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研究生:林德育
研究生(外文):De-Yu Lin
論文名稱:感染性廢棄物於院內的安全問題探討-以某醫學中心為例
論文名稱(外文):Study on safety and health issues associated with infectious wastes in a health care facility – a case study of a medical center in Taiwan
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:職業安全與衛生學系碩士班
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:2007
畢業學年度:95
語文別:中文
論文頁數:67
中文關鍵詞:感染性廢棄物危害辨識內部稽核
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感染性廢棄物於院內分類、收集、儲存、運送不當,可能造成職業危害。雖然國內對感染性廢棄物的貯存、清除、處理已有完備的法規及較多的研究,但在醫療院所內實際作業的風險較少被探討。
本研究選定某醫學中心為研究對象。該醫學中心除規模較大、聲譽卓著之外,其廢棄物管理制度亦頗為完備。研究方式以實地訪查為主,同時探討感染性廢棄物處理的制度面及執行面。在制度面,探討的內容包括分類、收集、貯存、運送、稽核管理等。在執行面之調查,則以兩個月的時間,定期調查該醫學中心各樓層不同科別和位置,實際瞭解醫院感染性廢棄物之清運作業流程,並訪談相關處理人員。觀察感染性廢棄物之分類及蒐集情形,記錄分類錯誤及有感染風險(如收集袋刺穿、過滿、未綁緊,針頭收集盒未密封等)之狀況。
本研究發現該醫學中心感染性廢棄物處理管理制度面雖完善,執行面上仍有部分缺失,如所有的感染性廢棄物垃圾桶中,分類錯誤佔9.3%;暫存區裡,所有的可燃性及非可燃性的感染性廢棄物垃圾袋中,刺穿、破損者佔3%。
該醫學中心在評鑑上已屬優良,但仍有改善感染性廢棄物處理管理的空間,由此可推知其他評鑑成績低於該醫學中心的醫院,其管理制度與安全衛生上的提升應更有改善的空間。
Inappropriate classification, collection, storage, and transportation of infectious waste within hospital could be harmful to safety and health of hospital employees. Most of attentions on infectious wastes, in terms of regulatory control, were mostly focused on the final incineration plants. Little study has been conducted to investigate the potential risk of infectious waste posed to hospital employees in the collecting and handling processes within the health care facility.
The study selected a reputable medical center which has a well-established medical waste management program. We looked into the management system by reviewing the written procedures of classification, collection, storage, cartage, and internal auditing processes. Besides, we observed every detailed steps of the infectious waste handling process and interviewed the related workers for a month. The improper handlings, including piercing, overfilling, and loosely-tied of collective bags as well as unsealed needle-stick box were found.
The study revealed that the waste management program of the studied medical center is well implemented, but certain improper handlings existed. For example, 9.3% of incorrect classification of infectious waste was observed; piercing or damaged collection bags consisted of 3% of total infectious waste collection bags.
Although the studied medical center has been ranked excellent for its hospital waste management program among the health care facilities in Taiwan, the results indicated that there are still some potential risks present in the handling processes within the hospital. It is reasonable to expect that improper handlings of infectious waste inside hospitals are common phenomena in Taiwan. The concern of occupational health and safety of hospital employees should be taken seriously by the high-level management.
一、前言 1
二、文獻探討 3
2.1感染性廢棄物之定義及分類 3
2.2感染性廢棄物分類之差異比較 5
2.3感染性廢棄物之危害 6
2.3.1病原體 7
2.3.2以空氣為傳播媒介之微生物 8
2.3.3潛在危害 8
2.4醫療廢棄物管理與風險 9
三、研究動機與目的 18
3.1研究動機 18
3.2研究目的 19
四、研究架構與方法 20
4.1研究架構 20
4.2研究方法 20
4.2.1可觀察之項目及相關法令規範 20
4.2.2衛生署評鑑資料蒐集 22
4.2.3稽核表單設計 22
4.2.4觀察處理流程 22
4.2.5實地訪查 23
五、研究結果與討論 28
5.1分類收集 28
5.2安全衛生 29
5.3與其他醫療院所之比較 29
六、結論 34
參考文獻 35
附錄 40
附錄一 美國EPA、MWTA、CDC及OSHA對感染性 廢棄物之定義 40
附錄二 Infectious diseases category(Japan) 43
附錄三 生物醫療廢棄物 45
附錄四 依病原體種類分類之感染性廢棄物 46
附錄五 40項感染性廢棄物選項危害風險之推估 49
附錄六 醫療院所推行醫療廢棄物管理制度自我檢查表 51
附錄七 具風險因子圖例 58
附錄八 各醫院評鑑成績 59
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