Journal of Taiwan Occupational Therapy Research and Practice
目的：洗手能預防腸病毒、嚴重急性呼吸道症候群(SARS)、新型流感(H1N1)等疾病感染的發生已是確定事實，慢性精神分裂症患者受限知覺動作及認知功能問題是否能完整執行正確洗手程序與動作仍然有待進一步探討，本研究旨在探討慢性精神分裂症患者之洗手衛生行為，以利衛生行為訓練之參考。方法：本研究採觀察評量方式，以南區某精神障礙養護所之171位病患為研究對象。參考國內疾管局宣導之洗手五步驟自行設計出「正確洗手評分表」，由第一作者親自觀察評量記分。所得資料以描述統計、t考驗、單因子變異數分析、多元迴歸分析等統計方法分析處理。結果：目前慢性精神分裂症患者對手指交扣搓揉、虎口輪狀搓揉、指尖對掌心搓揉、手腕輪狀搓揉及捧水三次沖水龍頭之表現僅在中等以下程度；不同整體功能狀態的受試者在正確洗手表現上有顯著差異(F=59.30, p<.001)；女性、男性之受試者在正確洗手表現是呈現不顯著差異情形(F=.068, p=.317)；不同年齡層的受試者在正確洗手表現上有顯著差異(F=4.03, p=.019)；教育程度不同的受試者在正確洗手表現上有顯著差異(F=5.72, p=.001)；障礙等級不同的受試者在正確洗手表現上有顯著差異(F=10.71, p<.001)。進一步在多元迴歸分析結果得知，對於精障者正確洗手表現層面顯示有預測功能的變項為：安養樓層及自治樓層，這二個變項共可解釋正確洗手表現總變異量的45.0%。其中，安養樓層為重要預測變項。結論：因為低整體功能之慢性精神分裂症病患，其洗手表現分數較低，故洗手訓練時需對該等對象花較多時間或調整教學方法，特別是搓揉之步驟及捧水之動作，需再多次重覆的教育、提醒並協助執行正確洗手方法。建議未來研究可再針對慢性精神病患之認知功能做探討並結合洗手衛生教育課程訓練，來釐清慢性精神病患對搓揉之步驟及捧水之動作之學習成效。
Objective: Handwashing is proven to prevent the infections of diseases such as the entrovirus, SARS, and H1N1 influenza. Whether patients with chronic schizophrenia, often presenting limited perceptual-motor and cognitive function, can correctly implement the correct handwashing procedures and actions is a problem yet to be explored. The purpose of this study is to investigate the handwashing hygiene behavior in patients with chronic schizophrenia in order to facilitate hygiene behavior training. Methods: This study used observation assessment methods, the study subjects are 171 patients in a psychiatric sanatorium in southern Taiwan. With reference to the five steps of handwashing developed by Centers for Disease Control, ROC (Taiwan), a "Correct Handwashing Score Sheet" was designed and used in the study. Results: At present patients with chronic schizophrenia were only able to perform the hand washing steps (rubbing palm to palm fingers interlaced, rotational rubbing of thumb, rubbing fingertips on the palm, rotational rubbing of wrist, and cupping hands under water to rinse tap three times) at a below average level; the overall functional status of the subjects showed significant differences in the performance of correct hand washing (F=59.30, p<.001); female and male subjects showed no significant difference in the performance of correct handwashing (F=.068, p=.317); different age groups showed significant differences in the performance of correct handwashing (F=4.03, p=.019); different educational levels of subjects showed significant differences in the performance of correct handwashing (F=5.72, p=.001); different disability levels of subjects showed significant differences in the performance of correct handwashing (F=10.71, p=.000). Furthermore, results from multiple regression analysis revealed that predictive variables for correct handwashing performance in patients with mental illness are: nursing floor, and autonomy floor, these two variables could explain 45.0 % of the total variance of proper handwashing performance. Among them, the nursing floor, was shown to be the main predicting variable. Conclusion: Poor overall function of chronic patients with mental illness showed relatively low scores in handwashing performance, thus presenting need to spend more time or adjust teaching methods during future handwashing training. In particular, the actions rubbing hands and cupping hands under water requires repeated instruction, reminders and assistance to implement proper handwashing. It is suggested that future research may explore the cognitive function of chronic patients with mental illness in conjunction with handwashing hygiene training courses, to clarify the learning effects of the patients in actions rubbing hands and cupping hands under water.