傳染性腸炎之感染管制

Infection Control of Contagious Enterocolitis

洪美娟(Mei-Chuan Hung) ； 張瑛瑛(Ying-Ying Chang) ； 盛望徽(Wang-Huei Sheng)

《內科學誌》 29卷2期 (2018/04) Pp. 81-85

https://doi.org/10.6314/JIMT.201804_29(2).04

摘要

發燒、腹痛及腹瀉是傳染性腸炎(contagious enterocolitis)常見的症狀，病毒、細菌或寄生蟲皆可引起，嚴重者甚至可能出現血便及休克，這些傳染性腸道疾病通常經由污染的食物或飲用水傳染，或透過人與人之間直接或間接接觸而傳播。依據傳染病防治法規定，霍亂、傷寒、副傷寒、桿菌性痢疾、阿米巴痢疾、急性病毒性Ａ型肝炎及腸道出血性大腸桿菌感染症等腹瀉疾病為第二類法定傳染病，臨床醫師診斷後需要於二十四小時內向衛生主管機關通報。此外，其他非法定傳染病但會造成腹瀉的重要病原，如諾羅病毒、輪狀病毒、非傷寒沙門氏菌等，因其常造成大規模群聚事件發生，亦為國內傳染病防治之重點監測項目，不容忽視。傳染性腸炎最直接的傳染途徑為糞口傳染，亦即為個人未保持良好之衛生習慣，直接或間接接觸患者的嘔吐物、排泄物或污染的食品而得到感染。然而近年來由於性行為的開放，經由肛門性交或口交而引起之傳染性腸炎個案也時有所聞，甚至也有發生因未防護的群體性行為造成群聚感染。傳染性腸炎預防方式為如廁後、進食或準備食物前務必勤洗手，做好個人衛生防護，食物應徹底煮熟再食用，手部衛生特別要加強濕洗手方式，因為酒精性乾洗手對於多種傳染性腸道疾病消毒效果差。如果出現傳染性腸道疾病常見的症狀，例如噁心、嘔吐、腹瀉、腹痛、發燒等症狀，病人應在家休息或就醫治療，直到嘔吐或腹瀉等症狀緩解至少四十八小時後，再恢復上學或工作，以降低病原藉由人與人接觸而增加傳播風險。另外，落實標準防護及接觸隔離防護，包括病室安排、執行正確洗手(濕洗手)、適當的環境及器械消毒，是防止這類傳染性腸炎致病菌傳播重要的感染管制方式。

關鍵字

腹瀉(Diarrhea) ； 傳染性腸炎(Contagious enterocolitis) ； 群突發(Outbreak) ； 手部衛生(Hand hygiene) ； 接觸隔離防護(Contact isolation precaution)

並列摘要

Symptoms such as nausea, vomiting, diarrhea, abdominal pain, fever, appear common in contagious enterocolitis. Contagious enterocolitis can be caused by viruses, bacteria or parasites. In severe cases, bloody stools and septic shock may even occur. Transmitted routes of these contagious intestinal diseases are usually caused by contaminated food or drinking water, infected, or transmitted through direct or indirect contact among people. According to the regulation for infectious diseases in Taiwan, some diarrhea diseases such as cholera, typhoid fever, paratyphoid fever, bacillary dysentery, amoebic dysentery, acute viral hepatitis A and enterohemorrhagic Escherichia coli colitis are the second category of notifiable infectious diseases, and the physician needs to notify the health authorities within 24 hours after diagnosis. In addition, other infectious diarrhea pathogens, such as Norovirus, Rotavirus, non-typhoid Salmonella, and so on, also should be alerted to prevent outbreaks at community and hospitals. Contagious enterocoitis is the most direct route of infection of fecal infection, that is, individuals do not maintain good health habits, direct or indirect contact with patients with vomit, fecal or contaminated food and get infected. In recent years, however, cases of contagious enterocolitis caused by anal intercourse or oral sex have also been seen due to the opening up of sexual activities. To reduce the risk of transmission, the implementation of standard isolation and contact isolation protection, including isolation cohorting, proper hand hygiene, appropriate disinfection of the environment and equipment, is important to prevent the spread of contagious enterocolitis.