COVID-19院內群聚感染期間醫療從業人員壓力程度及其影響因子之探討—以桃園某區域醫院為例

Stress levels and influencing factors among health-care workers during a nosocomial cluster infection period of the covid-19 pandemic—a case study of a regional hospital in Taoyuan

目標：自COVID-19疫情爆發，因台灣防疫有成，直到2021年1月11日才在桃園某區域醫院，爆發第一例大規模院內群聚感染案件。整個案件至2021年2月23日結束，在44天內總共確診21名本土個案，包含兩位醫師及四位護理師。在院內群聚感染期間，醫護人員面臨較平時更多心理壓力，將對醫療從業人員的心理健康產生影響。本文探討COVID-19院內群聚感染期間，該院醫療從業人員壓力程度及其影響因子。方法：採橫斷式研究，透過線上問卷填答，自變項包含社會人口學及工作組織變項共13項，依變項為醫護人員照顧高危險性傳染病患之壓力量表，內容包含四大構面：擔心與社會隔離、防護裝備引起的不適、感染與控制的焦慮及照顧病人的負擔，總共32題，每題採Likert 4分法，由無壓力（0分）～重度壓力（3分），總分為0~96分，結果採用多變項迴歸分析進行統計檢定。結果：參與研究之醫療從業人員共950人，整體壓力介於輕度到中度壓力之間，在四個構面中，以防護裝備引起的不適為最高，而單題項中最高的前三名為擔心親友被自己傳染、擔心感染後與家人及孩子分離，以及害怕自己被感染；在多變項統計發現，有未成年孩子者、主要工作在病房組、擔任護理師與被列為確診、居家隔離或自主健康管理者的壓力感受程度較高，而年齡、性別、婚姻狀況以及是否直接照護COVID-19病人與壓力感受之間無顯著相關。結論：院內群聚感染時，醫院應該提供數量充足且尺寸齊全的防護裝備，並制定合理輪班計畫及使用輕便且合規的裝備，來減輕防護裝備引起的不適。另外，針對壓力的高風險族群，院方應透過提供心理支持資源、制定靈活排班制度以及營造支持性氛圍等，來減輕醫療人員壓力。

Objectives: Since the outbreak of the COVID-19 pandemic, Taiwan’s successful pandemic prevention measures delayed the occurrence of large-scale nosocomial infections until January 11, 2021, when the first major cluster infection emerged in a regional hospital in Taoyuan. This cluster infection outbreak lasted until February 23, 2021, spanning 44 days and resulting in confirmed local COVID-19 infections in 21 patients, including 2 physicians and 4 nurses. During this period, health-care workers in the hospital experienced increased psychological stress compared with the stress experienced under routine conditions, potentially affecting their mental health. This study investigated stress levels among health-care workers in the hospital during the nosocomial cluster infection period and the factors influencing the stress levels. Methods: This cross-sectional study was conducted using an online questionnaire. Independent variables included 13 sociodemographic and organizational factors, and the dependent variable was the Stress Scale of Caring for Highly Infectious Disease Patients among Health-care Workers score. This scale comprises four dimensions: concern about social isolation, discomfort caused by protective equipment, anxiety about infection and control, and burden of patient care. The scale has a total of 32 items scored on a 4-point Likert scale with endpoints ranging from 0 (“no stress”) to 3 (“severe stress”); the total score ranges from 0 to 96 points. Multivariate regression was employed for statistical analysis. Results: A total of 950 health-care workers participated in this study. Overall, the total stress levels among the health-care workers ranged from mild to moderate. Among the four dimensions, discomfort caused by protective equipment had the highest score. The top three items with the highest scores were concerns about infecting family and friends, fear of separation from family and children due to infection, and fear of self-infection. Multivariate analysis revealed that having underage children, working primarily in wards, being a nurse, having confirmed COVID-19 infection, being under home quarantine, or implementing self-health management were associated with relatively high stress levels. Age, gender, marital status, and whether providing direct care to COVID-19 patients were not significantly associated with stress levels. Conclusions: During nosocomial outbreaks, hospitals should provide sufficient and appropriately sized protective equipment, implement reasonable shift schedules, and adopt lightweight and compliant protective gear to reduce health-care workers’discomfort from the equipment. Additionally, for high-risk groups, targeted interventions should be implemented, including providing psychological support resources, establishing flexible scheduling systems, and fostering a supportive work environment to alleviate stress among health-care workers.