SARS∼WHO 對門診/篩檢/住院的
環境安全建議

Hospital Infection Control Guidance for Severe Acute Respiratory Syndrome (SARS)

※Outpatient/triage setting　門診/篩檢環境

• Those presenting to health care facilities who require assessment for SARS should be rapidly diverted by triage nurses to a separate area to minimize transmission to others
  到醫療機構評估是否是SARS的病患，要立即由篩檢護士帶開到分離的區域，以免傳染他人。

• Those patients should be given a face mask to wear, preferably one that provides filtration of their expired air.
  必須拿口罩給病患戴上，口罩最好能過濾患者呼出的空氣。

• Staff involved in the triage process should wear a face mask (see below) and eye protection and wash hands before and after contact with any patient, after activities likely to cause contamination and after removing gloves.
  參與篩檢過程的人員應戴口罩、眼睛護具；接觸任何病患之前和之後，執行有可能引起污染的步驟之後，以及脫手套之後，都要洗手。

• Wherever possible, patients under investigation for SARS should be separated from the probable cases.
  若有可能，接受評估是否染上SARS的病患，要與可能病例（probable cases）分開。

• Soiled gloves, stethoscopes and other equipment have the potential to spread infection.
  污染的手套、聽診器及其他器材都可能散佈感染。

• Disinfectants such as fresh bleach solutions, should be widely available at appropriate concentrations.
  消毒劑（如新近準備的漂白水），應配成適當濃度並隨處可取得。

※Inpatient setting　住院環境
　　Care for probable SARS cases　照顧 SARS 可能病例,
　see Case Definitions for Surveillance of Severe Acute Respiratory Syndrome (SARS)

• Probable SARS cases should be isolated and accommodated as follows in descending order of preference:
  可能病例應隔離並收容在下列環境，適宜性依序遞減（１比３好）：
  1. negative pressure rooms with the door closed
     負壓環境並關門。
     （譯註：負壓指相對壓力較外部低，所以空氣只會進入室內，不會外洩。因空氣被抽出、過濾、消毒才排放，可避免病毒或細菌隨空氣散播出去。）
  2. single rooms with their own bathroom facilities
     單人房附獨立的衛浴設備。
  3. cohort placement in an area with an independent air supply, exhaust system and bathroom facilities
     將病患群聚在某一區，該區須有獨立的空氣供應、排氣設備與衛浴設備。

• Turning off air conditioning and opening windows for good ventilation is recommended if an independent air supply is unfeasible.
  若無獨立空調，則關掉空調並開窗以利通風。
  Please ensure that if windows are opened they are away from public places.
  請確定敞開的窗戶要遠離公共場所。

• WHO advises strict adherence to the barrier nursing of patients with SARS, using precautions for airborne, droplet and contact transmission.
  WHO 建議照護 SARS 病患要嚴格遵守防護措施，預防空氣、飛沫與接觸傳染。

• All staff, including ancilliary staff should be trained in the infection control measures required for the care of such a patient.
  所有員工（包括非醫療人員）都應接受訓練，以了解照顧 SARS 病患所需的感染控制措施。

• A member of staff must be identified who will have the responsibility of observing the practice of others and provide feedback on infection control.
  從員工中指派一人，負責觀察其他人的操作並回報感控情形。

• Disposable equipment should be used wherever possible in the treatment and care of patients with SARS and disposed of appropriately. If devices are to be reused, they should be sterilized in accordance with manufacturers’ instructions. Surfaces should be cleaned with broad spectrum disinfectants of proven antiviral activity.
  只要有可能，治療照顧SARS病患宜使用拋棄式設備，並適當的棄置。若設備必須重覆使用，應依製造商指示滅菌。表面應用具抗病毒效用的廣效殺菌劑清潔。

• Movement of patients outside of the isolation unit should be avoided. If moved the patients should wear a face mask.
  應避免將病患移出隔離單位。移送時病患應戴口罩。

• Visitors, if allowed by the health care facility should be kept to a minimum. They should be issued with personal protective equipment (PPE) and supervised.
  若衛生機關允許訪客，仍應將數量減到最低。他們應配發個人防護裝備並接受監督。

• All non-essential staff (including students) should not be allowed on the unit/ward.
  所有非必要人員（包括學生在內），不可進入隔離單位。

• Handwashing is crucial: therefore access to clean water is essential.
  洗手非常重要，能使用乾淨水源是最基本要求。
  Hands should be washed before and after contact with any patient, after activities likely to cause contamination and after removing gloves.
  接觸任何病患之前和之後，執行有可能引起污染的步驟之後，以及脫手套之後，都要洗手。

• Alcohol-based skin disinfectants could be used if there is no obvious organic material contamination.
  含酒精的皮膚消毒劑可以在無明顯有機物質污染時使用。

• Particular attention should be paid to interventions such as the use of nebulizers, chest physiotherapy, bronchoscopy or gastroscopy; any other intervention which may disrupt the respiratory tract or place the healthcare worker in close proximity to the patient and potentially infected secretions.
  在使用噴霧器、胸腔物理治療、支氣管鏡檢、照胃鏡時要特別留意。任何會干擾呼吸道，或讓醫療人員近距離接近病人或接近可能遭感染的分泌物時也要特別小心。

• PPE should be worn by all staff and visitors accessing the isolation unit.
  所有進入隔離單位的工作人員或訪客都要穿戴個人防護裝備。

• The PPE worn in this situation should include: 個人防護裝備包括：
  • A face mask providing appropriate respiratory protection (see below)
    提供適當呼吸保護的口罩（下詳）
  • Single pair of gloves 一副手套
  • Eye protection 眼睛保護裝置
  • Disposable gown 可棄式長袍
  • Apron 圍裙
  • Footwear that can be decontaminated 穿在腳上隔絕污染的東西

• All sharps should be dealt with promptly and safely.
  所有尖銳物品應立即與安全的處理掉。

• Linen from the patients should be prepared on site for the laundry staff. Appropriate PPE should be worn in this preparation and the linen should be put into biohazard bags.
  病患衣服應現場處理準備好才交給清潔工。操作時應著合適的防護裝備，並將病患衣服放進“生物危險品專用袋”中。

• The room should be cleaned by staff wearing PPE using a broad spectrum disinfectant of proven antiviral activity.
  房間應由穿戴個人防護裝備的工作人員以具抗病毒效用的廣效殺菌劑清潔。

• Specific advice concerning air conditioning units will be available soon.
  關於空調設備的建議近期會擬好（目前沒有）。

• Respiratory protection. This should where feasible be provided at
  呼吸道保護∼在可行之下應提供
  • *P100/FFP3, or P99/FFP2 filter level (99.97% and 99% efficiency respectively).
    P100/FFP3 或 P99/FFP2 過濾等級（分別具有 99.97% 和 99% 的過濾效率）
  • *N95 filters (95% filter efficiency) also provide high levels of protection and could be worn where no acceptable higher protection alternatives are available for example staff working in triage areas, prior to isolation.
    N95級的過濾材也能提供高度保護，如果沒有更令人滿意的替代方案時，也可以適用。比方說，在未隔離前的篩檢區工作的人員。
  Ideally, the masks used should be fit tested using an appropriate "fit test kit" in accordance with the manufacturing instructions.
  理想狀態，使用的口罩應依廠商指示，以 "fit test kit" 檢查是否貼合。
  Disposable masks should not be reused.
  拋棄式口罩不可重覆使用。

*N/R/P 95/99/100 or FFP 2/3 or an equivalent national manufacturing standard (NIOSH (N,R,P 95,99,100) or European CE EN149:2001(FFP 2,3) and EN143:2000 (P2) or comparable national/regional standards applicable to the country of manufacture.