台北市長期照護機構生物性環境暴露評估

Exposure Assessment of Biological Contaminants in Five Long-Term Care Facilities in Taipei, Taiwan

10.7005/JOSH.200706.0138

吳欣橋(Hsin-Chiao Wu)；趙馨(Hsing Jasmine Chao)；陳叡瑜(Ruey-Yu Chen)；張振平(Cheng-Ping Chang)；于台珊(Tai-Shan Yu)

長期照護機構 ； 暴露評估 ； 職業衛生 ； 可培養性真菌 ； 可培養性細菌 ； Long-term care facilities ； Exposure assessment ； Occupational health ； Culturable fungi ； Culturable bacteria

勞工安全衛生研究季刊

15卷2期（2007 / 06 / 01）

138 - 145

繁體中文

本研究針對台北市長期照護機構進行環境暴露評估，以瞭解工作環境中生物性污染物的分佈情形及員工暴露狀況。我們針對五家同意參與計畫之長期照護機構分別進行一個星期的密集環境採樣，採樣項目包括室內空氣中、空調通風系統出風口、以及室外空氣中的可培養性真菌和細菌，採樣同時並測量溫度、相對濕度和二氧化碳濃度。根據研究結果發現，室內平均總真菌濃度最高及最低的機構分別是機構D(1444.32 CFU/立方公尺)及機構B (426.69 CFU/立方公尺)；室內平均總細菌濃度較高的為機構C(811.83 CFU/立方公尺)及D(802.42 CFU/立方公尺)，最低的為機構E(282.12 CFU/立方公尺)。根據多變項迴歸分析，真菌濃度與相對濕度、上午或下午採樣、以及建築年齡有顯著相關，而細菌濃度則與二氧化碳濃度、採樣點人數、以及機構別有顯著相關。綜合研究結果發現，長期照護機構的生物性暴露主要應是環境及空調通風系統清潔不佳，以及通風量過低所致。因此建議長期照護機構應有完善的環境清潔程序及計畫，並且提供機構內各區域適當的戶外新鮮空氣，以降低員工及住民的生物性暴露。

We investigated five long-term care facilities in Taipei, Taiwan to determine the distribution of biological contaminants and to assess worker' exposure to these contaminants. A one-week intensive environmental sampling was performed at each study facility. We mouitored culturable fungi and bacteria in indoor air, near AC (air conditioning) diffusers, and outdoors as well as temperature, relative humidity, and CO2 levels. Facilities D and E had the highest (1444.32 CFU/m^3) and lowest (426.69 CFU/m^3) fungal concentrations respectively among the study facilities. Facilities C and D had higher bacterial levels (811.83 CFU/m^3 and 802.42 CFU/m^3, respectively) than other study facilities, and facility E had the lowest bacterial level (282.12 CFU /m^3). Based on the multiple regression analyses, fungal levels were associated with relative humidity, sampling time, and building age; bacterial concentrations correlated with CO2 levels, number of people, and facilities. In summary, biological exposure in long-term care facilities mainly results from inadequate environment and AC/HVAC (Heating, Ventilating and Air Conditioning) system cleaning and insufficient ventilation rates. Therefore, better AC/HVAC (Heating, V'entilating and Air Conditioning) cleaning and proper ventilation should be implemented in long term care facilities to decrease the biological exposure of residents and workers.

1. American Society of Heating(1992).Refrigerating and Air-Conditioning Engineers (ASHRAE). ANSI/ASHRAE Standard 55-1992, Thermal environmental conditions for human occupancy.Atlanta:American Society of Heating, Refrigerating, and Air-Conditioning Engineers, Inc..
2. Bolyard EA,Tablan OC,Williams WW,Pearson ML,Shapiro CN,Deitchmann SD(1998).Guideline for infection control in healthcare personnel.Infect Control Hosp Epidemiol,19,407-463.
3. Burge HA,Otten JA,Macher J, (editor.)(1999).Bioaerosols: Assessment and Control.Cincinnati, OH:American Conference of Governmental Industrial Hygienists (ACGIH).
4. Chiu L(2001).New commentary on long-term care.Taipei:Da-Yang.
5. Environmental Protection Administration,Executive Yuan, R.O.C.(2005).Draft Indoor Air Quality Guideline.
6. Gellert GA,Waterman SH,Ewert D,Oshiro L,Giles MP,Monroe SS(1990).An outbreak of acute gastroenteritis caused by a small round structured virus in a geriatric convalescent facility.Infect Control Hosp Epidemiol,11,459-464.
7. Gniadek A,Macura AB,Oksiejczuk E,Krajewska-Kułak E,Łukaszuk C(2005).Fungi in the air of selected social welfare homes in the Malopolskie and Podlaskie provinces-a comparative study.Int Biodeterior Biodegrad,55,85-91.
8. Górny RL,Dutkiewicz J(2002).Bacterial and fungal aerosols in indoor environment in Central and Eastern European countries.Ann Agric Environ Med,9,17-23.
9. Harkness GA,Bentley DW,Mottley M,Lee J(1992).Streptococcus pyogenes outbreak in a longterm care facility.Am J Infect Control,20,142-148.
10. Pegues DA,Woernle CH(1993).An outbreak of acute nonbacterial gastroenteritis in a nursing home.Infect Control Hosp Epidemiol,14,87-94.
11. Sepkowitz KA,Eisenberg L(2005).Occupational deaths among healthcare workers.Emerg Infect Dis,11,1003-1008.

1. 蘇千田、趙馨、葉錦瑩、麥子倩、陳叡瑜、莊媖智、張振平、洪粕宸(2013)。大台北地區醫院空氣品質與生物氣膠之分布與特性。勞工安全衛生研究季刊，21(4)，481-497。
2. 趙馨、陳叡瑜、莊媖智、張振平、張大邦、吳欣橋、方盈禎(2010)。台北市長期照護機構空氣中細菌之分佈與特性。臺灣公共衛生雜誌，29(3)，273-282。