南台灣某區域醫院類鼻疽群突發危機處理經驗

Endemic Outbreak of Melioidosis in Southern Taiwan: Experience of Crisis Management at A Community Hospital

2005年7月18日強烈颱風「海棠」侵襲台灣，八日後在台南某區域醫院發現第一例類鼻疽感染死亡個案，揭開了台灣類鼻疽群突發事件，持續到9月7日，證買了類鼻疽感染在台灣本土性地位。期間本院共收治類鼻疽感染患者28人，全是18歲以上成年人，沒有兒童病患，年齡≧65歲者佔53.5%，男女之比約為3.7:1，菌血症患者21人佔75%，肺部感染者6人佔21.4%，僅有1人是足部傷口感染。全部住院的類鼻疽感染患者中，1名肺部感染輕症患者自動出院後失聯，6名（21.4%）菌血症患者不治。所有病患皆來自高雄縣茄萣鄉、台南縣仁德鄉及湖內鄉、台南市南區灣裡路、喜樹路和鯤鯓路等分佈於二仁溪兩旁的地區，且無出國旅遊史。本院因地緣關係，直接承受此群突發事件的衝擊。面臨突如其來的重大考驗。自疫情爆發初期，立即訂定出應變策略和啟動危機處理機制：教育醫療照護團隊認識類鼻疽感染症、擬定相關感染管制措施以安定照護團隊、建立急診檢傷分穎、溝通管道及院內資訊系統以掌控疫情發展、全院動員分工以因應危機衝擊、尋求適切支援以減輕負荷，在整個群突發事件過程中，順利達成類鼻疽感染患者得到妥適的照顧，而不影響其他病患的就醫權利和安全。

After the 'Haiton' typhoon attacked Taiwan on July 18, 2005, we found an expired melioidosis case 8 days later at a community hospital in southern Taiwan. After that, there were totally 28 cases of melioidosis treated at our hospital till September 7, 2005. This outbreak confirmed the thesis that melioidosis is a localized endemic disease- in southern Taiwan. Among these 28 cases, all were adults and 53.5% of them were over the age of 65. The male to female ratio was 11:3. Out of the 28 cases, 21 had bacteremia, 6 had pulmonary infection, and one had wound infection of foot. One case with mild pulmonary infection refused medical care and 6 cases of bacteremia died. All of them were residents of areas near the Ar-Ren River in Tainan, with no history of traveling abroad. Because our hospital is the nearest community hospital for these areas, we were directly influenced by this sudden outbreak of so many cases without any warning, and must step up and face the challenge. We started the crisis management by educating our healthcare workers, planning the panel of infection control, setting up the triage, communication and information system, sharing responsibility to every member in duty, and searching support system to reduce our loading. The event was well-controlled as the melioidosis patients received suitable medical care and no any adverse effect on other patients treated in our hospital during the same period. (Infect Control J 2008; 18:1-11).