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| 題名: | 新冠疫情下住宿型機構感染管制經驗之研究：以嘉義長照機構為例 |
| 其他題名: | A Research on the Infection Control Experience of Residential Care Institutions during the Pandemic Covid 19: A Case of Chiayi Area |
| 作者: | 林美嘉
LIN, MEI-CHIA |
| 貢獻者: | 生死學系碩博士班
孫智辰;賴添福
SUEN, JR-CHEN;LAI, TIAN-FU |
| 關鍵詞: | 感染管制;住宿型機構;新冠疫情
infection cont;accommodation institutions;COVID-19 |
| 日期: | 2023 |
| 上傳時間: | 2023-11-13 13:21:38 (UTC+8) |
| 摘要: | 我國在2019年爆發嚴重的新冠肺炎疫情後，陸續傳出住宿型機構群聚感染之情形，為解決新冠疫情下住宿型機構在感染管制上發現的問題，本研究重點落在(1)工作人員管理與人力調度(2)住民安置與健康管理(3)工作人員與住民篩檢原則(4)外部人力與訪客管理(5)環境清潔與消毒等五大面向探討。因此，本研究採用個案研究法，針對目前在住宿型機構工作之9位工作人員為對象，進行住宿型機構在感染管制上的經驗探討。依此，本研究的研究結果如下：（一）工作人員管理與人力調度：(1)依機構建築物類型規劃隔離空間(2)進出隔離室流程規劃及專人負責(3)緊急召回人力支援(4)工作人員與住民篩檢流程(5)落實感染管制教育(6)運用科技照顧改善人力不足(7)照顧相關科系學生支援(8)確診工作人員返回職場；（二）住民安置與健康管理：(1)住民與工作人員體檢原則(2)疑似感染症狀住民之處理(3)住民就醫流程(4)洗腎住民人數控管(5)傳染病個案隔離情形；（三）工作人員與住民篩檢原則：(1)工作人員與住民施打疫苗情形(2)特殊個案就醫返回之快篩原則(3)確診之工作人員及住民就醫流程；（四）外部人力與訪客管理：(1)訪客探視流程(2)詢問TOCC旅遊史及體溫監測(3)防疫物資及感控教育訓練；（五）環境清潔與消毒：(1)定期執行環境清潔與消毒(2)高頻率接觸區域之消毒(3)終期消毒之規範。本研究最後依據研究結果提出數點研究建議如下：一、政策面建議：（一）疫情指揮中心應與地方主管機關防疫政策一制，在疫苗施打順序以及PCR篩檢時機、次數等，如指揮中心與地方主管機關政策不一致時，在實務執行上會出現各有各的作法，導致機構像無頭蒼蠅一樣無所適從。因此，建議中央應依照機構屬性、床位數、人力預先規劃可調整的空間。另，盤點各地區醫療資源、檢疫所、防疫旅館、防疫物資、人力資源等來修訂計畫的可能性。（二）地方主管機關應成立防疫小組，依各項指標決定應「立即清空」或「就地隔離照顧」等，並協助機構執行且提供相關資源，以防止疫情擴大時導致無法控制的局面。（三）機構應依各項指引針對應變整備作戰計畫作滾動式修正、盤點機構內各項資源、空間規劃、防疫物資、外部人力的備援、機構內各類人員及住民管理、環境清消等，且制定符合各類型機構適用的防疫演練。二、機構面建議：（一）針對衛生福利機構（住宿型）因應COVID-19之應變整備作戰計畫應重新檢討：建議分區的部分只針對工作人員（直接接觸者及非接觸住民者）及住民（全癱臥床者及有行動能力者）來作區分。（二）依據有無確診個案編列快篩、PCR篩檢、疫苗施打順以及施打的涵蓋率。（三）針對新住民、新工作人員、洗腎個案、住民住院等加強防疫措施。（四）依據機構建築物類型、樓層、住民人數以及失能狀況編列分艙的空間規劃，並加入防疫旅館、檢疫所等外部隔離資源。三、管理面建議：建議機構加強員工教育訓練增強向心力，以防止疫情期間之離職潮或同仁之間的不和睦。機構主管平時應建立良好溝通管道，且應在第一時間提供正確的疫情消息及應變措施讓工作人員以及家屬有完善的防疫資訊。四、照顧面建議：關於疫情期間大多人力皆投入防疫工作，導致機構人力不足，而機構在照顧人力比上出現無法負荷之情形。建議可加強智慧系統設備等非接觸式照顧，例如：感測系統或消毒機器人，透過遠端醫療減少就醫感染，在疫情期間禁止探視，可運用APP讓家屬參與長輩照顧過程，有助於穩定住民情緒以及解決家屬的疑慮。依此建議期待能作為住宿型機構在感染管制經驗上之參考。
After the outbreak of the severe COVID-19 epidemic in 2019, the situation of cluster infection in residential institutions continued to be reported in our country, in order to solve the problems found in infection control in residential institutions under the COVID-19 epidemic. This study focuses on (1) staff management and manpower management (2) resident placement and health management (3) staff and residents policy (4) external manpower and customer management (5) environmental cleaning and disinfection. Therefore, this study uses the case study method to explore the experience of infection control in residential institutions based on the nine workers currently working in residential institutions. According to this The results of this study are as follows: (1) staff management and manpower management: (1) isolation space according to machine building type planning (2) entry and exit compartment process planning and specialist training (3) urgent recall of manpower support (4) staff and residents management process (5) implementation of infection control education (6) use of science and technology photography to improve manpower shortage (7) related departments Student support (8) to ensure that staff return to the workplace (2) settlement and health management of residents: (1) principles of residents and staff system (2) handling of residents with suspected infections (3) resident management procedures (4) washing of residents (5) quarantine of cases of infectious diseases (3) guidelines for staff and residents: (1) vaccination between workers and residents; (2) policies for quick return in special cases; (3) confirmed staff and resident care procedures; (4) external manpower and customer management: (1) customer visit process (2) review of TOCC travel history and sports surveillance (3) epidemic prevention and control education programs (5) Environmental cleaning and disinfection: (1) carrying out environmental cleaning and disinfection on a regular basis; (2) disinfection in areas with a high rate of exposure; and (3) regulations on periodic disinfection. According to the results of this study, the final recommendations of this study are as follows: 1. Policy recommendations: (1) the epidemic control center should be in line with the epidemic prevention policy of the local competent authorities. In the sequence of vaccination and the timing and number of PCR, if the policies of the center are inconsistent with those of the local competent authorities, there will be different practices in practice, which will lead to the same compliance of the agencies. Therefore, it is recommended that the central government should plan the space that can be adjusted in advance according to the mechanism, the number of beds and manpower. In addition, we should focus on the possibility of purchasing resources, quarantine offices, epidemic prevention tours, epidemic prevention materials, human resources, etc., in various regions. (2) the local competent authorities shall set up epidemic prevention teams, according to the specifications of each item, should “immediately clear” or “local quarantine photos”, etc., and assist the institutions to carry out and provide relevant resources, so as to prevent the epidemic from becoming uncontrollable. (3) the organization shall, in accordance with the guidelines, make dynamic revisions to the planning and operation of the change equipment, various resources, space plans, epidemic prevention materials, assistance of external manpower, management of all kinds of personnel and residents in the organization, environmental clearance, etc., and formulate epidemic prevention exercises that meet the requirements of various types of institutions. 2. Institutional recommendations: (1) the health and welfare institutions (accommodation type) should be re-examined in response to the changes in the equipment of the COVID-19: part of the proposed sub-area should only distinguish between the staff (those who are directly connected to the residents and those who are not connected to the residents) and the residents (those who share the beds and those who have the ability to do so). (2) the coverage rates of express, PCR, vaccination and vaccination according to incorrect cases. (3) to strengthen epidemic prevention measures for new residents, new staff, washing cases and hospitalization of residents. (4) to make space plans for sorting according to the type of building, the number of residents and the disability of the organization, and add external quarantine resources such as epidemic prevention tours and quarantine centers. Third, suggestions on management: it is suggested that the organization should strengthen the education of staff and workers and strengthen the centripetal force, so as to prevent the tide of quitting work or discord among colleagues during the epidemic. The supervisor of the organization shall establish a good communication channel at ordinary times, and shall provide correct information on the epidemic situation and measures to be taken at the first time so that the staff and families can have complete information on epidemic prevention. 4. follow-up suggestions: during the epidemic period, most of the manpower was invested in epidemic prevention work, resulting in a shortage of manpower in the organization, and the agency was unable to bear the burden in terms of the ratio of care manpower. It is suggested that non-contact care such as intelligent system equipment can be enhanced, for example, people in sensory systems or disinfection machines can be infected less through terminal medical care, and visits are prohibited during the epidemic period, and APP doctors can be used to take care of the process, which will help to stabilize the feelings of the people and resolve the doubts of their families. According to this suggestion, it is expected that it can be used as a reference for residential institutions in infection control. |
| 顯示於類別: | [生死學系(生死學系碩士班,哲學與生命教育碩士班)] 博碩士論文-生死學系碩士班
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