環境監視與新冠病毒後疫情呼吸道疾病相關探討 — 以室內通風換氣為例

Abstract

2019年 12月於中國湖北省武漢市爆發的嚴重特殊傳染性肺炎引發全球大流行，自 2022年始以傳播力高、症狀輕微且致死率較低的 Omicron 與其亞型變種病毒株為感染主流；在有利於回復社交的同時，也面臨著過去盛行的呼吸道傳染性疾病流行重現以及脆弱族群再次感染的挑戰；為降低危害暴露的風險，有必要討論建築物室內通風換氣條件與呼吸道病毒傳染病經氣溶膠傳播的議題。 本報告預期完成的項目有二，第一，參考 PRISMA 2020 聲明書的檢索流程，合併以 STROBE 檢核表評讀研究以降低篩選偏誤風險，並使用 EndNote 20 文獻管理軟體，按照步驟進行系統性文獻回顧撰寫；第二，根據系統性綜合證據以臺灣苗栗縣竹南鎮某地區醫院為例，提出有助於維護醫療場所從業人員職業環境安全、降低院內感染風險的實質性建議。 系統性回顧主要檢索於 PubMed 和 Web of Science 資料庫，自 2019年 12 月至 2023年 11月索引的英文出版物，統合納入共 18 篇研究，強調新冠病毒主要於室內空間傳播，且受室內活動的型態影響；無論自然性或機械性換氣，達到有效換氣率皆能降低暴露風險；雖然過濾及淨化設備有優化換氣的效果，但換氣量才是影響通風換氣降低暴露風險的關鍵因素；且即便醫院建議以機械性換氣為首選，自然性通風的混合併用尚且重要。實習應用結論，建議該院候診人數增多或是呼吸道傳染性疾病盛行時，候診區前後門窗維持自然通風的同時增加排風扇以提升換氣量；為降低診室內氣溶膠再循環，建議全日半開對外門、室內陳設刪減並使用嵌入櫃體以避免阻礙氣流；實測診室換氣量，並定期以二氧化碳測量作為室內空氣品質的環境監測，間接提供通風換氣程度的證據，以監控呼吸道病毒的傳染風險，同時提示醫療場所工作人員評估增添個人防護設備的需要。

In December 2019, an outbreak of Coronavirus disease, Covid-19, in Wuhan, China triggered a global pandemic. Since 2022, Omicron and its subtype mutant virus strains with high contagiousness, mild symptoms, and low fatality rate have become the mainstream of infection, which is conducive to restore normal life. At the same time, we also face risks such as epidemics of past respiratory infectious diseases, and reinfection of vulnerable groups. Therefore, building ventilation design is worth exploring as one of the engineering control measures to reduce indoor exposure risks. There are two objects in this report. First, refer to the research process of the PRISMA 2020 statement, incorporate the STROBE checklist as a research review tool to avoid selection bias, and use EndNote 20 literature management software to conduct a systematic literature review. Secondly, based on the comprehensive results, taking the local hospital in Zhunan Town, Miaoli County, Taiwan as an example, it can help create a safe occupational environment for medical staff and prevent nosocomial infection. This systematic review searched PubMed and Web of Science databases for all publications in English between Dec. 2019 and Nov. 2023. A total of 18 studies were included, highlighting that Covid-19 mainly spreads in indoor spaces and that differences in types of activities result in different attack rates. Both natural and mechanical ventilation can reduce the incidence. While filtration and purification equipment can optimize results, ventilation rate is a key factor in reducing exposure risk. Natural ventilation remains important even though mechanical ventilation is preferred in hospitals. The practical implications for local hospitals are suggested as follows. Although natural ventilation is achieved through doors and windows, the use of fans or exhaust fans should be considered to increase ventilation rate especially when the number of patients waiting in the hospital increases or respiratory infectious diseases are prevalent. To reduce aerosol recirculation within the clinic, it is better to keep the door ajar throughout the day rather than closed. Also, indoor furniture should be reduced and replaced with built-in cupboards so as not to block airflow. Regular measurements of true ventilation rates and carbon dioxide levels in hospitals can help monitor indoor air quality in occupational settings and may also serve as a signal of infectious risk. Moreover, it may prompt healthcare facility staff to evaluate the need for additional personal protective equipment.