因應禽流感之醫院抗疫動線管理

Emergency Management of Hospital Infection Control Against Potential Pandemic Avian Influenza

二○○三年SARS事件衝擊我國固有防疫體系，其後新興傳染病持續盛行，尤以禽流感及新型流感全球大流行之威脅迫在眉睫。防疫初期A級時期將以「發現個案，攔截病毒，滴水不漏」之監測策略為主，於第一時間阻斷國內新生疫情。當小量之病毒及個案終於入侵我國而進入B級，此階段之策略仍為封鎖圍堵；立即動員投入大量機動防疫隊進行疫調，啟動專責醫院進行個案之收容隔離，一般醫院亦建議啟動抗煞時期之動線管制、檢疫留置病房及戶外篩檢站之分流機制。唯疫情之強度仍可能短期間內暴起而進入C級災難應變期。危及整體醫療結構；此一時期策略考量應為維繫最基本之一般急重症醫療需求，以保障社會之基本安全體系。吾輩宜充分利用目前有限之時間積極進行整備，並就上述之原則建構資訊化數位學習網絡系統及資訊通路，全力培訓應變所需之突湧式人力資源，再佐以系統性災難管理之演習機制，期能建構及強固大台北都會區之感控防疫動線網絡。

Severe acute respiratory syndrome (SARS) in 2003 had a major impact on our strategy ofprevention and control of the communicable epidemic disease. In post-SARS era we haveestablished an integrated system for different stages and magnitudes of different emergingcontagious diseases such as pandemic avian influenza. In level A, a nationwide and hospital-wideactive surveillance system will be applied to prevent the disease from invading our homeland. Inlevel B when there are limited cases of human-to-human transmission, the strategy recommendedis to surge up all the epidemiological efforts and resources available to contain the disease withinthe special isolation hospital. For the disaster response in level C when there are clusters ofoutbreaks in the community, more pre-selected special hospitals and shelters for medical care inlarge scale should be launched in order to maintain the fundamental structure of social security andbasal medical requirement. Bio-defense in general hospitals in level C should consist of setting upa detention ward in addition to above-mentioned outdoor screening stations and strict infectioncontrol programs. Finally at the present phase of preparedness, a well planned e-learning andtraining program for surge capacity in human resource will consolidate our network and enhanceour capability for prevention and control of emerging communicable diseases.