《慈济综合医院品管中心执行长李毅医师》由会员分享，可在线阅读，更多相关《慈济综合医院品管中心执行长李毅医师（63页珍藏版）》请在金锄头文库上搜索。
1、慈濟綜合醫院 品管中心執行長 李毅醫師Jersey General Hospital Fire 18th July, 1859 2005年12月15日中國遼源市中心醫院的大火造成 39名住院病人死亡，事後當局將該院院長、副院 長依失職罪起訴。2006年，莫斯科第17醫院發生火災， 造成45名病人死亡近醫院火災94：94.01.25 埔基醫院空調機房：電線走火94.02.08 台東馬偕醫院放腫科直線加速器ups散 熱(燃物品當堆放)94.12.17 高雄長庚醫院放腫科模型室：燃品 當堆放95：95.05.23 高雄義大醫院美食街：電線走火95.06.09 霧峰澄清醫院管道間：配電盤95.06.2
2、9 台馬偕醫院地下一：電線機房95.09.25 署台東醫院科病房：電線走火96：96.04.02中國附醫廚房：火引燃食用油 97：97.03.08 中國附醫停塔：消防檢修作業失誤97.06.13 口醫院：管道間縱火97.12.17 台大醫院開刀房：電線走火98：98.1.10 馬偕醫院開刀房：電線走火98.1.11 中山附醫地下室：照明配電盤冒煙98.3.15 中國附醫心導管室：配電盤電線短98.5.3 新光吳火獅紀念醫院地下2樓資料室起火Fires in the operating room by Yale D. Podnos, Irvine, CA, and Russell A. Will
3、iams, MD, FACS, Orange, CAthe Bulletin of the American College of Surgeons Vol. 82, Number 8August 1997 In the United States, there are approximately 2,260 reported hospital fires per year, resulting in about one death and 130 injuries. Of these, between 20 and 30 % occur in the operating room. Hist
4、orically these figures were much higher. 台灣病人安全通報系統(TPR)火災事件分 析2005年至2009年6月:已收案之醫療機構公共意外事件共1,063 件，其中火災有126件 2008年至2009年6月已收案之火災意外則有63件，其中5件對 病人造成傷害，中度傷害1件及輕度傷害2 件。原因63件火災通報事件中，77.8機構內有訂定 公共意外事件應變流程(49件)， 發生可能原因部分，以與器材設備相關因 素為最多，共45件，又以器材設備操作不當為最多，共18件，其次為器材設備故障16件，器材設備未定期保養亦有11件。原因63件火災意外中， 以電線走火1
5、7件為最多， 其次為微波爐使用不當15件、 病人或家屬不當行為13件(在病床上抽菸、 以酒精膏煮食物、隨意棄置未熄滅菸蒂)， 因電器故障起火有7件， 醫療人員使用器材不慎引起之火災(如滅菌 鍋、熱敷帶乾燒，將加熱器材置於易燃物 品上等)有4件。案例一家屬發現床頭後牆壁插座突冒黑煙並起火 燃燒，立即拉鈴通知護理站，護理師立即 聯絡中控室維修人員並關閉室內照明電源 ，並以滅火器滅火，查看後插座已燒毀， 周邊牆壁燻黑，幸無人員受傷。原插座缺 乏面版保護蓋，線路外露，加上線路老舊 ，可能因而造成走火。已加保護蓋處理， 並檢查其他插座。案例二病友曾因躲在棉被中抽菸點燃床單而引發火災 ，經制止後已加強防範
6、。但因菸癮大，於月 日破壞消防栓取出電線，將消防栓電線接於 病室插孔內，進行觸電導火，成功後，燃燒紙 箱及報紙製造煙霧，然後吸取煙霧來解菸癮， 因煙霧漸大產生異味且逐漸蔓延，護理人員發 現後，立即前往撲滅並通知主治醫師，前往處 理的同仁因吸入煙霧略感不適，且病人於點火 過程中亦有輕微灼傷紅腫。經主治醫師評估後 ，開立戒菸貼片每天使用。案例三執行手術前備妥電燒機，病人左側貼上全新電燒 導電片（單極迴路版），以75酒精性優碘為病 人消毒，消毒範圍由前頸至前胸乳線，並鋪無菌 布單。完成後，固定手術用物：抽吸管、電燒筆 ，執行電燒筆測試。以75酒精紗布擦拭劃刀部 位，並用乾紗布再擦拭一次。劃刀皮膚層約
7、1.5公 分，拿取電燒刀進行切割止血時，接觸病人第一 時間，主刀醫師及助手驚覺溫度急速升高，立刻 放棄手中電燒筆，隨即發現有煙冒出，病人所戴 的不織布手術帽著火，立即掀起無菌布鋪單散熱 及脫下帽子，結果造成病人後頸部、雙耳廓、肩 膀、背部及肩胛骨（約40*20CM）深二度灼燙傷， 燙傷面積為13.5。醫策會2005年迄今收集27件與使用電刀、電燒 有關之病人燒傷、產生火花點燃無菌布、紗布 ，甚至起火燃燒之事件。 美國緊急醫療照護研究機構(Formerly the Emergency Care Research Institute；ECRI) 調查發現，美國每年約有550650件手術中火 災事件
8、。Most surgical fires occur in or on the patient. The most common location of surgical fires are:During the period of April 2003 to February 2005 Tyco Healthcare Valleylab kept statistics on the number of surgical fires reported by health-care facilities. A total of 51 fires were reported:Root Causes
9、 of Fires :The Fire Triangle :Ignition Sources :Electrosurgical unit Electrocautery unit Laser Sparks tissue embersIgnition Sources :Heat-producing devicesHigh speed drill/burrs/saws Cardiac defibrillators Light sources Fiberoptic light cables Fuel Sources :In or On the PatientHair Gastrointestinal
10、gases Gases in surgical smoke Hydrogen and methane are extremely flammable gases produced by bacteria in the gastrointestinal tract in quantities of up to 200 ml per day. Forty percent of these gases are contained in the large bowel. Human flatus contains approximately 44 percent hydrogen and 30 per
11、cent methane. If in an environment of at least 5 percent oxygen, hydrogen can explode at concentrations of between 4 percent and 72 percent, while methane can explode at concentrations of between 5 percent and 15 percent. In the colon the concentration of oxygen is approximately 5 percent, but this
12、level is increased when oxygen or nitrous oxide is administered during anesthesia.Fuel Sources :Prepping Agents Alcohol Alcohol solutions - Up to 74% alcohol - Flammability warnings - Must dry 2-3 minutes * In ECRIs surgical fire update published February 2006, alcohol-based surgical preps were repo
13、rtedly involved in 4 percent of surgical fires.Fuel Sources :Operating Room AttireBarrier Materials should resist combustion Burn or melt when subjected to oxygen accelerant ALL materials burn more vigorously in the presence of oxygen Fuel Sources :SuppliesMattresses, pillows Blankets, sheets, towel
14、s Sponges, tape, ace bandages, stockinet, steridrapes Gloves Blood pressure cuffs Tourniquets Stethoscope tubing Fuel Sources :Red rubber catheters Pencil tip protectors Other material mistakenly used as insulatorFuel Sources :Anesthesia components carry enriched oxidant gases!Breathing circuits Mas
15、ks and airways Laryngeal Mask Airway Endotracheal tubes Oxidizers :Oxygen Oxygen-enriched atmosphere = O2 above 21% Nitrous Oxide Thermal decomposition of N2O can supply oxygen for a fire Preparing for Fires : Locate and test gas shutoff valves and circuit breakers Evaluate traffic patterns Note loc
16、ation and accessibility of fire extinguishers and alarms Keep wet sponge or towel in basin on back field Preparing for Fires :Fire ExtinguishersCO2 best choice for OR Know location and types Allow staff practice Preparing for Fires :Plan scenario Include safety officer Notify administration Designate observers Use drill evaluat
