諾羅病毒群聚感染從急性病房傳播到日間照護病房：北部某醫學中心精神科的經驗

Spread of Norovirus-outbreak from a Psychiatric Ward to Day-care Ward: The Experience in a Medical Center in Northern Taiwan

北部某醫學中心附設之精神科急性病房於2010年02月22日起，出現第一例住院病人腹痛、不明原因腹瀉之病例，且在群聚流行期間，因已被感染之工作人員跨院區進行醫療支援，疑似將感染源散播至日間照護病房。整起群聚事件腹瀉病例共計31位，其中有21位為精神科病房病人、2位為日間照護病房病人、8位為工作人員。共計送驗17件糞便檢體至疾管局以酵素免疫分析(ELISA)進行病毒檢驗，檢驗結果有4件證實為諾羅病毒(Norovims)陽性，陽性率為23.5％。調查發現指標病例疑似於社區時已被感染，並於入院後造成病房內的腹瀉群聚感染；且過程中因工作人員未警覺已被感染及輕忽病毒傳染力，造成感染期延長及兩病房間的交互感染。有鑑於此，我們得知沒出現症狀的病人或工作人員不等於沒有遭受到感染，因此，工作人員不論接觸病人的機會是否頻繁，皆應確實遵循五大洗手時機，使用乾、濕洗手設備或攜帶式乾洗手液正確清洗雙手，在接觸病人排泄物前也應著適度的防護裝備，因為，唯有所有人員共同遵行感控措施，才能遏止群聚事件的延續。精神科病房與一般群聚事件處理原則的差異，著實會影響感染管制措施執行成效；期盼藉由此次處理經驗的分享，能 做為精神科病房對於群聚事件防治的參考。

The first case of norovirus infection, presenting with acute abdominal pain and diarrhea was seen on February 22, 2010, in an acute psychiatric ward in a medical center in northern Taiwan. This infection was suspected to have spread to a daycare center of another branch of the medical center by health care providers who were infected during the norovirus outbreak period. In our study, we enrolled 31 cases who developed acute diarrhea during the outbreak period. Of these patients, 21 had psychiatric disorders, 2 had been admitted to the day-care center, and 8 were health care providers. Seventeen specimens from these patients were sent to the Center for Disease Control, Taiwan, for detecting norovirus by using enzymelinked immunosorbent assay (ELISA). Among these specimens, 4 tested positive for norovirus (positive rate, 23.5%). After investigation, the index case was believed to be a community-acquired infection that subsequently became the source of the outbreak. During the outbreak, the staff neglected the potential of infection and overlooked the clinical presentation of norovirus infection; this increased the duration of the contagious period and caused cross-infection between wards. Therefore, a strict compliance with infection control and an adequate understanding of novovirus are important factors in the prevention of spread of an outbreak. The health care providers should follow the guideline of five kinds of timing of washing hands, no matter the frequency of contact with patients. The use of portable alcohol hand sanitizers, adequate hand washing with soap and water, and appropriate use of personal protection equipment before contact with patients’ feces are crucial to infection control. Furthermore, relevant knowledge among hospital staff regarding the difference between psychiatric wards and other acute or chronic wards plays an important role in the implementation of infection control. To summarize, we report this investigation to share the unique experience of managing a norovirus-outbreak in a psychiatric ward and to provide a reference for infection control in a psychiatric ward.