醫院改建或整修工程之感染管制

Infection Control during Renovation and New Construction in Hospitals

醫院改建或整修過程中產生之粉塵、氣霧或水霧可能含有曲黴菌、退伍軍人菌、隱球菌…等微生物，能扮演媒介角色感染免疫力不全病人，因此，醫院工程之感染管制措施為一不容忽視之議題。感染管制人員於施工前應依感染管制風險評估（infection control risk assessment, ICRA）步驟判斷工程感染管制等級。工程感染管制等級分為I、II、III、IV共4級。等級I之工程感管措施著重於使用避免粉塵產生之方式施作、完工後可立即復原，並清潔施工區；等級II之工程應關閉空調系統並密封出風口、使用集塵器或水霧等設備控制粉塵量、人員離開施工區需以除塵墊移除鞋底粉塵…等；等級III之工程還需設置屏障以區隔施工區域、利用高效率過濾（high-efficacy particulate filtration, HEPA）裝置使施工區維持相對負壓、運送垃圾時需加蓋或以膠布覆蓋；等級IV之工程除上述措施外，人員進入施工區須穿上鞋套、應設置相對乾淨之除塵區域、人員離開施工區時以HEPA吸塵器移除身上粉塵…等。針對等級III／IV之工程，感染管制人員需至施工現場稽核，確認相關防護之落實度。於施作期間以及完工時介入適當感染管制措施方能避免工程相關感染之產生。

The pathogens that have been implicated in nosocomial outbreaks associated with dust or mist generated from renovation and construction activities include Aspergillus spp., Legionella spp., and Cryptococcus spp. Therefore, infection control during renovation and construction in health care facilities is highly important to prevent these nosocomial infections. Infection control risk assessment (ICRA) should be conducted at the initial stages of planning and design. According to ICRA, the infection control class is divided into four categories (I, II, III, and IV). For category I, construction workers should use work methods that minimize dust from construction operations and replace ceiling tiles immediately. For category II, isolation of air conditioning systems, use of water mist on work surfaces to control dust while cutting, and installation of dust mats at the exits of work areas are necessary. For category III, we recommend that critical barriers should be implemented to seal work areas from non-work areas and negative air pressure should be used within the work site. In addition, the transport carts for construction waste need to be covered by a solid lid. For category IV, an anteroom for dust removal, high-efficacy particulate filtration (HEPA) vacuum cleaners, and shoe covers can promote dust and debris control. Cooperation of infection control professionals and other health care practitioners facilitate the implement of infection control methods.