医院整建过程中之感染管制.pdf

醫院整建過程中之感染 管制 衛生署 疾病管制局 中區傳染病防治醫療網 王任賢指揮官 院感人員在醫院整建中之角色 主要任務 由感染管制的角度監控整個營建及改 建之進行 ，包括計畫之擬定 、修訂 、工程 執行 、及後續之監控 建築過程相關之感染殺手 : Aspergillus sp 建築過程相關之感染殺手 : Legionella sp 微生物之來源 : I 黴菌斑 、灰塵、土壤均會受黴菌孢子與細菌污 染  天花板、絕緣材質 、防火材質、牆壁剝落物 黴菌孢子可由戶外飛入 敞開的窗戶或未密閉的窗( 戶 ) 微生物之來源 : II 水管系統  水管漏水會造成天花板潮濕  灰塵與黴菌四散  換新水管時土壤中的Legionella sp.可以因此而進入 水管系統 微生物之來源 : III  空調系統  空調系統若有不完整將使營建區的空氣流通至病患 區域  空調系統並未完全密閉  不正確的壓力差  不正確之空氣交換  HEPA filters沒有保養 Risk factors of patients and environment  Exposure to construction and soil excavation Risk factors of patients  Patient characteristics  underlying medical conditions  immunosuppressive conditions  GVH disease, prolonged neutropenia / granulocytopenia,prolonged use of antibiotics, steriod therapy  dialysis and mechanical ventilation, smoking, patient age, very young and very old  diabetes, surgery, neoplastic, pulmonary, renal or cardiac disease Risk factors for infections with filamentous fungi  Exposure to construction activities  immunosuppressive conditions  AIDS, congenital immunodeficiencies  Dialysis, renal failure  Diabetic ketoacidosis  Mechanical ventilation  Smoking  Age of the patient - very young and very old Risk factors for Legionnaires’ disease  Exposure to soil excavation during construction and malfunction of plumbing systems  Immunosuppressive conditions  Advanced age  Chronic pulmonary disease  Smoking  Excessive use of alcohol  Surgery  Diabetes, neoplastic disease, renal failure, cardiac failure Risk assessment  Proactive approach  Minimise dust  Prevent dust infiltration into patient care areas adja