臺灣長期照護機構結核病的防治策略探析

The Strategic Framework in Preventing Tuberculosis and Challenges in Taiwan Long-term Care Facilities

林佩瑩(Pei-Yun Lin) ； 林鴻堂(Hung-Tang Lin) ； 姜秀子(Hsiu-Tzy chiang) ； 簡榮彥(Jung-Yien Chine) ； 陳彥旭(Yen-Hsu Chen) ； 薛博仁(Po-Ren Hsueh)

《感染控制雜誌》 28卷5期 (2018/10) Pp. 223-233

https://doi.org/10.6526/ICJ.201810_28(5).0003

摘要

隨著臺灣正式邁入高齡化社會，對長期照護的需求也隨之遽增，依據衛生福利部資料，我國長期照護機構家數近十年已從2007年1,002家成長至2016年1,082家。關於台灣結核病狀況，2016年新增個案數為10,328人（每十萬人口43.9人），其中年齡分布≥65歲者約佔總個案數的56%。國外研究顯示，機構中的長者較一般社區老人高出2.3倍的肺結核感染機率。老年人因免疫功能較差、多共病症與臨床表徵不典型等因素，增加結核病診斷及防治上的困難。國內文獻亦指出，機構內的集體生活，若再加上室內通風不良，則可能導致群聚事件。因此，長照機構中結核病的防治管理與落實是需要重視的議題。本篇主要參考國外對長照機構結核病策略與國內執行現況進行歸納與整理，感管措施主要建立在三個優先等級，第一優先為管理階層控制，其次為環境控制與呼吸道防護三大基本架構來規範，目的為了要降低機構工作人員、服務對象及訪客等感染結核菌的危險性。結核病患完治後，再接觸仍有機會感染及發病，長照機構平時應加強咳嗽禮節與防護，強化照護人員防治知識與處理能力，加上保持良好室內通風、主動篩檢與預防性投藥等積極措施，才能繼續保持機構內低結核菌感染風險。

關鍵字

長期照護機構 ； 結核病 ； 防治策略

並列摘要

With the rapid increase of the aging population in Taiwan, the demand of long-term care facilities is also increasing. According to the Ministry of Health and Welfare's report, the number of long-term care facilities gradually increased from 1,002 in 2007 to 1,082 in 2016. A total of 10,328 new TB cases were reported in 2016; 56% of the patients were older than 65 years. Elderly people in long-term care facilities were recognized to have 2.3 times more likely to contact tuberculosis than those living in the community. Aging itself, waning immunity, comorbidities, and atypical presentations of disease made timely diagnosis and prevention more difficult. Other studies indicated that residents in congregate settings could promote transmission and potentially lead to outbreaks. Thus, infection control and prevention of tuberculosis were crucial in long-term care facility settings. Therefore, this review article aimed to identify and summarize the current TB prevention strategies in other countries and the status of policy implementation in Taiwan. TB control strategies were mainly established on three levels. The top level was in administration control, the second was environmental control, and the third was personal protection. The idea was to minimize susceptible contacts and risk of exposure. Good cough and sneezing etiquette should be practiced in the facility settings, and caring staff should be educated on infection control. Furthermore, maintaining good air ventilation and active screening for susceptible population and preventive treatment were also important in minimizing the transmission risk.

並列關鍵字

Long-term care facilities ； tuberculosis ； prevent strategy