题名

醫院感染管制措施與院內感染之應變

并列篇名

Management of COVID-19 Healthcare Associated Outbreak with Enhanced Infection Control Measures

DOI

10.6320/FJM.202111_25(6).0004

作者

廖俊星(Chun-Hsing Liao);楊家瑞(Chia-Jui Yang);李明玲(Ming-Ling Lee);楊玉儀(Yu-Yi Yang)

关键词

COVID-19 ; 院內感染 ; 疫苗接種 ; 照護容量 ; 監測 ; COVID-19 ; outbreak control ; vaccination ; capacity of care ; surveillance

期刊名称

台灣醫學

卷期/出版年月

25卷6期(2021 / 11 / 25)

页次

739 - 747

内容语文

繁體中文

中文摘要

自2021年5月中旬以來,台灣北部在短時間內出現了大量「嚴重特殊傳染性肺炎」(COVID-19)病例。有1個病人在亞東紀念醫院住院4天後才被診斷為COVID-19感染患者,在這段期間內已將疾病傳播給其他病人、陪病者和醫療工作人員。除了按照疾病管制署規定之應變處置建議執行院內感染管控外,醫院的應對措施是快速執行「營運管制」減少常規臨床服務,「清空管制」在數週內,以簡單的隔間區隔出緩衝區,迅速擴充專責病房和重症加護病房照護空間,以減少患者在急診室的停留時間,並對醫護人員、病人及其陪病者進行大規模檢測,積極推動同仁緊急接種COVID-19疫苗。藉著迅速的反應,第1波院內感染得到控制。後來又發現了另一起小規模院內傳播,但透過加強監測和整體照護量能提升,第2次的院內感染很快就得到控制。在堅定的領導和所有員工共同努力下,整合性的介入措施,可以阻止COVID-19在醫院的傳播,幫助全社會對抗疫情。

英文摘要

A surge of COVID-19 cases emerged in northern Taiwan since mid-May 2021. A patient with COVID-19 infection was detected 4 days after hospitalization at Far Eastern Memorial Hospital (FEMH) and spread the disease to other patients, chaperons, and healthcare workers (HCWs). In addition to the application of CDC protocol for outbreak control, the hospital responded with decreased routine clinical services within days, emergent massive vaccination to healthcare workers, rapid expansion of wards and intensive care units with simple construction within weeks to minimize patient stay at emergency department, and large-scale testing for HCWs, patients and their chaperons. With the rapid response, the first outbreak was controlled. Another small outbreak was detected later but controlled soon with enhanced surveillance and capacity of care. With determined leadership and concerted efforts by all workers, combined interventions can stop the transmission of COVID-19 in the hospital and help the whole society to fight against the epidemic.

主题分类 醫藥衛生 > 醫藥衛生綜合
参考文献
  1. Li Q, Guan X, Wu P, et al. Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia. N Engl J Med 2020:382: 1199-207.
    連結:
  2. Moynihan R, Sanders S, Michaleff ZA, et al. Impact of COVID-19 pandemic on utilization of healthcare services: a systematic review. BMJ Open 2021:11:e045343.
    連結:
  3. Chen HH, Kao JH, Chen JS, et al. What we have learned from COVID-19 pandemic? J Formos Med Assoc 2021:120 Suppl1:S1-5.
    連結:
  4. Chen CL, Lai CC, Luh DL, et al. Review of epidemic, containment strategies, clinical management, and economic evaluation of COVID-19 pandemic. J Formos Med Assoc 2021:120 Suppl1:S6-18.
    連結:
  5. Yen MY, Yen YF, Chen SY, et al. Learning from the past: Taiwan's responses to COVID-19 versus SARS. Int J Infect Dis 2021:S1201-9712(21)00490-2.
    連結:
  6. Ng TC, Cheng HY, Chang HH, et al. Comparison of estimated effectiveness of case-based and population-based interventions on COVID-19 containment in Taiwan. JAMA Intern Med 2021:e211644.
    連結:
  7. Huang PY, Wu TS, Cheng CW, et al. A hospital cluster of COVID-19 associated with a SARS-CoV-2 superspreading event. J Microbiol Immunol Infect 2021:S1684-1182(21)00145-6.
    連結:
  8. Ho HL, Wang FY, Lee HR, et al. Seroprevalence of COVID-19 in Taiwan revealed by testing anti-SARS-CoV-2 serological antibodies on 14,765 hospital patients. Lancet Reg Health West Pac 2020;3:100041.
    連結:
  9. Lacobucci G. Covid-19: NHS is placed on highest alert level as intensive care beds fill up. BMJ 2020;371:m4296.
    連結:
  10. Kleinpell R, Ferraro DM, Maves RC, et al. Coronavirus disease 2019 pandemic measures: reports from a national survey of 9,120 ICU clinicians. Crit Care Med 2020;48:e846-55.
    連結:
  11. Aziz S, Arabi YM, Alhazzani W, et al. Managing ICU surge during the COVID-19 crisis: rapid guidelines. Intensive Care Med 2020;46:1303-25.
    連結:
  12. Akhmetzhanov AR, Jung SM, Cheng HY, et al. A hospital-related outbreak of SARS-CoV-2 associated with a novel variant Cal.20C (B.1.429) in Taiwan: transmission potential and outbreak containment under intensified contact tracing, January-February 2021. Int J Infect Dis 2021:S1201-9712(21)00517-8.
    連結:
  13. Cho SY, Kang JM, Ha YE, et al. MERS-CoV outbreak following a single patient exposure in an emergency room in South Korea: an epidemiological outbreak study. Lancet 2016;388:994-1001.
    連結:
  14. Hsu SM, Cheng TK, Chang PJ, et al. Tracking hospital visitors/chaperones during the COVID-19 pandemic. Appl Clin Inform 2021;12:266-73.
    連結:
  15. Yang H, Sürer Ö, Duque D, et al. Design of COVID-19 staged alert systems to ensure healthcare capacity with minimal closures. Nat Commun 2021;12:3767.
    連結:
  16. Su SY, Lee WC. Monitoring the peaks of multiwave COVID-19 outbreaks. J Microbiol Immunol Infect 2021;S1684-1182(21)00144-4.
    連結:
  17. Rodriguez-Llanes JM, Castro Delgado R, Pedersen MG, et al. Surging critical care capacity for COVID-19: Key now and in the future. Prog Disaster Sci 2020;8:100136.
    連結:
  18. Kadri SS, Sun J, Lawandi A, et al. Association between caseload surge and COVID-19 survival in 558 U.S. Hospitals, March to August 2020. Ann Intern Med 2021: M21-1213.
    連結:
  19. Tiede A, Sachs UJ, Czwalinna A, et al. Prothrombotic immune thrombocytopenia after COVID-19 vaccine. Blood 2021;2021011958.
    連結:
  20. Benenson S, Oster Y, Cohen MJ, et al. BNT162b2 mRNA Covid-19 vaccine effectiveness among health care workers. N Engl J Med 2021;384:1775-7.
    連結:
  21. Treibel TA, Manisty C, Burton M, et al. COVID-19: PCR screening of asymptomatic health-care workers at London hospital. Lancet 2020;395:1608-10.
    連結:
  22. Galanis P, Vraka I, Fragkou D, et al. Seroprevalence of SARS-CoV-2 antibodies and associated factors in healthcare workers: a systematic review and meta-analysis. J Hosp Infect 2021;108:120-34.
    連結:
  23. Hartnett KP, Kite-Powell A, DeVies J, et al. Impact of the COVID-19 pandemic on emergency department visits — United States, January 1, 2019–May 30, 2020. MMWR 2020;69;699-704.
    連結:
  24. Kokudo N, Sugiyama H. Hospital capacity during the COVID-19 pandemic. Glob Health Med 2021;3:56-59.
    連結:
  25. Yen MY, Schwartz J, Shih CL. Seventeen years after first implementation of traffic control bundling. J Microbiol Immunol Infect 2021;54:1-3.
    連結:
  26. Shah SU, Xiu Ling Loo E, En Chua C, et al. Association between well-being and compliance with COVID-19 preventive measures by healthcare professionals: A cross-sectional study. PLoS One 2021;16:e0252835.
    連結:
  27. Lin YJ, Yen CF, Chang YP, et al. Comparisons of motivation to receive COVID-19 vaccination and related factors between frontline physicians and nurses and the public in Taiwan: Applying the extended protection motivation theory. Vaccines (Basel) 2021;9:528.
    連結:
  28. Kerlin MP, Costa DK, Davis BS, et al. Actions taken by US hospitals to prepare for increased demand for intensive care during the first wave of COVID-19: A national survey. Chest 2021:S0012-3692(21)00478-5.
    連結:
  29. Lum BX, Liu EH, Archuleta S, et al. Establishing a new normal for hospital care: A whole of hospital approach to COVID-19. Clin Infect Dis 2020:ciaa1722.
    連結: