醫院全面員工水痘抗體篩檢及疫苗注射之成本效益分析

Universal Antibody Screening and Vaccination for Controlling Varicella among Health Care Workers: A Cost-effectiveness Determination

水痘為高度傳染性疾病，而在醫院因封閉建築共用空調的特性及臨床照護水痘或帶狀皰疹病人的原因，導致員工亦曝露在感染風險中。因為本院在2003至2008年每兩年即有院內員工群聚感染的事件發生，故於2008年5月至2009年5月針對所有在職員工及2009年6月後新進員工進行水痘全面血清抗體檢測，並建議血清陰性員工接受疫苗注射。在血清陰性的員工中有62.9%接受疫苗預防注射。經此感控策略後醫療照護者感染水痘人數由施打疫苗前之每年7.8人下降至施打後3.0人，平均每年可以減少4.8人的感染；若以員工每千人的發生密度來比較的話，施打疫苗前為2.0±1.3（千人年），而全面施打疫苗後則下降至0.4±0.4（千人年），比較之下為有統計意義的差距（P=0.018）。檢測的成本在第一年因為全體在職員工普查費用較高外，接下來每年只需檢測新進員工（每年10%替換率），以十年的期間來估算，全面篩檢及疫苗注射的策略共花費2,559,670元。相對若無此策略，十年醫院必須支出費用2,812,272元於處理醫療健康照護者發生水痘感染。相較之下處理感染的費用高於主動篩檢及提供疫苗注射政策。另外尚有許多潛在無法估計成本的益處包括：員工職業安全的注重、工作人力調整的彈性、減少醫療照護相關感染甚至造成病患感染可能引起的潛在性醫療糾紛及醫院聲譽受損。本研究提供的經濟效益分析可以提供在台灣醫院及衛生單位制訂醫院內水痘感染管制措施及疫苗政策之參考依據。

Varicella is highly transmissible, especially within hospitals, owing to the presence of closed air handling systems and patients with varicella or herpes zoster infections. Health care workers (HCWs) are at risk for contracting varicella infections, and outbreaks of nosocomial infections among HCWs tend to occur every 2 years in our hospital. In 2008, we began a universal employee-screening program examining varicella antibodies. Active vaccination was recommended to all susceptible employees, with 62.9% receiving the vaccination. The average number of HCWs infected with varicella decreased from 7.8 to 3.0 persons/year. Thus, an average of 4.8 HCWs, per year, avoided contracting varicella infection. The cost of the program was high during the first year, due to the universal screening, but has since remained low because only new employees require testing; the staff turnover rate is 10%. According to a 10-year estimate, the program cost will total 2,559,670 NTD. In contrast, the extra cost associated with managing outbreaks among HCWs was estimated to be 3,406,272 NTD over 10 years. The policy of active antibody screening and vaccination is cost-effective, according to our analysis. Additionally, there are other benefits, such as ensuring HCW occupational safety; protecting the hospital’s reputation; reducing nosocomial transmission, especially to immunocompromised patients; and preventing legal challenges. This cost analysis provides valuable information for government offices and hospitals, in Taiwan, seeking to establish their own infection control policies.