困難梭菌感染之感染管制措施

Infection Control Measures for Clostridium difficile Infections

困難梭狀桿菌（Clostridiumdifficile，簡稱困梭菌）是種厭氧性革蘭陽性桿菌，體外環境能形成孢子，抵抗熱、化學藥劑、酒精及抗生素，是困梭菌在醫療環境常存重要原因。困梭菌感染可能造成輕微腹瀉、偽膜性腸炎、毒性巨腸症（toxicmegacolon），甚至腸穿孔，甚至死亡。近年歐美困梭菌感染個案數逐年增加，因此台灣醫界不可輕忽困梭菌感染的潛在威脅。照顧困梭菌病人時，應採感染管制措施，減少病原散播風險：定期監測困梭菌發生率；照顧時戴手套和穿隔離衣；病人、家屬或醫護人員確實洗手；單人房隔離或與區域隔離；照顧感染腹瀉病人需採接觸隔離；醫護人員進行教育；抗生素管理計畫；及5,000ppm次氯酸鈉（hypochloritesodium）清潔環境。

Clostridium difficile is an anaerobic, gram-positive bacillus that can form spores ex vivo, which are resistant to heat, chemical agents, alcohol, and antibiotics. These characteristics allow for its survival in the medical environment. Clinically, C. difficile can cause mild diarrhea, pseudomembranous colitis, toxic megacolon, colon perforation, and even death. The incidence of C. difficile infection (CDI) is increasing in Western countries; it is also expected to be a potential health threat in Taiwan. In caring for patients with CDI, infection control measures should be implemented to prevent the spread of disease. Essential strategies include monitoring CDI incidence, donning gloves or dressings during patient care, single room or cohort isolation, discontinuation of contact isolation at 48 hours after cessation of diarrhea, personnel education, antibiotics stewardship, and environmental disinfection with 5,000 ppm hypochlorite sodium.