muhlich, M., Scherrer, M., Daschner, FD. (2003). Comparison of infectious waste management in European hospitals. J of Hospital Infection. 55: 260-268.
Peterson, ML. (1971). Pathogens associated with solid waste processing. US EPA publication No. SW 49r. Washington DC: Government Printing Office.
Peterson, ML. (1974). Soiled disposable diapers- a potential source of viruses. American Journal of Public Health. 64: 912-914.
Phillips G. (1999). Microbiological aspects of clinical waste. J Hosp Infect. 41:1-6.
Pruss, A., Giroult, E., Rushbrook, P. (1999). Definition and characterization of health-care waste. Safe Management of Wastes from Healthcare Activities. (pp. 2-19). WHO.
Pruss, A., Giroult, E., Rushbrook, P. (1999). Health impacts of health-care waste. Safe Management of Wastes from Healthcare Activities. (pp. 20-30). WHO
Rutala, WA., Odette, RL., Samsa, GP. (1989). Management of infectious waste by US hospitals. JAMA. 262:1635-1640.
Rutala, WA., Weber, DJ. (1991). Mismatch between science and policy. New England Journal of Medicine. 325: 578-582.
Rutala, WA., Mayhall, CG. (1992). Medical waste. Infection Control and Hospital Epidemiology. 13: 38-48.
Salkinoja-Salonen, MS., Helander, I. Rylander, R. (1982). Toxic bacterial dusts associated with plants. In Bacteria and Plants ed. Rhodes-Roberts, ME and Skinner, FA. Society for Applied Bacteriology Technical Series 10. pp 219-233. London: Academic Press.
Sarri, C., Eng, E., Runyan, C. (1991). Injuries among medical laboratory housekeeping staff; incidence and worker perceptions. Journal of Occupational Medicine. 33: 52-56.
Slade, JE., Pike, EB., Eglin, RP. Colbourne, JS., Kurtz, JB. (1989). The survival of human immuno-deficiency virus in water, sewage and sea water. Water Science and Technology. 21: 125-129.
Sprott, MS., Kearns, AM., Keenlyside, D. (1988). A microbiological study of absorbent pads. Journal of Hospital Infection. 12: 125-129.
Starting health care waste management in medical institutions, WHO, 2000.
Taylor, LJ. (1988). Segregation, collection and disposal of hospital laundry and waste. Journal of Hospital Infection. (Suppl. A), 57-63.
Technical guidance on clilnical waste management facilities(draft), UK Environmental Agency, 2001.
Ware, SA. (1980). A survey of pathogen survival during municipal solid waste and compost treatment processing. EPA 600/88-80-834. Washington DC: Government Printing Office.
Wastes from health care activities: Information from WHO. Journal of Environmental Health. 2003. vol 66, no 1: 40-41.
Weir, E. (2002). Hospitals and the environment. JAMC. 166(3):354.
WHO, (2001). Review of health impacts from microbiological hazards in healthcare wastes(draft).
Zafar, AB., Butler, RC. (2000). Effect of a comprehensive program to reduce infectious waste. American J Infection Control. 28:51-53.
QRCODE
 
 
 
 
 
                                                                                                                                                                                                                                                                                                                                                                                                               
第一頁 上一頁 下一頁 最後一頁 top