背景：2003年，一個新興傳染性疾病-嚴重急性呼吸道症候群在全球造成醫院、醫護人員以及公共場所傳染危機。在全球所有感染的8098位可能病例中，醫護人員(Healthcare worker)總共有1707位，佔總數的21%，成為最容易受到感染的最大族群。目的：我們以回朔性的血清檢測方式，分析台灣地區醫護人員SARS抗體血清盛行率，並且探討醫護工作人員感染SARS的相關危險因子。材料及方法：我們採集醫護人員血清，以酵素免疫分析法（ELISA）檢測SARS冠狀病毒的IgG抗體，篩檢出台灣部分醫療院所急診醫護人員的SARS感染率。再以陽性個案為病例組，並選取與楊性個案同醫院同年齡而抗體陰性之醫護人員為對照組，進行病例對照研究。結果：共收集26家醫院，1525個血清檢體，其中58個檢體呈現陽性反應，其總感染率為3.80﹪。單變項分析結果顯示醫護人員在醫療院所造成感染的主要保護因子如下：為喝咖啡或茶、照顧病人超過8天以上、執行CPR、抽痰、量體溫、戴P100口罩、戴N95口罩、戴面罩、戴護目鏡、穿防護裝、離開工作病房時脫手套，在急診隔離區與發燒篩檢站工作皆為具統計意義的保護因子，而吃紅棗是危險因子。但是經多變項分析後，發現，戴P100口罩（勝算比：0.056；95%信賴區間：0.019-0.162；p 值<0.001），在急診隔離區工作（勝算比：0.153；95%信賴區間：0.029-0.810；p 值0.027）或在發燒篩檢站工作（勝算比：0.103；95%信賴區間：0.011-0.963；p 值0.046）是最重要的保護因子。所以，我們建議戴P100口罩與急診的分區工作可有效地預防醫護人員感染SARS。

Severe acute respiratory syndrome (SARS) is an emerging infectious disease that first manifested in humans in China in November 2002 and has subsequently spread worldwide. According to the World Health Organization, 8098 cases occurred during the outbreak, and healthcare workers accounted for 1707 (21%) of the cases. To determine the prevalence of SARS infection of healthcare workers in Taiwan, we performed a serosurvey by the recombinant protein-based enzyme-linked immunosorbent assay (ELISA) to test for immunoglobulin (Ig) G antibodies to the SARS coronavirus (SARS-CoV) among 1525 healthcare workers in 26 hospitals that admitted SARS patients in mid-May, 2003. Then, a case-control study was carried out to evaluate the risk factors of SARS infection among the healthcare workers. A total of 52 infected staffs and 78 hospital and age matched non-infected controls were recruited. The seroprevalence rate was 3.68% (58/1525) for healthcare workers. Univariate analysis showed that with the habit of drinking coffee or tea, taking care of fever patients more than 8 days, ever practice of CPR, suction of sputum, taking patient’s temperature, use of P100 mask, use of N95 mask, use of face cover, use of goggles, use of gown, removing gloves after work, working in isolation area or fever screen station were significantly protective factors. In addition, eating jujube was a risk factor for SARS infection. Then, the multivariate analysis showed that use of P100 （OR: 0.056, 95%CI: 0.019-0.162, p value: <0.001）and working in isolation area （OR: 0.153, 95%CI: 0.029-0.810, p value: 0.027）or fever screen station（OR: 0.103, 95%CI: 0.011-0.963, p value: 0.046）were the most important protective factors for SARS infection. These findings suggest that nosocomial infection of SARS can be prevented effectively by use of P100 and the triage screening in emergency departments.

誌謝 i
中文摘要 iii
英文摘要 iv
表目錄 v
附錄 vi
第一章 緒論 1
第一節 研究緣起與動機 1
第二節 研究目的 4
第三節 研究重要性 5
第二章 文獻探討 6
第一節 2003年SARS跨國流行簡介 6
第二節 SARS冠狀病毒 12
第三節 實驗室診斷 14
第四節 台灣衛生署疾病管制局公佈之SARS定義 15
第五節 感染防治措施 17
第六節 醫護人員感染SARS的情形與因素 19
第三章 研究架構 21
第一節 概念架構 21
第二節 研究假設 23
第四章 研究方法 27
第一節 研究對象 27
第二節 問卷設計 28
第三節 資料收集 30
第四節 實驗方法 31
第五節 生物統計分析 33
第五章 研究結果 34
第一節 篩檢結果人口學資料分析 34
第二節 篩檢結果血清學分析 35
第三節 SARS-CoV抗體陽性與陰性兩組醫護人員於食物攝取與運動之
比較 37
第四節 SARS-CoV抗體陽性與陰性兩組醫護人員其接觸史暴露時間之比較 38
第五節 SARS-CoV抗體陽性與陰性兩組醫護人員其醫療處置之比較 39
第六節 SARS-CoV抗體陽性與陰性兩組醫護人員其個人防護裝備之比較 39
第七節 SARS-CoV抗體陽性與陰性兩組醫護人員其接觸病房器物之比較 40
第六章 結論與討論 42
第一節 感染因子探討 42
第二節 研究限制 48
參考文獻 50
表 57
附錄 67

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CDC局慶特刊-「抗SARS關鍵紀錄」
行政院衛生署疾病管制局疫情報導19(4):167-198