Title

大台北地區醫院空氣品質與生物氣膠之分布與特性

Translated Titles

The Distribution and Characteristics of Indoor Air Quality and Bioaerosols in the Hospitals of the Greater Taipei Area

Authors

麥子倩(Chelsea Mak);蘇千田(Chien-Tien Su);莊媖智(Ying-Chih Chuang);陳叡瑜(Ruey-Yu Chen);葉錦瑩(Ching-Ying Yeh);洪粕宸(Po-Chen Hung);張振平(Cheng-Ping Chang);趙馨(Jasmine Hsing Chao)

Key Words

醫院 ; 生物氣膠 ; 職業衛生 ; Hospitals ; Bioaerosols ; Occupational health

PublicationName

勞工安全衛生研究季刊

Volume or Term/Year and Month of Publication

21卷4期(2013 / 12 / 01)

Page #

481 - 497

Content Language

繁體中文

Chinese Abstract

醫療院所是各類傳染性疾病暴露的高風險場所,特別是藉由空氣或飛沫傳播的呼吸道疾病,因此本研究針對大台北地區兩家醫院進行空氣品質以及生物氣膠(包括可培養性真菌及細菌)的監測。本研究進行監測地點為人群密集和高濃度生物氣膠的環境,包括兩家醫院(A及B)的掛號大廳、急診,以及胸腔內科、小兒科、耳鼻喉科、感染科和家醫科的門診及病房。根據研究結果顯示,醫院A及醫院B的總真菌平均濃度分別為148 CFU/m^3及44 CFU/m^3,而總細菌平均濃度分別為476 CFU/m^3及399 CFU/m^3,濃度最高的地點皆為掛號大廳。受訪醫院空氣中常見的優勢真菌為Non-Sporulating Fungi、Penicillium、Cladosporium及Aspergillus,最常見的細菌為革蘭氏陽性球菌。多種環境因子與醫院空氣中生物氣膠濃度有顯著相關,包括溫度、相對濕度、二氧化碳、懸浮微粒及採樣點人數;多種生物氣膠濃度間亦有顯著正相關。兩家醫院的總細菌濃度最大值與二氧化碳平均濃度,以及醫院B的臭氧濃度高於環保署建議值,環境管理應有改善的空間。建議醫院應維持適當的溫濕度避免生物氣膠滋生,並增加通風量控制污染物濃度,以維護員工的健康及工作效率。

English Abstract

High exposure risk to various infectious agents in health care facilities is of special concern, especially to airborne and droplet-borne respiratory diseases. Therefore, we conducted a study to monitor indoor air quality and important bioaerosols (including culturable fungi and bacteria) in two hospitals in the greater Taipei area, Taiwan. Environmental monitoring was carried out at the most crowded areas of the study hospitals, and the departments with high concentrations of bioaerosols. The sampling sites included main lobbies, emergency department, outpatient departments (internal medicine, pediatrics, ears, nose, and throat (ENT), infectious disease, family medicine), and wards (internal medicine and pediatrics). According to the results, the concentrations of total culturable fungi were 148 CFU/m^3 and 44 CFU/m^3 in hospitals A and B, respectively; the concentrations of total culturable bacteria were 476 CFU/m^3 and 399 CFU/m^3. Mean concentrations of airborne fungi and bacteria were both highest in the main lobbies. In the study hospitals, the predominant fungal taxa were Non-Sporulating Fungi, Penicillium, Cladosporium, and Aspergillus. The most prevalent bacteria were Gram-positive cocci. Many environmental factors had statistical significant correlations with bioaerosols in the study hospitals, including temperature, relative humidity, carbon dioxide (CO2), suspended particulates, and number of people in the sampling locations. Interrelationships were also observed among many bioaerosols. The total bacterial and CO2 concentrations of the two study hospitals, as well as the ozone level in hospital B, were higher than the levels recommended by the Taiwan Environmental Protection Administration. Environmental management of these hospitals needs further improvement. In order to improve health and productivity of their workers, hospitals should keep appropriate temperature and relative humidity to avoid microbial growth, and increase ventilation rate to control indoor pollutant levels.

Topic Category 醫藥衛生 > 預防保健與衛生學
醫藥衛生 > 社會醫學
社會科學 > 社會學
Reference
  1. Fang, YC,Chao, HJ,Wu, HC,Chen, RY,Chuang, YC,Chang, CP(2010).Distribution and characteristics of airborne bacteria in long-term care facilities in Taipei, Taiwan.Taiwan J Public Health,29,273-82.
    連結:
  2. Wu, HC,Chao, HJ,Chen, RY,Chang, CP,Yu, TS.(2007).Exposure assessment of biological contaminants in five long-term care facilities in Taipei, Taiwan.Journal of Occupational Safety and Health,15,34-41.
    連結:
  3. (2005)。職業病概論。華杏出版股份有限公司。
  4. Centers for Disease Control, R.O.C. (TW). Nosocomial infections surveillance system [Internet]. Taiwan CDC, Fifth Division; [cited 2012 Mar 6]. Available from: www.cdc.gov.tw/public/Data/0114146571.pdf
  5. World Health Organization. Preventable hospital infections are a major cause of death and disability for patients: WHO [Internet]. WHO Regional Office for South-East Asia; 2005 Oct 13 [updated 2007 Apr 12; cited 2012 Mar 6]. Available from: http://www.searo.who.int/en/section316/section503/section1861_10481.htm
  6. American Society of Heating, Refrigerating, and Air-Conditioning Engineers (ASHRAE). Addendum d to ANSI/ASHRAE/ASHE Standard 170-2008: Ventilation of Health Care Facilities. Atlanta, GA: American Society of Heating, Refrigerating, and Air-Conditioning Engineers, Inc.; 2010..
  7. 趙馨。醫療院所安全衛生-第一章醫療院所常見職業安全衛生問題、第二章空氣及飛沫傳染病原菌危害與控制。行政院勞工委員會安全衛生專業人員訓練教材研究與北區推廣中心;2007:pp.1-1~2-52。
  8. World Health Organization. Summary of probable SARS cases with onset of illness from 1 November 2002 to 31 July 2003 [Internet]. WHO; 2003 Dec 31 [cited 2012 Mar 6]. Available from: http://www.who.int/csr/sars/country/table2004_04_21/en/index.html
  9. American Conference of Governmental Industrial Hygienists,Macher, J(ed.)(1999).Bioaerosols: Assessment and Control.Cincinnati, OH:American Conference of Governmental Industrial Hygienists.
  10. Anderson, K,Morris, G,Kennedy, H,Croall, J,Michie, J,Richradson, MD(1996).Aspergillosis in immunocompromised paediatric patients: Associations with building hygiene, design, and indoor air.Thorax,51,256-61.
  11. Araujo, R,Cabral, JP,Rodrigues, AG.(2008).Air filtration systems and restrictive access conditions improve indoor air quality in clinical units: Penicillium as a general indicator of hospital indoor fungal levels.American Journal of Infection Control,36,129-34.
  12. Arnow, PM,Sadigh, M,Costas, C,Weil, D,Chudy, R.(1991).Endemic and epidemic aspergillosis associated with in-hospital replication of Aspergillus organisms.Journal of Infectious Diseases,164,998-1002.
  13. Bolyard, EA,Tablan, OC,Williams, WW,Pearson, ML,Shapiro, CN,Deitchmann, SD.(1998).Guideline for infection control in healthcare personnel, 1998. Hospital Infection Control Practices Advisory Committee.Infect Control Hosp Epidemiol,19,407-63.
  14. Curtis, L,Cali, S,Conroy, L,Baker, K,Ou, CH,Hershow, R(2005).Aspergillus surveillance project at a large tertiary-care hospital.Journal of Hospital Infection,59,188-96.
  15. Destaillats, H,Maddalena, RL,Singer, BC,Hodgson, AT,McKone, TE.(2008).Indoor pollutants emitted by office equipment: A review of reported data and information needs.Atmospheric Environment,42,1371-88.
  16. Gniadek, A,Macura, AB,Oksiejczuk, E,Krajewska-Kułak, E,Łukaszuk, C.(2005).Fungi in the air of selected social welfare homes in the Małopolskie and Podlaskie provinces - A comparative study.International Biodeterioration and Biodegradation,55,85-91.
  17. Gorny, RL,Dutkiewicz, J.(2002).Bacterial and fungal aerosols in indoor environment in Central and Eastern European countries.Annals of Aoricultural and Environmental Medicine,9,17-23.
  18. Jaffal, AA,Nsanze, H,Bener, A,Ameen, AS,Banat, IM,El Mogheth, AA.(1997).Hospital airborne microbial pollution in a desert country.Environment International,23,167-72.
  19. Kim, KY,Kim, YS,Kim, D.(2010).Distribution characteristics of airborne bacteria and fungi in the general hospitals of Korea.Industrial Health,48,236-43.
  20. Krajewska-Kułak, E,Łukaszuk, C,Hatzopulu, A,Bousmoukilia, S,Terovitou, CH,Amanatidou, A(2009).Indoor air studies of fungi contamination at the Department of Pulmonology and Internal Medicine in Kavala Hospital in Greece.Advances in Medical Sciences,54,264-8.
  21. Lacey, J,Dutkiewicz, J.(1994).Bioaerosols and occupational lung disease.Journal of Aerosol Science,25,1371-404.
  22. Laussmann, D,Eis, D,Schleibinger, H.(2004).Comparison of mycological and chemical analytical laboratory methods for detecting mold damage in indoor environments.Vergleich mykologischer und chemischanalytischer Labormethoden zum Nachweis von Schimmelpilzbefällen in Innenräumen,47,1078-94.
  23. Li, CS,Hou, PA.(2003).Bioaerosol characteristics in hospital clean rooms.The Science of the Total Environment,305,169-76.
  24. Lugauskas, A,Krikštaponis, A.(2004).Filamentous Fungi Isolated in Hospitals and Some Medical Institutions in Lithuania.Indoor and Built Environment,13,101-8.
  25. Macher, J(ed.)(1999).Bioaerosols: Assessment and Control.Cincinnati, OH:American Conference of Governmental Industrial Hygienists=ACGIH.
  26. Martins-Diniz, JN,da Silva, RAM,Miranda, ET,Mendes-Giannini, MJS(2005).Monitoring of airborne fungus and yeast species in a hospital unit.Monitoramento de fungos anemófilos e de leveduras em unidade hospitalar,39,398-405.
  27. Meklin, T,Husman, T,Vepsäläinen, A,Vahteristo, M,Koivisto, J,Halla-Aho, J(2002).Indoor air microbes and respiratory symptoms of children in moisture damaged and reference schools.Indoor Air,12,175-83.
  28. Obbard, JP,Fang, LS.(2003).Airborne concentrations of bacteria in a hospital environment in Singapore.Water, Air, and Soil Pollution,144,333-41.
  29. Park, JH,Spiegelman, DL,Gold, DR,Burge, HA,Milton, DK.(2001).Predictors of airborne endotoxin in the home.Environmental Health Porspectives,109,859-64.
  30. Price, DL,Simmons, RB,Crow, SA, Jr,Ahearn, DG.(2005).Mold colonization during use of preservative-treated and untreated air filters, including HEPA filters from hospitals and commercial locations over an 8-year period (1996-2003).Journal of Industrial Microbiology & Biotechnology,32,319-21.
  31. Qudiesat, K,Abu-Elteen, K,Elkarmi, A,Hamad, M,Abussand, M.(2009).Assessment of airborne pathogens in healthcare settings.African Journal of Microbiology Research,3,66-76.
  32. Reinthaler, FF,Marth, E,Eibel, U,Enayat, U,Feenstra, O,Friedl, H(1997).The assessment of airborne microorganisms in large-scale composting facilities and their immediate surroundings.Aerobiologia,13,167-75.
  33. Salonen, H,Lappalainen, S,Lindroos, O,Harju, R,Reijula, K.(2007).Fungi and bacteria in mould-damaged and non-damaged office environments in a subarctic climate.Atmospheric Environment,41,6797-807.
  34. Schabrun, S,Chipchase, L.(2006).Healthcare equipment as a source of nosocomial infection: a systematic review.Journal of Hospital Infection,63,239-45.
  35. Sehulster, LM,Chinn, RYW,Arduino, MJ,Carpenter, J,Donlan, R,Ashford, D(2004).Guidelines for environmental infection control in health-care facilities. Recommendations from CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC).Chicago IL:American Society for Healthcare Engineering.
  36. Shintani, H,Taniai, E,Miki, A,Kurosu, S,Hayashi, F.(2004).Comparison of the collecting efficiency of microbiological air samplers.Journal of Hospital Infection,56,42-8.
  37. Spengler, JD,Sexton, K.(1983).Indoor air pollution: A public health perspective.Science,221,9-17.
  38. Sudharsanam, S,Srikanth, P,Sheela, M,Steinberg, R.(2008).Study of the indoor air quality in hospitals in South Chennai, India - Microbial profile.Indoor and Built Environment,17,435-41.
  39. Tang, CS,Chung, FF,Lin, MC,Wan, GH.(2009).Impact of patient visiting activities on indoor climate in a medical intensive care unit: A 1-year longitudinal study.American Journal of Infection Control,37,183-8.
  40. Tortora, GJ,Funke, BR,Case, CL.(2002).Microbiology: An introduction.San Francisco, CA:Benjamin Cummings.
  41. Wong, LT,Mui, KW,Hui, PS,Chan, WY,Law, AKY.(2008).Thermal environmental interference with airborne bacteria and fungi levels in air-conditioned offices.Indoor and Built Environment,17,122-7.
  42. Wu, PC,Li, YY,Chiang, CM,Huang, CY,Lee, CC,Li, FC(2005).Changing microbial concentrations are associated with ventilation performance in Taiwan's air-conditioned office buildings.Indoor Air,15,19-26.
  43. Zhu, H,Phelan, PE,Duan, T,Raupp, GB,Fernando, HJS,Che, F.(2003).Experimental study of indoor and outdoor airborne bacterial concentrations in Tempe, Arizona, USA..Aerobiologia,19,201-11.
  44. Zorman, T,Jeršek, B.(2008).Assessment of bioaerosol concentrations in different indoor environments.Indoor and Built Environment,17,155-63.
  45. 吳孟儒、陳崇文、黃嘉文、詹東霖、楊明杰、趙又麟(2001)。醫用微生物學。台灣省台北市:合記圖書出版社。
  46. 張靜文(1998)。空氣中生物性危害與呼吸防護(上)。勞工安全衛生簡訊,32
  47. 勞工安全衛生研究所(2003)。醫療院所職業性生物危害預防指引-空氣傳播病原菌。行政院勞工委員會勞工安全衛生研究所。
  48. 趙馨、陳叡瑜(2005)。,行政院勞工委員會勞工安全衛生研究所。
  49. 潘致弘、張靜文(2008)。,行政院勞工委員會勞工安全衛生研究所。
Times Cited
  1. 溫欣然(2015)。風管中即時殺菌單元風洞暨實場測試。中山醫學大學職業安全衛生學系碩士班學位論文。2015。1-166。