精神科病房A型流感群突發之調查及處理

Investigation or Outbreak of Influenza a in A Psychiatric Ward

黃美麗(Mei-Li Hunge) ； 賴芳足(Fang-Chu Lai) ； 林瑞鳳(Chul-Feng Lin) ； 林奇勇(Chi-Yung Lin) ； 劉尊榮(Chun-Eng Liu)

《感染控制雜誌》 17卷3期 (2007/06) Pp. 137-144

https://doi.org/10.6526/ICJ.200706_17(3).0001

摘要

流行性感冒(Influenza)是由流行性感冒病毒所引起的。可分爲A型、B型、及C型3種，其中A型病毒所引起的流行性感冒病人的症狀最爲嚴重，較易造成大規模的流行。2004年8月於某醫學中心精神科病房48位流位住院病人中，共有9位病患出現上呼吸道感染症狀，包括：發燒9位(100%)、咳嗽7位(78%)、喉嚨痛4位(44%)、有痰4位(44%)、流鼻水4位(44%)；畏寒3位(33%)及頭痛1位(11%)。發燒個案包括7名男病患及2名女病患。對9名病患採集喉頭拭子做上呼吸道病毒培養，結果有5名病患(56%)培養出influenza A。8月17日指標個案與來訪家屬有相同的臨床症狀，因此高度懷疑由家屬探訪傳染給病患。由於精神科病房爲－密閉性空間，病患皆在室內活動，極易散播，因此採取以下之感染管制措施，如感染個案集中隔離照護、有發燒病患及所有工作人員配戴外科口罩、工作人員接觸病患前後務必洗手、限制有發燒家屬的探訪、家屬進入探訪前須先量體溫確認無發燒、務必配戴外科D罩才能進入探訪、暫停收住院病患3天及以0.05%(500ppm)漂白水環境總消毒等措施，經由感染管制介入處理及精神科工作人員之配合下，8月26日之後無任何新個案產生。

關鍵字

流行性感冒 ； 精神科病房

並列摘要

Influenza is caused by influenza virus, which can be classified as type A, B, and C. Among them, type A can cause the most severe symptoms on human and may cause pandemic outbreaks. In August 2004, 9 out of 48 inpatients in a psychiatric ward of a medical center suffered from upper respiratory tract infection. All 9 patients (7 male, 2 female) had fever, 7 had cough, 4 had sore throat, 4 had sputum production, 4 had runny nose, 3 had chilly sensation, and one had headache. The average duration of hospitalization was 31 days (20-53 days). The larynx swab was collected for virus culture Influenza A virus was isolated in 5 out of 9 patients. Since no medical staff or any other staff was infected before the episode, we ruled out the virus transmission from staff: to patients. Before the first index case had symptoms, some visitors who showed similar symptoms had visited him on August 17. Therefore we highly suspected the virus was passed to the patient by the visitor. Psychiatric ward is a relatively isolated and close area. Usually patients conduct their daily activities indoors, In such an environment where influenza virus is easy to spread. The following control methods were adopted to contain the infection: infected patients were cohorted, all patients and staff suffering from fever should wear a surgical mask, all staff should wash their hands before and after taking care of patients, visitors with fever should be barred, visitors' temperature should be measured before admitted, visitors should wear surgical masks, the ward stopped admitting new patients for 3 days and used bleach (0.05%) to disinfect the environment of the ward. With the aforementioned intervention and the cooperation of the staff at the psychiatric ward, the outbreak was terminated on August 26.

並列關鍵字

Influenza ； psychiatric ward