| 摘要: | 抗癌危害性藥品多數具有高細胞毒性，醫護人員在進行藥品調配、傳送、給藥，照護病人與環境清潔時，皆可能受到暴露，並且有健康危害風險。近年各國紛紛對抗癌危害性藥品訂定相關規範及指引，臺灣腫瘤護理學會亦於2013年提出「抗癌危害性藥品給藥防護作業指引」，是國內目前較詳盡的建議規範。
本研究立意抽樣臺灣北部一家醫學中心(A醫院)與兩家區域醫院(B、C醫院)為樣本醫院，利用自行設計之檢核表(每院藥劑和護理部門各由主管填寫一份)及問卷(以所有接觸抗癌危害性藥品之藥劑部和護理部人員為發放對象)，評估各醫院藥劑部與護理部之指引實施情況和人員遵從程度，並以含鉑藥品(Cisplatin、Carboplatin、Oxaliplatin)之鉑作為環境汙染指標，進行環境採樣分析，並分析三者間之關係。
結果在檢核表部分，三院藥劑部指引實施情況總得分率A、B醫院均高於90%，C醫院則僅78.8%，顯示C醫院較A、B醫院未落實2013年「抗癌危害性藥品給藥防護作業指引」之建議作法；三院護理部的指引實施情況總得分率均超過80%，其中以C醫院最高，達94.5%。問卷部分，藥劑部回收55份有效問卷(回收率78.6%)，護理部回收196份有效問卷(回收率93.3%)。工作人員指引遵從程度，在藥劑部僅傳送藥品題組的得分於三院間達統計上顯著差異，A醫院分數顯著高於B醫院；而護理部亦僅給予藥品題組分數在三院間達統計上顯著差異，B醫院分數統計上顯著高於A醫院與C醫院分數。不論藥劑或護理人員，各種個人防護器具的使用頻率比2006年及2008年高，顯示個人防護有改善的趨勢。環境擦拭樣本分析結果，三院藥劑部清潔前鉑濃度中位數依序為0.36、4.25、18.21 pg/cm2，清潔後鉑濃度中位數依序為0.22、2.22、1.25 pg/cm2；護理部的清潔前鉑濃度中位數依序為1.44、1.75、2.09 pg/cm2，清潔後鉑濃度中位數依序為1.48、1.62、1.68 pg/cm2，環境汙染均屬極低濃度。C醫院藥劑部門之指引實施情況為三院中最差，而其清潔前環境濃度亦為三院最高，然因本研究三家醫院的癌症病人數與抗癌危害性藥品使用量差異大，且環境樣本僅採樣一次，無法推論指引實施情況與環境汙染量之關係。
本研究為國內第一篇評估醫院抗癌危害性指引實施情況以及員工指引遵從程度的研究，雖因選擇三家相關規範較完善的醫院進行調查，環境汙染濃度均低，難以推論醫院指引實施情況、員工指引遵從程度與環境汙染之相關性，不過建議可以於未來擴大研究對象，以本研究開發之檢核表和問卷，建立醫院指引實施情況、員工指引遵從程度與環境汙染之關係，並應用於抗癌危害性藥品的使用管理上，甚至列入癌症診療品質認證之評鑑項目之一。
Antineoplastic drugs were used to treat tumors and cancer, and could result adverse health effects due to their cytotoxic properties. Health care workers might be exposed to antineoplastic drugs when they were handling drugs and cleaning environment. Studies indicated that dermal exposure from surface contamination was the major route of exposure. A Taiwan version guideline of safe handling antineoplastic drugs was proposed in 2013, and was a complete and detailed guideline in Taiwan at the moment.
This study chose a medical center (Hospital A) and two regional hospitals (Hospital B, Hospital C) as sample hospitals by purposive sampling in northern Taiwan. Designed checklist and questionnaire by referring guideline which proposed in 2013 in Taiwan. Checklists were given Pharmacy and Nursing Department to ask “Implemental effect of the guidelines”. Questionnaires were given pharmacists and nurses to ask “Demographic profile”, “Obedient degree of workers”, “Usage of personal protective equipment” and “Management situation of antineoplastic drugs”. Environmental wipe samples were collected before and after cleaning work , while the sites of sampling were from different departments, including pharmacy and cancer nursing care unit. Platinum-based drugs(Cisplatin, Carboplatin, Oxaliplatin) were selected to be the pollution index. ICP-MS was used to detect the platinum concentration.
The implemental effect of the guidelines of pharmacy was 94.9% in hospital A, 90.9% in hospital B and 78.8% in hospital C, and of nursing department was 83.6% in hospital A, 89.0% in hospital B and 94.5% in hospital C. 70 questionnaires for pharmacists were distributed and 55 copies returned with recovery rate of 78.6%, 210 questionnaires for nurses were distributed and 196 copies returned with recovery rate of 93.3%. Transport drugs question group of obedient degree of workers, hospital A was statistically significant higher than hospital B. Given drugs question group of obedient degree of workers, hospital B was statistically significant higher than hospital A and hospital C. The results of the environmental wipe samples, the median of pre-clean in three pharmacies were 0.36, 4.25, 18.21 pg/cm2, respectively. The median of post-clean in three pharmacies were 0.22, 2.22, 1.25 pg/cm2, respectively. The median of pre-clean in three cancer nursing care units were 1.44, 1.75, 2.09 pg/cm2, respectively. The median of post-clean in three cancer nursing care units were 1.48, 1.62, 1.68 pg/cm2, respectively.
This study is the first study to survey the implemental effect of the guidelines, obedient degree of workers, and surface contamination on antineoplastic drugs in Hospital. Although the three sample hospitals had well specification and low surface contamination on antineoplastic drugs, recommend that add the environmental monitoring of antineoplastic drugs into hospital accreditation, and survey the management situation of antineoplastic drugs by using checklist and questionnaire. |
