癌症病人感染管制之策略與實務──基於感染傳遞鏈的系統性防禦

Infection Control Strategies for Cancer Patients Based on Chain of Infection

隨著癌症診斷與治療技術進展，癌症病人存活率顯著提升，但免疫抑制及各種侵入性醫療處置，使其面臨極高感染風險。本文運用「感染傳遞鏈」之核心概念，分別從易感宿主、病原體及傳播途徑三個面向，系統性闡述癌症病人感染管制之實務策略。在易感宿主方面，透過預防性使用白血球生長激素、適當疫苗接種、黏膜照護、皮膚完整性維護及侵入性導管管理，以增強宿主防禦能力，並保護潛在病原入侵點。病原體控制則著重於環境與飲食管理，包括限制活體植栽、水管理計畫、施工風險評估及防護、落實環境清潔消毒，以及遵守食品安全原則。傳播途徑方面，涵蓋硬體設施與人員行為管理，建議將保護性／隔離病房與建材選用納入整體規劃，而人員應落實執行手部衛生、呼吸道衛生與咳嗽禮節、個人防護裝備使用與健康監測措施。透過多層次且系統性策略作為，期能降低感染發生，提升治療安全與照護品質。

Advances in cancer diagnosis and treatment have improved patient survival significantly. However, immunosuppression and the various invasive medical interventions often involved in these treatments increase infection risks. The core concept of“Chain of Infection”is used in this article to elaborate systematically on practical infection control strategies for cancer patients in three dimensions: the susceptible host, the infectious agent, and the mode of transmission. Strategies related to the susceptible host focus on enhancing host defense mechanisms and protecting potential portals of entry through the prophylactic use of granulocyte colony-stimulating factor, appropriate vaccinations, mucosal care, and skin integrity maintenance as well as the stringent management of invasive catheters. Strategies related to infectious agent control focus on environmental and dietary source management, including the restriction of live plants, implementation of water management plans, infection-control risk assessment and protection during construction, rigorous environmental cleaning and disinfection, and adherence to food safety protocols. Strategies related to mode of transmission focus on the management of both physical infrastructure and personnel behavior, recommending that protective/isolation rooms and material selection be incorporated into facility planning and that personnel should consistently practice hand hygiene, respiratory hygiene, and cough etiquette; use personal protective equipment properly; and surveil their own health condition. In applying these multi-level and systematic strategies, the incidence of infections may be effectively reduced and treatment safety and quality of care ensured.