某醫學中心使用二氧化氯系統性管路消毒退伍軍人菌移生之經驗

Experience of Using Chlorine Dioxide Systemic Water Pipe Disinfection for Eradicating Legionella Colonization in a Medical Center

某醫學中心每半年定期針對高風險單位進行供水系統出水口退伍軍人菌檢驗。於2014年6月起連續每月採檢供水系統出水口（水龍頭）退伍軍人菌多數皆為陽性（2014年6月26日陽性率為12.5%、7月9日陽性率為50%、7月24日陽性率為80%、8月19日陽性率為50.0%）。且經過兩次使用次氯酸鈉消毒與一次使用二氧化氯清洗出水口末端管路，仍半數以上呈現陽性，因為陽性檢體的退伍軍人菌血清分型皆為同一型（血清型第六型），為避免院內群突發，故展開此次事件的調查及尋求解決之道。經由出水口末端管路清洗與改由二氧化氯系統性消毒，一個月後再次複檢高風險單位出水口，結果皆為陰性（2014年9月30日陽性率為0.0%），半年後再以二氧化氯系統性消毒及複查，其結果亦皆為陰性，且此段時期無醫療照護相關感染退伍軍人菌個案發生。

The water supply system of high-risk units was routinely surveyed for Legionella colonization every half year in a medical center in Taiwan. The distal sites of the water supply system revealed positive findings of Legionella continuously for three months since June, 2014 (12.5% on June 26, 50.0% on July 9, 80% on July 24, 50.0% on August 19), despite using 0.06% NaClO disinfectant twice, and using chlorine dioxide disinfectant once. Because the Legionella species in different units (including ICU and general ward) were the same (L. pneumophila type 6), we investigated these events and considered an alternative resolution method. We changed the method and used chlorine dioxide systemic water disinfection system throughout the hospital. We rechecked the water supply system of high-risk units after chlorine dioxide systemic disinfection and found negative findings of Legionella colonization; after checking half a year later, we again found negative findings. No Legionella infected case was found clinically during this positive colonization period.