醫院感染管制措施與院內感染之應變

Management of COVID-19 Healthcare Associated Outbreak with Enhanced Infection Control Measures

自2021年5月中旬以來，台灣北部在短時間內出現了大量「嚴重特殊傳染性肺炎」（COVID-19）病例。有1個病人在亞東紀念醫院住院4天後才被診斷為COVID-19感染患者，在這段期間內已將疾病傳播給其他病人、陪病者和醫療工作人員。除了按照疾病管制署規定之應變處置建議執行院內感染管控外，醫院的應對措施是快速執行「營運管制」減少常規臨床服務，「清空管制」在數週內，以簡單的隔間區隔出緩衝區，迅速擴充專責病房和重症加護病房照護空間，以減少患者在急診室的停留時間，並對醫護人員、病人及其陪病者進行大規模檢測，積極推動同仁緊急接種COVID-19疫苗。藉著迅速的反應，第1波院內感染得到控制。後來又發現了另一起小規模院內傳播，但透過加強監測和整體照護量能提升，第2次的院內感染很快就得到控制。在堅定的領導和所有員工共同努力下，整合性的介入措施，可以阻止COVID-19在醫院的傳播，幫助全社會對抗疫情。

A surge of COVID-19 cases emerged in northern Taiwan since mid-May 2021. A patient with COVID-19 infection was detected 4 days after hospitalization at Far Eastern Memorial Hospital (FEMH) and spread the disease to other patients, chaperons, and healthcare workers (HCWs). In addition to the application of CDC protocol for outbreak control, the hospital responded with decreased routine clinical services within days, emergent massive vaccination to healthcare workers, rapid expansion of wards and intensive care units with simple construction within weeks to minimize patient stay at emergency department, and large-scale testing for HCWs, patients and their chaperons. With the rapid response, the first outbreak was controlled. Another small outbreak was detected later but controlled soon with enhanced surveillance and capacity of care. With determined leadership and concerted efforts by all workers, combined interventions can stop the transmission of COVID-19 in the hospital and help the whole society to fight against the epidemic.