先撥掉前言:
今天CNN頭條的照片
http://www.cnn.com/2003/HEALTH/05/20/sars/index.html, 我又看到醫護人員手套防護衣等穿戴錯誤的情形． 再講一次："Vinyl"因為拉伸會造成分子結構變形分離，造成穿孔及體腋穿透情形，所以有戴等於沒戴，醫護人員根本不能使用vinyl材質之耗材．
我想要幫忙, 而且向上頭申請了一筆經費, 願意提供市府衛生單位, 免費到美國舊金山總院接受infection control的訓練. 北京為什麼可以控制較快, 日本為何沒有sars病例, 這與醫護人員是否接受專業訓練有密切關連. 至於是否能加入WHO不是當之急, 是如何幫助台灣醫護人員正確防疫及"infection control".
這是San Francisco General Hospital給我的回覆, 我目前在拍一個個短片, 內容訪談到州立衛生局及三番市總院有關infection control的諮詢; 希望能為台灣民眾盡一分心力. 至於完成後, 是否能轉交到當局手里, 或直接給馬市長過目, 是重要的一環.
我還在努力，這全是義務性質，非關商業；萬一媒體也有興趣，那麼我想你們會開始認識我的聲音．
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-----Original Message-----
From: Felt, Sue [mailto:sue@epi-center.ucsf.edu]
Sent: Tuesday, May 20, 2003 12:42 PM
Subject: Infection Control Video
Hi Serrina -
Yesterday and today have been crisis city, so I am only just getting to
this!
Infection Control came to be an integral part of hospitals in the 1950's
when there were some hospital outbreaks of Staphylococcus aureus. Infections
which are acquired in the period of time that a person is hospitalized are
called "nosocomial" infections, and a major focus of Infection Control
professionals is to minimize nosocomial infections. As more and more
invasive technology becomes routine in medical care (chest tubes, central
venous catheters, even organ transplants, etc.) there is increasing
opportunity for infection.
In the 1980s, with the discovery that HIV/AIDS is a bloodborne pathogen,
major changes came about in the way we deliver health care. Throughout the
nation it became a standard of practice (and the law) to use personal
protective equipment. In addition, equipment changes, such as safety
needles, and procedural changes like managing infectious waste, and annual
"Bloodborne Pathogen" training for all health care workers. "Universal
Precautions" policies were created in virtually every hospital, mandating
that all patients, at all times, be treated as though they were infected
with a bloodborne pathogen. Gloves, face shields, and gowns were to be
available to all health care workers, and worn when there was any
probability of being exposed to blood or body fluids. Policies and
guidelines were created to address the protection of patients and staff from
organisms transmitted by air, contact, and blood or body fluids.
Infection Control departments not only helped in teaching and enforcing safe
practices, increasingly, Infection Control practitioners (ICPs) became
epidemiologists, tracking and determining the causes of nosocomial
transmission of pathogens in hospitals. Infection Control is involved with
every department and service of the hospital, assisting with policy writing,
education, consultation, and enforcement of infection control policy.
Hand hygiene is the most important intervention for interrupting the spread
of disease. Unfortunately, in spite of over 150 years of evidence, many
health care workers do not wash their hands between patient contacts.
Because handwashing is both time consuming and often inconvenient,
antimicrobial hand cleaners are now used in most European, and many
American, hospitals.
Intake areas of hospitals and clinics are likely to be the first to see the
patient with a communicable disease. Thus, they should all have policies
which require patients to put on a mask if arriving with a cough, or rash
and fever. When there is suspicion of TB, or SARS, or other airborne
illness, the patient should be removed from the waiting and placed in an
isolation room.
Well, there's a start...I have had at least fourteen interruptions, but I
thought I should get back to you, so I'll send it! The rest of this week is
really, really packed.
Talk with you soon!
Sue
Sue C. Felt, RN, MSN, MPH, CIC
Associate Hospital Epidemiologist
San Francisco General Hospital
1001 Potrero Avenue
Bldg. 100, Room 301
San Francisco, CA 94110
Phone: (415) 206-5466
Pager: (415) 719-1457
Email: sue@epi-center.ucsf.edu
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馬市長, 您好:
有關嚴重急性呼吸道症候群，本人在國外近幾個月來的感染人數劇以日增；中國部份城市及香港地區是宣稱控制住了，但若想由世衛除名，可能還需要見到單日感染人數達到世衛標準，才有機會爭取國際社會的國流。目前，我看到香港積極著手相關平面，利用各種管道，告訴全球：“香港是安全的。” 然後，我又看到，南京政府規定（或經營者自覺）共有五百多家飯店餐飲業關閉，希望人民都居家自守，極少進入密閉室公共空間，以求自保。根據數據顯示，中國的sars病例有下降趨勢。
反觀台灣，由於部份行政疏失，或無立即採取嚴控措失，疫情不減反增；目前政府已經著手從事病情控制，但仍有幾件事情讓我覺得驚訝：Sogo百貨稍早有一收銀員疑似感染，但相關人員並無立即要求Sogo封館；後來，那收銀員正式通知為sars病患，可Sogo負責人仍未封館十日，反而採取半價行動，藉以吸引人潮，造成搶購活動。上百人處於此一密閑室空間，看了令人心驚膽顫，誰知道又會有多少人員因此而接觸傳染，多麼可怕！
另外，我又看到，人人都說“只有N95”的口罩才可以防sars….然後我又驚嚇了一下。3M的N95以上型口罩，是用來給油漆工人或木匠工人防止粉塵及微粒物質進入人體的一個備具；我想當初3M的Distributor應該是在第一時間發了這樣的訊息，以致於人們有這樣先入為主的觀念 。倘若您留心香港、中國或其他地區的疫情報導，醫護人員早就換上普通綠色或白色那種三層的“醫療性口罩”，由下列數據顯示，N95並不能夠有效防菌，特別是人民因為N95單價較高，而捨不得一次性使用，造成更多呼吸道感染：
PRODUCT MATERIALS: NIOSH
Before choosing respiratory protection, it is imperative that safety directors and end users understand the basics of how this regulation works. 42 CFR Part 84 categorizes respiratory filters according to the filter efficiency along with resistance to filter efficiency degradation. Filter efficiency is rated at 3 levels: 95%, 99% and 99.97% (considered 100%). Resistance to filter efficiency is also rated on three levels: N = Not resistant to oils, R = Resistant to oil (some restrictions may apply) P = oil proof (some time restrictions may apply). These 9 classifications of filters are as follows:
Filter Efficieny Levels
95%
99%
100%
N
For Solid particulates and Non-aerosols that do not Degrade filter performance
N95
N99
N100
R
For Solid particulates and Degrading oil based aerosols (Use limitations)
R95
R99
R100
P
For Solid particulates and Degraded oil based aerosols. (no limitations)
P95
P99
P100
Under 42 CFR Part 84, before selecting any respirator, the user must know or determine the specific particulate contaminant present, the concentration of the contaminate in the area and whether oil aerosols are present within the environment. NIOSH no longer approves respirators for specific uses or applications; therefore, the user is required to be knowledgeable regarding potential exposure to particulate contaminants.
上列的N95只能達到95%的隔菌塵，而Disposable 一次性的普通醫療性口罩，郤可達到99.5%的隔菌塵．
Sample Number
Sample Identification
Delta P
(mmH2O/cm2)
Percent BFE
1
YN352018-2 2.5
99.5%
CONTROL AVERAGE: 2581 CFU
MEAN PARTICLE SIZE: 2.7 μm
事實上，無論是N95或一般性口罩，都必需是一次性使用，才能有效防菌。人類對流行感染病並不陌生，而人類許多行為如疫苗生產與癈水處理對人類有利；但其他無數行為卻對病菌有利。在疫情爆發當即，管理當局應當採取嚴厲手段，加強監控並診斷公共衛生，迅速壓制可能再度爆發的疫情才是當務之急。
另外，對於防疫教育更是不可少。口罩並不是唯一可以防止接觸病菌的方法，對於人類的雙手，更是極應重視的一環。在美國，USDA食品管理局明文規定，處理食物時必需使用手套；餐飲業也在洗手間內即掛上標語，告訴消費者如何洗手的正確觀念；在潔淨房或各大醫院內，更是告訴你：先以防菌劑洗手，再抹防菌隔離手霜，然後再戴手套；工作完結時，再以同樣方式潔淨手部。
倘若，台灣的餐飲飯店業也能同樣重視到這個環結，自覺性重視這個課題，台灣的疫情豁免將很可觀，國際回流指日可待。
這只是一個觀念，一個防疫教育及宣導；對於所以生物途徑傳染疾病，衛生當局應當十分重視。在大家都忙著報導今天又有多少台灣同胞受到感染或傷亡的同時，如果可以宣導這個根本的層面，將會帶來無限的福祉。畢竟，研製疫苗的時間以及成功率，都不是人類可以等待的。
（草草寫完，錯字不訂正．要來去焚膏繼晷了．呼呼～）
