某準醫學中心附設護理之家諾羅病毒感染群突發處理經驗

Experience in Managing a Norovirus Outbreak at a Nursing Home Affiliated with a Quasi-Medical Center

諾羅病毒是病毒性腸胃炎最常見的病原之一，每年在台灣導致多起食物中毒及群突發事件，若發生於長照機構的住民，臨床表現可能更加嚴重。本文報告某準醫學中心附設護理之家諾羅病毒感染群突發事件的處理經驗。群突發從2023年5月12日開始至5月18日止，共計7日，住民25人以及工作人員18人當中，19名住民以及6名工作人員出現腸胃炎症狀，總侵襲率為58%；當中4名住民住院治療，皆康復出院。12名個案共14件糞便檢體施行諾羅病毒PCR檢測，12件呈現陽性，檢體陽性率86%，當中5件檢體經疾病管制署實驗室確定均為諾羅病毒GII.17基因型。護理之家強化感染管制措施，包括：腸胃炎症狀監測、落實手部衛生及濕洗手、落實接觸隔離、分區集中照護、染病工作人員請假、限制訪客、加強環境清潔消毒等。調查過程中發現醫療工作人員習慣乾洗手、忽略濕洗手的使用，易造成病毒散播（手部明顯髒污或沾有血體液、暴露於酒精效果不佳的病原體時建議使用濕洗手）；此外一些文獻顯示諾羅病毒可透過氣溶膠傳播，建議染病住民儘快啟動單人隔離或集中照護。

Norovirus is one of the most common pathogens that cause viral gastroenteritis, often leading to food poisoning outbreaks annually in Taiwan. When outbreaks occur among residents of long-term care facilities, their health impacts are even more significant. This study describes the management of a norovirus outbreak at a nursing home affiliated with a quasi-medical center. The outbreak lasted for 7 days, from May 12 to May 18, 2023. Among the 25 residents and 18 staff members, 19 residents and 6 staff members developed acute gastroenteritis, resulting in a total attack rate of 58%. Four residents were hospitalized, and all recovered. Fourteen stool samples were collected from 12 patients for the norovirus PCR test, and 12 samples tested positive, resulting in a positive rate of 86%. Five of the positive samples were confirmed by the Centers for Disease Control and Prevention laboratory as the Norovirus GII.17 genotype. Infection control measures were implemented at the nursing homes, including monitoring for symptoms of gastroenteritis, promoting hand hygiene, implementing contact isolation, isolating infected residents in a single rooms or cohorts, granting sick leave for infected staff, restricting visitors, and enhancing environmental cleaning and disinfection. During the investigation, it was found that medical staff often relied on hand sanitizers and neglected proper handwashing, which could facilitate the spread of norovirus. Additionally, some studies suggest that norovirus can be transmitted via aerosols; therefore, it is recommended that single-room or cohort isolation of infected residents be promptly initiated.