某區域教學醫院精神科病房流感群突發處理經驗

Experience of Managing an Outbreak of Influenza in a Psychiatric Ward

流行性感冒（簡稱流感）是由流感病毒感染所引起。流感病毒一般分為A、B、C型三種，感染人類又以A、B型為主，而A型流感是近百年來引起全球大規模流行的元兇。2005年7月12日起於某區域教學醫院精神科病房44位住院病人中，陸續有14位（11位男性，3位女性}病患及3位女性醫護人員，共17位，出現上呼吸道感染及類流感症狀，包括發燒17位（100%），咳嗽12位（71%），喉嚨痛、鼻塞流鼻水、全身倦怠各11位（68%），骨頭酸痛5位（29%），有痰、寒顫、肌肉酸痛各3位（18%）。其中可5位經咽喉拭子採樣送流感快速抗原檢驗、反轉錄酶聚合酶連鎖反應及病毒培養，結果有6位（40%）培養出A型流感病毒。由於精神科病房相對其他科病房是一較封閉、擁擠的環繞，經由呼吸道散播感染極為快速，所以感控及早介入，及精神科醫護人員的全力配合，採取呼吸道及接觸隔離，病患分區集中隔離照護，每日體溫監測，要求所有工作人員及患者當須配戴外科口罩，加強洗手，限制訪客，單位內環境清潔及消毒，使疫情得以控制，7月24日之後無新個案產生。此次事件發現，醫護人員的警覺性不足，因此藉由本研究的經驗，希望可作為醫院或機構在處理傳染病群突發事件時之參考。（感控雜誌2008;18:273-82）。

Influenza is caused by influenza virus, which can be identified as type A, B, and C. Type A and B influenza are mainly responsible for human influenza, and the former accounted for the three globally pandemics in the past century. In July 2005, 14 (11 male, 3 female) patients hospitalized in a psychiatric ward of a tertiary hospital and 3 female personnel suffered from influenza-like illness (ILI). All 17 subjects had fever, 12 had cough, 11 had sore throat, stuffy/ running nose or generalized lethargy, 5 had arthralgia, 3 had sputum and chills or myalgia. Throat swabs for the detection of influenza virus by rapid antigen test, RT-PCR (reverse transcriptase-polymerase chain reaction) and viral culture were obtained from 15 subjects. Influenza A virus was subsequently identified in 6 cases. Psychiatric ward is a relatively closed and crowded circumstance, in where influenza virus is easily transmitted from person to person. Being aware of the outbreak, we immediately implemented the following infection control measures: the patients with ILI were aggregated in an area of the ward for cohorted care, body temperature was monitored in each patient twice daily, standard precautions were implemented, all the patients were educated to wear masks, and wash hands if necessary, visitors were restricted, and the ward were augmented disinfected. None developed influenza after July 24. Apparently, this outbreak resulted from the lack of alertness in the personnel working in the psychiatric ward. Our experiences can be provided to prevent and/or interrupt the occurrence of similar outbreaks in other institutes. (Infect Control J 20D8;18:273-82).