COVID-19感染預防和控制：居家照護防疫策略

COVID-19 Infection Prevention and Control: Prevention Strategies for Home Care Settings

王鳳葉(Feng-Yeh Wang)

《呼吸治療》 20卷1期 (2021/01) Pp. 81-88

https://doi.org/10.6269/JRT.202101_20(1).0010

摘要

背景：2019嚴重特殊傳染性肺炎（coronavirus disease, COVID-19）最常見的是藉由近距離飛沫、直接或間接接觸帶有病毒的口鼻分泌物、或無呼吸道防護下長時間與確診病人處於2公尺內密閉空間裡，將增加人傳人之感染風險。臨床上從事居家照護的醫護人員和服務個案都可能患有COVID-19感染而沒有症狀，或者在訪視時出現未檢測到的輕度或非典型症狀。故本文期盼透過匯整相關暫行指引及文獻，提供臨床人員照護及流程制定參考，建立新型冠狀肺炎的防疫防護之家訪。方法與結果：本文為參考台灣疾病管制署及世界衛生組織和加拿大衛生組織的暫行指引，結合相關文獻及臨床流程與經驗進行撰文分享，提供居家醫事機構在執行居家訪視照護過程應注意之防疫措施。建議居家醫事機構應制定預防感染的措施，訪視前進行居家安全風險評估，加強工作人員與服務個案之健康監測與管理，提供醫療照護工作人員個人防護裝備，居家訪視醫療用物的使用原則及清潔消毒，並提供案家居家防疫的正確知識，以防止COVID-19進入居家環境，減少個案及居家醫事人員傳染風險。結論：COVID-19疫情持續延燒，從事居家照護第一線醫護人員，也可能面臨病毒感染威脅，居家照護之醫事機構應加強工作人員與服務個案之健康監測與管理，制定相關感染管制措施，落實防疫家訪前風險評估、家訪時的防護措施及防護設備，家訪後醫療設備的清潔與消毒，提供個案諮詢、轉診機制甚至必要時採取遠距照護，以確保照顧者、個案、醫護人員，安全家訪之防疫防護。

關鍵字

2019嚴重特殊傳染性肺炎 ； 新型冠狀病毒 ； 居家護理 ； 感染控制 ； 個人安全防護

並列摘要

Background: Over the last few months, our understanding of COVID-19 has rapidly expanded. Person-to-person transmission is increasing in communities. There is evidence of unrecognized asymptomatic, pre-symptomatic or pauci-symptomatic transmission of this virus. Both staff and clients in home care settings may have COVID-19 infection without symptoms, or with undetected mild or atypical symptoms at the time of visits. This article looks forward to sharing the infection control strategies on COVID-19 in home setting by compiling relevant temporary guidelines and literature, except to provide interim guidance to home care organizations and staff, to prevent the transmission of COVID-19 in home care settings. Methods and Outcomes: This article refers to the Taiwan Centers for Disease Control(Taiwan CDC) and the World Health Organization's interim guidelines and Public Health Agency of Canada interim guidelines, also include relevant literature and clinical procedures and experiences. Infection prevention and control strategies to prevent or limit transmission of COVID-19 in the home care setting are suggest established infection prevention and control preparedness, home safety risk assessment is completed for each client to determine whether the client environment is suitable for home care services, conduct active screening of staff and clients for symptoms or signs of COVID-19, provide adequate Personal Protective Equipment for all staff for duration of visits, client and household member education. Conclusion: Organizations providing home care must ensure that how to safely and effectively care for a client with suspected or confirmed COVID-19 to prevent the infection from spreading to household contacts.

並列關鍵字

coronavirus disease (COVID-19) ； severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) ； Infection control ； Home care ； Personal Protective Equipment