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Author: 劉昌邦
Chang-Pan Liu
Thesis Title: 健康管理的新策略~以預防麻疹及抗藥性細菌為例
A New Strategy of Health Management for Measles Prevention and Multidrug- resistant Bacteria
Advisor: 盧希鵬
Hsi-Peng Lu
Tain-Yi Luor
Committee: 盧希鵬
Hsi-Peng Lu
Tain-Yi Luor
Sun-Jen Huang
Kung-Jeng Wang
Chao-Ming Wu
Degree: 博士
Department: 管理學院 - 管理研究所
Graduate Institute of Management
Thesis Publication Year: 2020
Graduation Academic Year: 108
Language: 中文
Pages: 85
Keywords (in Chinese): 疫苗接種創新策略健康管理群突發政策遵從率
Keywords (in other languages): Vaccination, New strategy, Health management, Outbreak, Compliance of policy
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  • 研究文獻主要探討於2018年3月底時在台灣長庚紀念醫院爆發了因虎航航班而引發的麻疹疫情。同時期亦對抗藥性細菌進行管理及研究。在此麻疹疫情爆發之前,在馬偕紀念醫院的麻疹疫苗接種遵從率只有85.3%。為了預防傳染病,達成院內零感染,我們必須盡快制定新的管理政策。本研究整合Rogers創新擴散理論而成的Rogers & MPPTR模型,再進一步擴散到醫療人員採用創新策略。在研究期間內,先針對第一線醫療人員進行免費的麻疹抗體普查,作為預防麻疹疫情的新策略。然後以較少的人力和經費,針對無抗體的醫療人員進行主動篩檢,無抗體的醫療人員必須接受麻疹疫苗接種。本研究結果:召募了719位第一線醫療人員進行普查。麻疹抗體的整體陽性率為85.8% (617/719)。在調查後的第一個月內,再接種率為86.3% (88/102)。結論:本研究內容顯示,在疫情爆發期間對第一線醫療人員進行快速的普查以及免費的抗體篩檢,可有效預防傳染病。新策略實施後第一個月,血清陽性或再接種率上升到98.1%,在第二個月後血清陽性或再接種率上升到99.4%,此策略可視為對麻疹預防有效的健康管理。

    At the end of March 2018, a clustered outbreak of measles linked to Tigerair Taiwan broke out in Chang Gung Memorial Hospital, Taiwan. Meanwhile, the multidrug resistant bacteria were also under management and investigation. Prior to this measles outbreak, the compliance rate for measles vaccination was only 85.3% in MacKay Memorial Hospital. It was important to urgently formulate a new strategy to achieve the zero intra-hospital transmission for epidemic prevention.
    Health medical personnel in the MacKay Memorial Hospital were enrolled in this study from April 23, 2018 to May 22, 2018. During this short study period, a free general survey of measles antibody was conducted for first-line medical personnel under the diffusion of innovation theory as a new strategy for measles outbreak prevention. Active screening of susceptible health medical personnel was performed using less manpower and at low cost. Susceptible medical personnel were required to undergo measles vaccination within 1 month following screening. A total of 719 first-line medical personnel was enrolled for the general survey. The overall positive rate for measles antibody was 85.8% (617/719). The positive rate for measles antibody was 76.1% (287/377) in the vaccinated generation born after 1978, and the positive rate of measles antibody was 96.5% (330/342) for the generation born before 1978 (p value <0.001). After implementation of the new strategy, the immunization coverage increased to 98.1% in the first month of re-vaccination, and was 99.4% at the end of the second month. It would be regarded as an effective health policy to prevent measles infection.

    摘要 I ABSTRACT II 誌謝 III 目錄 IV 圖目錄 VI 第一章、 緒論 1 1.1 研究背景 1 1.2 研究目的 9 第二章、 研究設計 11 2.1 理論基礎 11 2.1.1 Rogers 創新擴散理論 11 2.1.2 PPTR-健康照護模型 12 2.1.3 整合Rogers理論與Modified PPTR模型 13 2.2 研究架構 14 2.3 醫務管理 16 2.3.1 負壓隔離病室作業管理 17 2.3.2 急診發燒動線管制管理 19 2.3.3 麻疹病毒測試 20 2.3.4 麻疹群聚風險管理 20 2.3.5 參與研究員工 22 2.3.6 最速疫調 23 2.3.7 最速檢驗 24 2.3.8 最速接種 24 2.3.9 疫苗儲量 24 2.3.10 資訊化管理 25 2.4 抗藥性細菌管理 29 2.4.1 抗藥性細菌管理執行步驟 29 2.4.2 脈衝場凝膠電泳(Pulsed-field gel electrophoresis,PFGE) 29 2.4.3 多基因座序列分型(Multilocus sequence typing,MLST) 30 2.5 假設推論統計方法 31 第三章、 研究發現 33 3.1 接觸者的健康管理 33 3.2 非接觸者的健康管理 34 3.3 抗藥性細菌的管理 39 第四章、 討論與建議 41 4.1 麻疹2018年的疫情 41 4.2 麻疹2019年的疫情 46 4.3 綜合討論 56 4.4 Rogers創新擴散理論的研究意涵 65 4.5 結論建議 65 文獻 68 附錄一:醫院員工麻疹認知調查表 75

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