醫院醫護人員疑似開放性肺結核暴露之評估- 通報系統資料分析

Tuberculosis exposure in health care worker of medical center

徐美勤(Mei-Chin Hsu)

指導教授 ： 何啟功

高雄醫學大學/健康科學院/職業安全衛生研究所/碩士(2006年)

摘要

背景與目的：近年來，國內發生數起肺結核院內感染事件，醫護人員基於照顧病人，因此在醫院中有很大的機會暴露到結核菌而感染。本研究目的是分析某醫學中心通報系統資料，以瞭解肺結核病人延遲隔離之可能因素及醫療人員暴露肺結核的情形。
研究方法：取自南台灣某醫學中心民國94年，醫療工作人員疑似肺結核暴露之造冊名單，並實際查閱相關病人的病歷。此通報系統共收集相關病人129人，其中115人經實驗診斷證實有肺結核菌感染納入本次的研究，並以中位數的延遲隔離時間做切割點，用以分析影響延遲隔離時間較長的因素。
分結果：一位疑似肺結核病人住院一次造成醫護人員暴露人數的中位數為20人(2-184人)。從病人入院至住進隔離病房的時間(延遲隔離)中位數為7天(IQR,3-14天)。以單變項分析影響延遲隔離超過7天的因素為非胸腔病房、胸部X光呈現非空洞的結果及抗酸性抹片陰性/培養陽性者；以對數複廻歸(Logistic regression )分析年齡、性別、住院科別，臨床症狀、胸部X光呈空洞、住加護病及實驗室診斷結果，其影響延誤診斷超過7天的因子為非胸腔科病房(OR=6.0,95% CI 2.2-16.4,p<0.001)，胸部X光沒有空洞者(OR=3.9, 95% CI 1.1-13.9, p=0.033)及檢驗結果抗酸性抹片陰性/培養陽性者(OR=15.7，95% CI 3.4-72.5,p<0.001)
結論：造成延遲隔離的因素為非胸腔科病房、胸部X光呈現非空洞及抗酦性抹片陰性/結核菌培養陽性的實驗診斷結果。醫療人員暴露於住院中未隔離的肺結核病人具有高的風險。

關鍵字

醫院 ； 疑似開放性肺結核 ； 延遲隔離 ； 院內感染 ； 醫療人員

並列摘要

Background: Health care workers(HCWs) have historically borne a heavy burden of tuberculosis(TB) infection and disease. The aim of this study was to investigate the exposure of health care workers in hospitalized patients who had delay diagnosis of tuberculosis in medical center in southern Taiwan and to evaluate the factors of delay isolation.
Patients and Methods: From Jan 2005 to Dec 2005, 115 of 129 registration cases who were collected from the infection control unit in a medical center in southern Taiwan were positive for all acid-fast bacilli (AFB) or result of culture. Isolattion delay time was defined as the interval from hospital admission to isolation room admission or discharge. Delay was characterized as less than the median or at or greater than the median.
Result：The median of delay time was 7 days (IQR, 3-14). Univariate analysis showed the factors significantly associated with delay of longer than 7days (long delay) were non-chest ward, non-cavity on CXR and negative result of smear with culture positive. Multiple logistic regression analysis was performed including age, sex, ward, cavity on chest X-ray, ICU admission, presence of ≧1 symptoms, the result of laboratory. The risk factors for long delay were non-chest ward (OR=6.0,95% CI 2.2-16.4,p<0.001), smear(-)/culture(+) than smear(+) (OR=15.7, 95% CI=3.4-72.5, P<0.001), and non-cavity on chest X-ray (OR=3.9, 95% CI=1.1-13.9, P=0.033). A median of 20 hospital personnel might be exposed to each patient who was not isolated at the time of admission .
Conclusion：Our data suggest the risk factors for long delay were non-chest ward, smear(-)/culture(+) and non-cavity on chest X-ray. The presence of tuberculosis patients in a hospital ward creates high potential for health care workers in that ward to be exposed to mycobacterial aerosols.

並列關鍵字

hospital ； suspected tuberculosis ； HCWs ； delay isolation

參考文獻

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