新冠肺炎COVID-19疫情下醫院肺結核曝觸事件之影響因素與管理挑戰

Exploring the impact of nosocomial tuberculosis exposure during the COVID-19 pandemic

結核病（Tuberculosis, TB）在全球仍是重要的公共衛生議題，尤其是在新冠肺炎（COVID-19）大流行的背景下，對於肺結核病人的就醫診治帶來諸多影響。本研究旨在探討新冠肺炎流行期間，住院後患者診斷肺結核的曝觸事件、其相關因素及對醫院政策管理之影響。透過回溯性世代研究，分析某醫學中心肺結核患者的相關資料：包括166人於住院期間進行法定傳染病通報確診的肺結核患者，並將其分為住院當日直接隔離（未曝觸）101人和延遲隔離或未隔離（曝觸）65人。研究發現本院於新冠肺炎流行期間（2020/01/01至2023/04/30）結核病總通報確診數為494人，曝觸件數為65件，平均曝觸發生率為13.1%；相較於未受新冠肺炎疫情影響期間（2016/01/01至2019/12/31）結核病總通報確診數為717人，曝觸件數為112件，平均曝觸發生率為15.6%，發生率下降2.5%。典型胸部X光變化、入住胸腔科或感染科病房、住院三天內有胸腔科或感染科醫師診治、懷疑結核病三天內送驗痰塗片耐酸性染色鏡檢及痰檢體送交後24小時內發出痰塗片的報告等因素與曝觸事件呈現顯著相關。結果顯示早期介入、有效的結核病篩檢和感染管制措施對於降低曝觸事件的重要性，並提供醫院管理者和臨床醫師之實用建議，以改善對肺結核患者的管理和感染管制策略，從而減少曝觸事件的發生。

In the era of the coronavirus disease (COVID-19) pandemic, tuberculosis (TB) remains a significant public health issue worldwide. Only a few studies have focused on unidentified and incidental exposure to TB during the COVID-19 era. We retrospectively analyzed the data from 166 patients hospitalized at a medical center with newly diagnosed pulmonary TB. Of these, 65 patients experienced delayed quarantine, defined as not being quarantined on the first day of admission. Logistic regression analysis revealed significant associations between delayed quarantine and factors such as atypical chest radiograph presentation, delayed radiograph review, lack of management by chest or infectious disease specialists, and delays in sputum acid-fast Bacillus smear testing and reporting. These findings underscore the importance of early intervention, prompt specialist consultation, effective screening, and robust infection control measures to minimize exposure incidents during the COVID-19 era.