精神科病房引起的諾羅病毒感染群突發事件調查

An Outbreak of Norovirus- associated Diarrhea in a Psychiatric Ward in a Regional Hospital

2008年3月南部某區域醫院慢性精神科病房發生諾羅病毒（Norovirus）引起腸胃道感染群突發，43位住院病人中有11位病人及9位工作人員中有1位發生急性腸胃炎，其感染率分別為25.6%及11.3%。通報個案症狀包括有腹瀉12位（100%）、發燒11位（92%）、嘔吐4位（33%）及噁心4位（33%）。針對通報個案採檢肛門拭子進行細菌培養皆為陰性。精神科病患本身疾病特性造成採檢配合度不夠，因此只有6名個案採到新鮮糞便進行病毒檢驗，檢驗結果有5名證實諾羅病毒，檢驗陽性率為83.3%。另1名個案檢驗結果為仙人掌桿菌（Bacillus cereus）。病人因精神疾病無法適切反應病情，又加上個入衛生習慣不佳，所以在密閉空間下，容易造成交叉感染，導致群突發事件發生。當感控小組接獲通報後，立即介入感染管制措施包括：病人採分區隔離、嚴謹執行接觸隔離及徹底環境消毒等措施，於疫情發生後8曰將疫情控制，該病房不再發生新病例。如何在精神科病房落實感控措施實為一大挑戰，本研究提供該院處理精神科腹瀉群聚事件之經驗，做為精神科專科醫院對於腹瀉群聚防治之參考。

An outbreak of acute gastroenteritis caused by norovirus occurred in the psychiatric ward of a regional hospital in Southern Taiwan. Between March 21 and March 29, 2008, 11 of 43 hospitalized patients (25.6%) and 1 of 9 health care workers (11.3%) developed acute gastroenteritis. The presenting symptoms were diarrhea (12, 100%), fever (11, 92%), vomiting (4, 33%), and nausea (4, 33%). In 11 cases, results of rectal bacterial culture were negative, but in 1 case, growth of Bacillus cereus was detected. Viral reverse trancscrip-tion-polymerase chain reaction was performed for 6 stool samples, of which 5 were positive for norovirus. After implementation of stringent infection control measures, which included isolation of infected patients, cohort care, contact precaution, promotion of frequent hand-washing, and aggressive environmental disinfection, the outbreak was finally brought under control in 8 days. Since hospitalized psychiatric patients live in closed environmental conditions, cross-infection is common among these patients. The implementation of infection control strategies in psychiatric wards merits further consideration by all health care providers.