預防性接觸隔離措施對疥瘡防治的成效

The Efficacy of Controlling Scabies Outbreak by Contact Precaution

由於老年人口越來越多，安養中心的需求與曰俱增。安養中心病患多為長期臥床病患，而疥瘼的臨床症狀常不典型，容易因此造成群突發。本院設有特定病房，專門收治安養中心轉介病人。在此病房的工作同仁，每隔二、三個月，就會有人因為皮膚癢疹而被懷疑感染疥瘡。此病房於民國2007年11月，發生疥瘡群突發，共有二名病人和九名工作人員感染疥瘡。檢討後發現，因為指標個案有不典型的皮膚表現，被誤診為藥物疹，而造成群突發。針對這一點，我們將所有安養院轉介而來的病患，住院後一律施行預防性接觸隔離14天，並在病房設置顯微鏡。當發現疑似疥瘡的病灶，則馬上刮下皮屑作檢查並照會皮膚科。此措施施行後，已經13個月，並未發現群突發或有同仁感染疥瘡。將這段時間內感染疥瘡的病人作統計分析，發現長期使用類固醇的病入容易造成疥瘡的延遲診斷。而曾經診斷過疥瘡的病人則較不會有延遲診斷的現象。另外發現，延遲診斷疥瘡的病人有較長的住院天數。醫療院所針對由長期照護機構轉入之病人，尤其長期使用類固醇者，應特別注意是否有疥瘡感染；入院後14天內採取預防性接觸隔離措施並嚴密監測皮膚病灶，可避免延遲診斷而導致交互感染。

The increasing population of the elderly has led to increasing demands for long-term care facilities. Patients residing in nursing homes are mostly bedridden and unconscious. In our hospital, the patients who were referred from the nursing homes were hospitalized in a special ward. Some of the nurses in this ward developed scabies infection every 2-3 months. Since patients with scabies show atypical manifestations, which can be misdiagnosed, an outbreak of scabies occurs easily. In November 2007, an outbreak of scabies occurred in our hospital, in which 2 patients and 9 nurses acquired scabies infection. This outbreak occurred because scabies was misdiagnosed as drug eruptions. Therefore, we carried out a preventive measure of contact precaution for 14 days during which we microscopically examined the furfur from the skin lesions of the patients in this ward. This strategy was followed for 13 months during which scabies was not detected in any person in that ward. Patients diagnosed with scabies have a low risk for delayed diagnosis. Patients with delayed diagnosis of scabies have a long duration of hospitalization. Our analysis revealed that chronic usage of steroids was associated with delayed diagnosis of scabies. In hospitals, patients receiving long-term care and steroid therapy should be especially investigated for infection with scabies. The 14-day preventive strategy of contact precaution along with close monitoring of skin lesions is effective for preventing other patients and nurses from acquiring scabies infection from patients with delayed diagnosis of scabies.