醫院預防員工感染水痘的策略與效益分析

近年來醫療工作者的疫苗政策及院內感染之醫療成本效益漸為醫界所重視，水痘為來自社區之高傳染性疾病，而以醫院封閉之環境特性，工作於醫院之醫療員工均已淪為易感染之高危險群。本調查係民國89年8月本院新生兒中心經由病患傳染給醫護人員水痘事件，針對藉由兒科系醫護人員進行水痘病史調查及血清抗體檢測，並將有無水痘疫苗政策之成本提列並分析其差距，以了解醫療院所針對員工施行水痘感染防治策略的成本與效益。主要參與調查共八十位；人員有小兒科醫師、護士及治療師。結果發現：血清抗體為陰性佔11.3 % ( 9 / 80 )，並在水痘病史調查中發現自述水痘感染病史陽性可信度為96.7％、陰性可信度為35％。在可計算之金額內，無疫苗政策花費包括流行處理費用（共72,840元）顯然高於有疫苗政策（共42,000元），且尚須承擔許多無法估計之成本，如：管理成本、患者因素（院內感染、病情惡化、隔離…）及潛在性醫療糾紛。建議醫療院所對新進人員及在職人員進行水痘病史調查，無免疫力者給予預防性注射，是可降低工作人員因感染所造成成本損失，而具成本效益的，預防性的水痘疫苗政策，是值得考慮應用。特別是高危險性單位，如小兒科或加護病房的醫護人員應給予預防性疫苗接種，以確保所有的醫護同仁都有保護性的抗體。如能經由施打疫苗而預防感染，則不但可節約醫療成本，更可避免醫療資源的浪費；因員工罹病而產生人力不足之連鎖反應。

關鍵字

水痘；水痘疫苗；成本效益分析；院內感染

並列摘要

In August, 2000, there was nosocomial inction of 3 employees in the New Born Center at our hospital. We therefore undertook a cost analysis of the varicella vaccination policy for the hopital employees. Eighty pediatric staffs, including doctors, nurses, and therapists were enrolled in this survey. The seronegative rate was 11.3% (9/0). Based on all measurable outlays, the cost of this varicella nosocomial infection incidence was NT$ 72,840, including those of the work hours lost and medications for the infected; whereas the cost for the varicella prevention policy is NT$ 42,000, including those for antibody testing and vaccinations. There are immeasurable costs involved in case of nosocomail infections, such as the one for management, potential nosocomial infections to patients with further deterioration of their clinical conditions, costs for isolation, and legal liabilities. Based cn this study, we recommend varicella infection survey for all new and existing medical and nursing staff, with vaccinations for the non-immune individuals.

並列關鍵字

varicella ； varicella vaccination ； cost-effectiveness analysis ； nosocomial infection

國際替代計量

醫院預防員工感染水痘的策略與效益分析

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