南部某區域教學醫院加護病房疥瘡感染群突發之調查

疥瘡是具有傳染性的皮膚疾患，乃疥蟲（SarcOPtes Scabiei）寄生於皮膚所致，其傳染途徑以密切接觸傳播為主，臨床上最主要症狀是皮膚發疹及劇癢。此次疥瘡群突發是發生在南部某區域教學醫院的加護病房，於七月份下旬皮膚就出現癢及紅疹，至民國90年7月31日為止，有十位護理人員及一位住院病患受到感染及疑似感染，分別於四肢、軀幹、背部及腹部等不同部位有癢及紅疹情形，其中下腹部及肚臍周圍出現紅疹有七人、大腿內側紅疹有五人、肘關節屈側紅疹有五人、軀幹結褲帶處紅疹有五人、腋窩前後緣紅疹有三人、背部紅疹有二人，其中有5位護理人員及1位住院病患共6位經皮膚科診斷確定為感染疥瘡，護理人員感染率為13.2 %，該加護病房住院病人感染率為4％。感管人員立即展開調查工作及必要之感染管制措施，包括對該單位已感染疥瘡之病患及護理人員予以Scalphen ointment治療，疑似感染疥瘡工作人員予以Eurax（Crolamiton）藥物治療，照護感染病患時採接觸隔離措施，並加強洗手、穿隔離衣、戴手套以及隔離防護之再教育等。此群突發之發生，追究極可能由於醫護人員認為感染來源之病患已擦藥二星期傳染力減低而未適時採取適當隔離措施所致，後經皮膚科醫師診斷及藥物治療以及嚴格的防護措施以及更衣室空間的改善措施後，該單位未再發現任何新的疥瘡個案。

關鍵字

疥蟲；疥瘡；隧道；群突發

並列摘要

Scabies dermatitis, an ectoparasite infestation, is highly contagious, and caused by the human itch mite, Sarcoptes scabiei. Its transfer is facilitated by intimate personal contact, and less frequently via sharing of contaminated bedding or clothing. The clinical presentation of itching and rashes associated with scabies derives from sensitization reaction directed against the excreta that the mite deposits in its burrow. Since July, 2001, there were 11 cases (10 nursing staff and 1 patient) reported with symptoms resembling that of the scabies dermatitis in an ICU of a 410-bed teaching hospital in southern Taiwan. (There were 2 resident doctors, 38 nurses, 1 nursing assistant staffed in the ICU.) After taking detailed histories and examination, 6 cases (5 nurses and 1 patient) were diagnosed to have scabies and 5 nurses were suspect infection by the dermatologist. All the staff of ICU were interviewed by the infection control nurse at the hospital. Only the 11 cases had symptoms: 7 cases had rash over low abdomen and periumbilical area, 5 cases over inguinal area, 5 over the trunk, 3 at the axillary area, 2 in the back , and 5 others over the flexor side of forearms. All 6 infected cases were treated with Scalphen ointment topically, and suspect infection nurses in the ICU used Eurax (Crolamiton) for prophylaxis for 7 days. Additional measures for infection control were carried out, included isolation of the infected patients , handwashing ,and contact precaution with gloves and gowns. This outbreak might have been prevented by early identification of the infected cases. On the hindsight, there have been no new cases of scabies reported in the ICU over the next 6 months.

並列關鍵字

Sacoptes scabie ； scabies ； burrow ； outbreak

國際替代計量

南部某區域教學醫院加護病房疥瘡感染群突發之調查

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