呼吸治療技術與醫院空氣品質

Respiratory Therapy Techniques and Hospital Air Quality

現今醫療技術的進步使得人類生命得以延長，但也間接引發不少醫療處置的相關問題，其中較為嚴重的院內感染問題不僅會增加病人的住院天數及醫療成本之外，也會造成死亡率的攀升。根據世界衛生組織調查，已開發國家中的急性住院病人之院內感染發生率為5％～10％，而臺灣的研究指出，成人加護病房的院內感染發生率為每一千個住院天數中有14件。由於加護病房的病人往往抵抗力較差，而且容易出現呼吸道感染，因此醫院的空氣品質應該受到重視。文獻指出使用開放式抽痰技術的病人會比使用密閉式抽痰技術的病人，在痰液中發現較高濃度的細菌，而且開放式抽痰技術的病人發生呼吸器相關肺炎的機率也較高。另外使用機械換氣輔助呼吸的病人在進行開放式抽痰過程中，空氣中的PM_(2.5)和PM_1微粒濃度會明顯上升，同時開放式抽痰技術也會增加醫護人員暴露細菌的風險。臨床上使用機械換氣輔助呼吸的病人經常需要給予霧化藥物治療，而藥物會隨著病人吐氣氣流而附著在呼吸器吐氣管路末端的細菌過濾器上，此細菌過濾器經重複高溫高壓滅菌後之過濾效果有待評估。由於成本的考量，目前國內臨床作業以使用開放式抽痰管為主，建議未來醫護人員在使用開放式抽痰技術進行抽痰期間做好防護措施，同時加強提升醫院的室內空氣品質，依各病人單位的實際需求，進行通風量的調整，定期辦理醫護人員教育訓練課程，教導醫護人員正確使用個人防護設備，如此應可降低醫院環境的污染與醫護人員暴露生物氣膠的風險。

The advanced medical technology has extended the lives of people, yet some medical issues need to be discussed. The hospital-acquired infection is one of the most concerned issues, as it increases hospitalization days, medical costs, and mortality. According to the World Health Organization, the occurrence of hospital-acquired infection among inpatients with acute illnesses is approximately 5%~10% in developing countries. Moreover, the infection occurs 14.0/1000 patient-days in adult intensive care unit (ICU) in Taiwan. The ICU patients have lower immunity due to prolonged hospitalization, and stay in the risk of upper airway infection due to prolonged intubation. Hence, the air quality of hospital should be concerned. According to recent research, patients with open suction system had been found higher concentration of bacterial contamination in their sputum and had higher incidence of ventilator-associated pneumonia than the ones with closed suction system. The concentration of airborne PM_(2.5), PM_1, and bacteria was clearly higher when open suctioning was used in mechanically ventilated patients. This phenomenon demonstrated that open suctioning may increase the risk of bacterial exposure for health care providers. When patients with mechanical ventilation receive aerosol therapy, aerosolized drugs tend to stick to a bacterial filter. Therefore, there is a need to examine the filtration efficiency of bacterial filters after repeated autoclaves. However, due to the cost of the catheter, the use of open suction system is still favored in Taiwan. Suggestions are made for health care providers to implement self-protection strategies while open suctioning is used. Meanwhile, increasing air circulation and periodically inspecting the ventilation system are recommended to improve hospital air quality. To minimize environmental pollution in hospitals and decrease the risk of bioaerosol exposure, continuing education may focus on proper precautions, hand hygiene, and wearing suitable personal protective equipment.