加護病房生物氣膠特性及其抗藥性評估採樣

本研究在台灣中部某醫學中心之內、外科加護病房，以Andersen six-stage、AGI-30及BioSampler三種生物氣膠採樣器進行會客前後之空氣採樣。採樣時間為每季採樣，持續一年。採樣後之菌種皆以BBL™ Trypticase™ Soy Agar （含5% Sheep Blood）培養基進行培養，並使用BD Phoenix™全自動微生物鑑定和藥敏性試驗分析儀，進行菌種鑑定及抗藥性分析。研究結果顯示：在內外科加護病房環境中所採集之生物氣膠，細菌分佈以截取粒徑3.3 µm以下為主（83%），此粒徑範圍極有機會進入人體肺泡區，造成伺機性的感染。在統計方面，發現季節對於濃度並沒有顯著之影響（P>0.05）；而會客活動確實會影響生物氣膠濃度（P<0.001）；且採樣時之溫度、相對濕度也會影響生物氣膠的濃度（P<0.001）；另外，換氣次數並不會影響生物氣膠濃度的差異（P>0.05）。在菌種鑑定的部分，以革蘭氏陽性菌（Micrococcus spp., Bacillus spp., Staphylococcus spp., Arthrobacter spp.）居多，其危險群等級（risk group, RG）多為第二等級（RG1:27%、RG2:73%）；而在抗藥性的評估中，可得知於內外科加護病房中，細菌對於健保局規定之第一、二線之抗生素（第一線：17種、第二線：18種），約有63.5%的細菌對於一、二線抗生素具有抗藥性，極可能影響於此環境中工作之醫護人員，因此建議加護病房內之通風設計應評估其院內感染控制之效能，且人員之個人防護具應配戴正確，才能有效防範生物氣膠的伺機性感染，降低生物氣膠暴露之危害。

關鍵字

生物氣膠；加護病房；抗生素

並列摘要

Our research was based in a medical center’s Internal Medicine Intensive Care Unit （MICU）and Surgery Intensive Care Unit （SICU） located in central Taiwan. Three bioaerosol samplers were utilized （Anderson six-stage, AGI-30, and BioSampler） for sampling before and during patient visiting. Upon acquisition of samples, they were inoculated and cultured on BBL ™ Trypticase ™ Soy Agar （with 5% Sheep Blood） medium for growth. The bacterial colonies were later identified and analyzed for antibiotic-resistant characteristics via BD Phoenix ™medium ted microbial identification and susceptibility test analyzer. Research results have showed from the bioaerosol samples acquired within the MICU that dominant concentration of bacteria and fungi were below cut off size of 3.3 μm, and they had high possibility to enter human lung’s alveolar regions of the body, thereby causing opportunistic infections. The factor of season and air change rate per hour did not statistically associate with bioaerosol concentration （P>0.05）; However, factor of patient visiting and temperature, relative humidity during sampling showed statistically agreement with bioaerosol concentration （P<0.001）. In terms of bacterial strain identification, Gram-positive bacteria were mainly isolated with risk group （RG）of II. As for antibiotic-resistant bacteria analysis of MICU, strains were identified 63.5 % that were resistant to National Health Insurance Administration （NHIA） designated first （17 types） and second （18 types） line antibiotics. This phenomenon could very likely affect the medical staffs working within the hospital environment. As a result, recommendations for MICU ventilation designs should be carefully evaluated for the effectiveness of controlling nosocomial infections as well as proper implementation of personal protective equipment in order to reduce bioaerosol opportunistic infections and harmful exposure effects.

並列關鍵字

bioaerosol ； ICU, ； antibiotic

參考文獻

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加護病房生物氣膠特性及其抗藥性評估採樣

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