挪威型疥瘡感染群突發：某區域醫院加護病房的處置經驗

Outbreak of Norwegian Scabies: Experience from an Intensive Care Unit of a Regional Hospital

挪威型疥瘡常發生於貧窮擁擠地區，工業化國家則常發生於長照機構，對醫護人員有高度傳染性。2014年4月某區域醫院加護病房發生挪威型疥瘡群突發事件，一名自安養中心轉入的病人，其脫屑型的皮膚病，與典型的疥瘡紅疹不同，以致延遲診斷。結果共有加護病房護理師28名、員工眷屬10人（大人4人、小孩6人）、病患2名、清潔人員2名、專科護理師1名、書記1名及一般病房醫師1名，共45名感染疥瘡。初步感染管制措施採用集中照護的隔離方式治療病人，無症狀者施行預防性塗藥及衣物環境消毒等策略。然而無症狀且曾經預防性用藥僅一天的員工，陸續出現感染症狀共11人，且引發第二波家屬的感染。隨後採用員工及家屬「全面、同時間」投藥兩次、環境第二次徹底清潔消毒等，疫情才得以有效控制。疫情期間病房關閉7床66人日，感染員工得以放假以解決人力問題，亦是此次群突發能快速消弭的因素之一。此次群突發事件有兩項新措施，一為密切且需長時間接觸感染病人的工作同仁，改穿連身防護衣照護病人；二為無症狀員工家屬需同步施行預防性塗藥。穿連身防護衣照護高度傳染性疥瘡是否具正面幫助，仍待進一步評估。

Norwegian scabies is usually associated with poverty and crowded conditions. In industrialized countries, scabies occasionally causes outbreaks in long-term care facilities, in which healthcare workers are often involved. In April 2010, a nursing home resident with crusted skin lesions was admitted to the intensive care unit (ICU) of a regional teaching hospital. Because of a delay in diagnosis, an outbreak of scabies occurred. A total of 45 persons including 1 doctor, 28 nurses, 1 nurse practitioner, 1 clerk, 2 janitors, 2 patients, and 10 families (4 adults and 6 children) were infected. Infection-control measures were carried out immediately after identification of the cluster. Additionally, patient isolation, contact precaution, cohort care, preemptive treatment, and disinfection of environment were implemented. Unfortunately, secondary spread occurred in household members. Therefore, all the exposed personnel including family members applied scabicide on the same day and repeated treatment in the next week. Due to this outbreak, 66 ICUs needed to be shut down, and the patient-days and sick leaves of the affected healthcare workers were effectively controlled. We have 2 suggestions for the prevention of such an outbreak in the future. First, when in close contact with patients infected with Norwegian scabies, all health care workers should wear encapsulated, whole-body garments. Second, during outbreak of Norwegian scabies, preemptive treatment should be mandatory for all asymptomatic household members who are in contact with the affected person.