2013年美國加利福尼亞州長期照護機構結核病感染管制措施建議

Recommendations for Prevention and Control of TB in California Long Term Health Care Facilities May 2013

台灣之人口結構將於2025年進入超高齡社會，老人的結核病發生率相較於其他年齡層更高，在臨床上可能出現不典型表現，導致診斷和防治的困難。老年人肺結核罹患率較高，除本身抵抗力下降之因素外，因結核桿菌可於人體數十年後，於宿主抵抗力降低時發病，為另一導致老年長期照護機構中高肺結核病罹患率之原因，因此老年人潛伏結核感染的問題值得重視。本篇主要是參考2013年美國加利福尼亞州之「Guidelines for Prevention and Contro lof Tuberculosis In California Long Term Health Care Facilities」進行建議，內容主要有認識結核病（潛伏性結核感染、活動性結核病症狀及診斷）、傳染病通報方式、住民篩檢計畫（新住民篩檢、對已知或疑似肺結核的住民入住計畫、再入院篩檢、住民醫療記錄保存問題）、工作人員篩檢計畫（新進工作人員肺結核症狀篩檢、年度篩檢、曝觸後篩檢、懷疑或確診活動性結核病的工作人員、記錄保存、工作人員教育訓練）等進行介紹及建議。期望提供感染管制人員和長期照護機構醫療人員足夠的參考資料，以利機構能管理和實施住民和工作人員結核病的早期篩檢防治與計劃來減少活動性結核病傳播。

Taiwan will become hyper-aged society by 2025. The incidence of tuberculosis (TB) in the elderly is higher than in any other age group. Moreover, atypical clinical manifestations may occur among elderly populations, leading to difficulties in diagnosis and prevention. Elderly populations with high incidences of TB, combined with a declining immune function, can activate latent TB infection (LTBI). Therefore, latent TB infection in the elderly is a major public health problem. The recommendations developed in this work include: an overview of TB (LTBI, symptoms and diagnosis of active pulmonary TB), reporting requirements, resident screening programs (new admission screening program, admissions for residents with known or suspected TB, readmission screening and resident recordkeeping), and healthcare worker (HCW) screening programs (new HCW TB symptom screening, annual HCW screening program, post-exposure HCW screening, retention of records, and TB education). The purpose of these recommendations is to provide a framework for infection control staff and long-term care providers for the design and implementation of screening programs for residents and employees with TB. Therefore, TB transmission may be reduced through the prompt detection and management of active TB cases.