高感染風險經皮穿刺傷後對醫療人員生理與心理之影響

୯ҥᆵ᡼εᏢᙴᏢଣៈ౛Ꮲࣴز܌

റγፕЎ

Department of Nursing College of Medicine

National Taiwan University Doctoral Dissertation

ଯགࢉ॥ᓀ࿶Ҝऀڈ໾ࡕჹᙴᕍΓ঩

ғ౛ᆶЈ౛ϐቹៜ

Physical and psychological impacts from high infection risk percutaneous injuries on healthcare workers

ֆഓ๭

Hsueh-Ching Wu

ࡰᏤ௲௤Ǻᑵలሏ റγ

Advisor: Judith Shu-Chu Shiao, Ph.D.

ύ๮҇୯ 104 ԃ 7 Д

July 2015

ᇞ ᇞᖴ

ϖԃޑറγғఱಖܭ֋΋ࢤပΑǴЈύкᅈ഻৹ᆶགᐟǴ೭΋ၡޑԋߏᆶ॥

ඳǴ໒ബΑךόӕޑຎഁǴࣁךӧᏢೌ྅୸ύǴ൚ۓΑؼӳޑዹҡǴ࣬ߞᐕ࿶Αറ γ੤ᝄ቉ा؃ޑేግၸำǴ҂ٰޑᏢೌϐၡஒ׳ૈڶฅय़ჹᆶ୲࡭όᏮǹԶ೭൳ԃ ӧπբǵৎ৥ᆶറγ੤ޑᏢಞᐕำύǴ׳ाགᖴғڮύคኧޑ຦ΓǴԖΑாॺޑࡰ

ЇᆶڐշǴ໒௴ךΓғޑќ΋ଆᗺǴᖴᖴாॺǼ

२ӃǴനགᖴޑࢂךޑࡰᏤ௲௤ᑵలሏറγǴӧόᘐޑ૸ፕύЇᏤךࡘԵࣴ

زЬᚒǴ٠৖౜ჹࣴزޑჴ٣؃ࢂᆒઓǹ࣮ډԴৣჹᏢޣᔈॄޑޗ཮ೢҺᆶ஑཰౛

གྷϐ୲࡭Ǵόᘐಕᑈჴ᛾ኧᏵǴ٠ᗘԶό௭ࣁϦӅࡹ฼ගр୲ჴޑࡌقǹ׳Їሦך و຾ᙍ཰ፁғៈ౛ޑሦୱǴ࣮ډ೭ሡा׫Ε׳ӭᜢݙᆶёаวච׳ӭԋਏޑ஑཰ǹ ԶӧВத࣬ೀύǴ׳ࢂೀೀᜢЈǵҔЈჹࡑ؂ՏᏢғǴкϩวචៈ౛஑཰ӕ౛ޑ੝

፦Ǵ೭٤೿ుుቹៜ๱ךǴ׳ࢂךಖғᏢಞޑڂጄǶ

གᖴ೾ػؼ௲௤ޑ஼ЈࡰᏤǴӧ 2 ԃъޑঅፐᆶ஑ᚒ૸ፕύǴЇሦךჹᕉნ ᙍ཰ᙴᏢǵࢬՉੰᏢ׳ుΕޑᡏ৴Ǵ٠ቚ຾ᙁൔޑמѯǹЪӧ؂ԛޑ૸ፕύᕴૈق ᙁཀၝᆒྗޑඓඝख़ᗺǴԶځᓬ໡ᖰᇽޑ॥ጄǴаϷ኏ΚࣁϦޑᆒઓǴ׳ࢂך஖ལ ޑིኳǶགᖴ஭ۺཁ௲௤வၗ਱Ե໒ۈޑ΋ၡЍ࡭ᆶፕЎޑࡰᏤǴՖߪണറγϷഋ ЬඵറγӧࣴزБݤǵፕЎϩ݋ǵቪբ΢ޑࡰᏤᆶڐշǴϷჹᏢғޑᡏፊᆶЍ࡭Ǵ ନᡣፕЎ׳ᑪֹ๓ѦǴΨ೿ᡣךഢགྕធǶ

གᖴѠεៈ౛س܌Ϸ܌ԖৣߏǴගٮךॺӵԜᓬؼޑᏢಞᕉნᆶ॥਻ǴϷӧ

௲Ꮲᆶࣴز΢ޑࡰᏤǴৣߏॺޑ஑཰ᆶ዗၈Ǵ׳ࢂךᏢಞޑᄦኬǶགᖴറγ੤ޑӕ ᏢǴ჏࣓ǵݒ܃ǵ੿ऍǵҏᗪǵЈྼǵ܃໡ǵऍզǴ΋ଆӅӕᏢಞǴ΋ଆр୯ว߄ ፕЎǵ΋ଆ࣬ϕן࡭ᆶႴᓰǴᖴᖴԖգॺޑഉՔǴ٬ךޑറγ؃Ꮲғࢲ׳уޑᙦ൤

ᔾឳǶΨགᖴ 101 ᒤϦ࠻Ꮲۂॺྕធޑۊۂ௃ፉǴԖ୤࣑ǵਇ्ǵᓉૠǵඁӵǵػ ૠǵە໺ǵ٩Ꮒǵ᜽మޑ዗௃Ѝ࡭ᆶڐշǴᡣࣴزޑၸำύǴቚబคኧޑ៿ઢᆶྕ

ཪǴΨుుӑ૶ӧךޑတੇ္Ƕ

གᖴཥғᙴ஑ߏ۔ჹך຾অޑЍ࡭ᆶڐշǴ׳ᖴᖴᏢਠӭՏπբӳუՔǺЎ ੧ǵҥ҇ǵҏ۩ǵ۩〉ǵలඁǵ᐀๩ǵٵەǵનृૈ໼᠋ᆶϩ٦ך຾অޑለౡधᇺǴ ٠ගٮᔅշᆶႴᓰǴᡣךૈӧԆ࿛ޑറγғࢲύǴϝૈ໩ճֹԋπբ΢ޑा؃ᆶҺ

୍ǶΨགᖴεᏢӕᏢનӲǵች޹ǵۑەǵᝊⱋǵλጔǵጰᙜ฻ޑѺ਻ǹ׳ाགᖴך ຬભӳܻ϶లृ΋ၡوٰޑ࣬ՔᆶႴᓰǴᡣךӧ਋שᆶ଎ைύǴΞԖཥޑ୏ΚᆶҞ

኱Ƕ

നࡕനाགᖴޑࢂךനᒃངޑৎΓǺךޑݿݿ༰༰ǴନΑ߻Οԃࣁךྣ៝ԃ Ѵޑ΋ჹηζѦǴ٠ૈᒿਔྗഢЍජࡑڮǴᡣךૈคࡕ៝ϐኁޑ຾Չঅፐᆶԏਢǹ གᖴֻЎǵ᜽௵ǵ㡔ᲹǵቼᓪڐշᔅԆྣ៝ӳݿ༰ǴᡣךόҔࣁߏ፸ᏹЈǹΨགᖴ ςӧϺ୸ޑϦϦӄΚޑЍ࡭ǹ׳ाགᖴךᒃངޑԴϦහጩǴ೭ϖԃٰޑٌधǴନΑ ԾρᕷԆޑπբϷᓸΚѦǴᗋाڐշ஥࠸ηǵᆅ௲࠸ηǵϩᏼৎ୍ǵගٮᒌ၌ǵ໼

᠋ႴᓰϷ஑཰ࡌ᝼ǴӢࣁԖգޑх৒ᆶᡏፊǴךωૈֹԋറγᏢՏǴԖգ੿ӳǶᗋ ԖךёངޑႠ൏ᆶ߀ཾǴႠ൏ޑᐱҥϷԾךा؃Ǵ߀ཾޑຠЈϷ؂ఁӧਜ܊߻ᇸെ

“༰ࠓϞϺёаഉךᅵ᝺༏”Ǵ೿ࢂ០୏ךуᆙոΚޑচ୏ΚǴගᒬԾρा׳Ԗਏ౗

ޑֹԋ၀଺ޑ٣୍Ƕ

ӆ΋ԛޑགᖴӧךറγ੤؃ᏢғఱύǴ܌Ԗමᔅշǵڐշǵх৒ǵᡏፊϷЍ

࡭ךޑ؂΋ՏৣߏǵӕᏢǵӕ٣ǵܻ϶ϷৎΓǴӢࣁԖாॺǴךωૈֹԋךޑფགྷǴ

҂ٰҭ׆ఈԖாॺޑЍ࡭Ǵૈ೴؁ֹԋךޑ౛གྷǴᖴᖴாॺ!! ᖴᖴ!!

ഓ๭ ܭѠч 2015ԃ 7 Д

ύ

ύЎᄔा

ࣴزङඳ

࿶Ҝऀڈ໾ࢂᙴᕍΓ঩നதـޑᙍ཰໾্ǴЀځࢂੰΓྍࣁ໚܄ё࿶Ոన໺

ኞ܄ੰচᡏϐଯགࢉ॥ᓀ࿶Ҝऀڈ໾Ǵځ࠶ુхࡴ೏གࢉޑᐒ౗ǵ໚ᙯޑ॥ᓀǵႣ

ٛ܄׫ᛰ܌஥ٰޑيᡏբҔǵࣗԿёૈԝΫޑ࠶ુǴ׳ёૈԖЈ౛΢ޑ໾্Ϸჹπ բᕉნޑόӼӄག฻Ǵࣣ཮೷ԋᙴᕍΓ঩Ϸᙴᕍᙍ൑ख़ाޑፂᔐǶ

Ҟޑ

ҁࣴزх֖Οঁ೽ϩǴಃ΋೽ϩࣁ௢՗୯ϣ࿶Ҝऀڈ໾ޑวғ౗Ǵගٮჹᙴ ᕍΓ঩࿶Ҝऀڈ໾׳ుΕΑှวғޑᖿ༈Ǵ٠ёբࣁӧӄय़ගٮӼӄଞڀ߻ޑ୷ ጕၗ਑ǹಃΒ೽ϩࣁ຾΋؁ϩ݋ӚᙍᜪᙴᕍΓ঩ଯགࢉ॥ᓀ࿶Ҝऀڈ໾ϐࢬՉੰ

ᏢǴ٠௢՗ёૈ໚ᙯޑ॥ᓀǹಃΟ೽ϩջଞჹමวғଯགࢉ॥ᓀ࿶Ҝऀڈ໾ޑᙴᕍ Γ঩຾Չ፦܄ೖፋǴుΕΑှځჹଯགࢉ॥ᓀ࿶Ҝऀڈ໾ޑЈ౛ቹៜᆶፂᔐǴаග ٮᙴᕍ୺཰ᕉნ׳ᆒዴޑୖԵᆶࡌ᝼Ƕ

Бݤ

ಃ΋ǵΒ೽ҽࣴزࣣࢂ௦Ҕӣྉ܄ԛભၗ਑ϩ݋ǴճҔᙴᕍΓ঩Ӽӄፁғύ ЈϐȨύЎހ EPINet ଞЌ೯ൔس಍ȩύϐ೯ൔၗ਑৤ڗள࿶Ҝऀڈ໾೯ൔϷځଓ ᙫၗ਑ǴၮҔ಍ी೬ᡏ JMP Ϸ SAS ຾Չϩ݋ᆶ௢՗ǶಃΟ೽ϩࣴز፦܄ࣴزݤǴ аుࡋೖፋǵҥཀڗኬБԄԏਢǴ٠௦Ҕ፦܄ϣ৒ϩ݋ݤϷᝄᙣࡋԵໆǶ

่݀

ಃ΋೽ϩࣴز่݀ᡉҢаᙴଣੰ׉ኧǵӄᙍᙴᕍΓ঩ኧǵϷՐଣВኧ௢՗ӄ ୯ᙴᕍΓ঩࿶Ҝऀڈ໾ϐวғԛኧӧ 6,710 ډ 8,319 ԛ໔ǹϝᆶ 2004 ԃޑၗ਑࣬

߈Ǵՠӧᙴৣޑ೯ൔԛኧϷ HIV ޑଯགࢉ॥ᓀ࿶Ҝऀڈ໾Ԗቚуޑᖿ༈Ƕ

ಃΒ೽ϩࣴز่݀ᡉҢǴวғଯགࢉ॥ᓀ࿶Ҝऀڈ໾ޑӦᗺύǴᙴৣаȨౢ

܊ȩǵȨᔠࢗ࠻ȩǵȨ໒Θ܊ȩၨଯǹៈ౛Γ঩аȨՈన೸݋࠻ȩǵȨуៈੰ܊ȩǵ Ȩੰ܊ȩၨଯǹᙴᕍמೌΓ঩ӧȨуៈੰ܊ȩǵȨܜՈύЈȩၨܰวғǹԶЍජΓ

঩߾аȨੰ܊ȩวғޑКٯനଯǶќӧ 2012 ԃޑ೯ൔၗ਑ύǴ܌ԖᙴᕍΓ঩Һ΋

໚܄ଯགࢉ॥ᓀ࿶Ҝऀڈ໾วғ౗ࣁ 0.87 ҹ/100 ՏӄᙍᙴᕍΓ঩Ǵ٠௢՗؂ԃё

ૈӢଯགࢉ॥ᓀ࿶Ҝऀڈ໾Զགࢉ HBV ޑᙴᕍΓ঩Ԗ 52~133 ΓǵHCV ޣ 41~82 ΓǵHIV ࣁ<1~5 ΓǶ

ಃΟ೽ϩଞჹ࿶ᐕଯགࢉ॥ᓀ࿶Ҝऀڈ໾ϐᙴᕍΓ঩ޑЈ౛ቹៜϐ፦܄ࣴز

่݀ǴӅᘜયрϖεЬᚒǴϩձࣁ௃ᆣ֚ᘋǵჹ੯ੰ࠶ુޑགڙǵલЮЈ౛Ѝ࡭ǵ ׯᡂᙍ཰዗וϷ҅ӛፓ፾Ƕ

่

่ፕᆶࡌ᝼

ҁࣴزࡌ᝼ᙴᕍᙍ൑ᔈ:٩ςᒣ᛽рϐଯགࢉ॥ᓀ࿶Ҝऀڈ໾ޑวғӦᗺᆶ

௃ნගٮόӕᙍᜪᙴᕍΓ঩຾Չٛݯ௲ػ૽ግϷගٮ࣬ᜢٛៈ௛ࡼǹ೛ҥ࿶Ҝऀ

ڈ໾ൂ΋೯ൔืαϷ኱ྗϯೀ౛؁ᡯǹଞჹ྽٣ޣගٮനཥޕ᛽ǵᆢៈځ៾੻Ǵӵ π໾ଷޑҙፎᆶЈ౛ᒌ୘ᇶᏤᙯϟ฻Ƕӕਔҭࡌ᝼Ьᆅᐒᜢૈ๓ᅰᅱ࿎ᆶዽਡϐ

ೢхࡴ:ଞЌࢂցዴჴ೯ൔϷӼӄଞڀϐඹж౗ࢂց٩ݤೕा؃ǹԜѦǴ҂ٰҭё ଞჹӼӄଞڀ٬Ҕࢂցё෧Ͽ࿶Ҝऀڈ໾วғԶफ़ե࿶ᔮ઻ཞ຾Չԋҁਏ੻ϩ݋Ǵ а଺ࣁࡹ฼ڋۓϐ٩ᏵǶ

ᜢᗖຒ

࿶Ҝऀڈ໾ǵଯགࢉ॥ᓀǵଞЌ೯ൔس಍ǵ໚ᙯǵЈ౛ቹៜ

Abstract Background

Percutaneous injury (PI) is the most common occupational hazard for healthcare workers (HCWs), especially the high infection risk PI from source patients who are positive blood-borne pathogens (BBP). These include risk of infection and seroconversion, impacts to physical health due to post-exposure prophylaxis and even threat of death. Even more crucial are feeling psychological harm and unsafe working environment. All of these risks have great impacts to HCWs and healthcare settings.

Objectives

This study includes three parts. First is to estimate the incidence of PI in Taiwan so as to understand PI occurring trend and to provide baseline data before mandatory usage of safety needles; Second is to further analyze high infection risk PI to different job category of HCWs and estimate risk of seroconversion; The final part is to conduct qualitative in-depth interviews with HCWs experiencing high infection risk PI to understand their psychological impacts. Through these three parts, the study aims to provide more precise references and suggestions to medical practice environment.

Methods

The first and second parts of the study adopted a retrospective secondary data analysis approach, with reporting and tracking data from Chinese Exposure Prevention Information Network (EPINet) of the Center for Medical Employees’ Safety and Health being analyzed and estimated by using statistical software JMP and SAS. The third of the study was designed using qualitative methods and purposive sampling approach. In- depth interviews were conducted for data collection, qualitative content analysis was performed and also the stringency rigor of the research was taken into account.

Results

The results of the first part revealed a national estimate of PI between 6710 and 8319 in 2011 by using estimated number of hospital beds, full-time HCWs, and days of inpatient care, which are similar to a previous study using 2004 data. There are increasing trend in reporting numbers of physicians and high infection risk PI of HIV.

The second part’s results showed that high infection risk PI for physicians often

ICU, and ward; and for medical technician in ICU, blood collection counter; while for support personnel in ward. In addition, the notification data in 2012 revealed the incidence of any positive high infection risk PI for HCWs is 0.87 cases/100 full-time HCWs. The estimated annual number of high infection risk PI is 52~133 persons due to HBV, 41~82 to HCV and <1~5 to HIV.

The qualitative study results of the third part of analyzing psychosocial impacts of infectious PI had been extracted into five themes: emotional distress, perceived threat of seroconversion, perceived lacking humanity support from work, altered professional enthusiasm, and positive adjustment.

Conclusions and Suggestions

The study suggests healthcare settings should provide different prevention education training and relevant preventive interventions to HCWs based on their job categories as location and mechanisms for highly infectious PI are different. It is necessary for healthcare settings to set up a single window reporting system and standard procedures after PI. Healthcare settings should also provide the most updated information and protect such HCWs’ rights as taking work-related injury leave and making referral to psychological consultations. The study also suggests government authorities supervise and audit healthcare settings to ensure their PI reporting and replace rates of using safety needles are in compliant with regulations. Furthermore, it may be necessary to conduct a cost and benefit analysis to explore whether the use of safety needles could reduce the PI incidence rate so as to reduce economic cost. The study results may also be used as a reference for future policy making.

Keywords

percutaneous injury (PI), high infection risk, Exposure Prevention Information Network (EPINet), seroconversion, psychological impact.

Ҟ Ҟᒵ

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ಃ΋࿯ ࣴزङඳ ...1

ಃΒ࿯ ࣴزҞޑ ...4

ಃΟ࿯ Ӝຒۓက ...5

Ў᝘௖૸ ...7

ಃ΋࿯ ࿶Ҝऀڈ໾ϐࢬՉੰᏢ ...7

ಃΒ࿯ ࿶Ҝऀڈ໾ޑགࢉ॥ᓀ ...12

ಃΟ࿯ ଯགࢉ॥ᓀ࿶Ҝऀڈ໾ࡕჹᙴᕍΓ঩ϐЈ౛ቹៜ ...22

ࣴزБݤ ...25

ಃ΋࿯ ᙴᕍΓ঩࿶Ҝऀڈ໾ӄ୯วғ౗ϐ௢՗ ...27

ಃΒ࿯ ϩ݋Ѡ᡼ӚᜪᙴᕍΓ঩ଯགࢉ॥ᓀ࿶Ҝऀڈ໾ϐࢬՉੰᏢ ...32

ಃΟ࿯ ፦܄ࣴز--ᙴᕍΓ঩ଯགࢉ॥ᓀ࿶Ҝऀڈ໾ϐЈ౛ፂᔐ...37

ࣴز่݀ ...44

ಃ΋࿯ ࿶Ҝऀڈ໾ӄ୯วғ౗ϐ௢՗ ...44

ಃΒ࿯!ϩ݋Ѡ᡼ӚᜪᙴᕍΓ঩ଯགࢉ॥ᓀ࿶Ҝऀڈ໾ϐࢬՉੰᏢ ...54

!૸ፕ ...93

ಃ΋࿯ ӄ୯ᙴᕍΓ঩࿶Ҝऀڈ໾ϐ௢՗ ...93

ಃΒ࿯ ϩ݋Ѡ᡼ӚᜪᙴᕍΓ঩ଯགࢉ॥ᓀ࿶Ҝऀڈ໾ϐࢬՉੰᏢ ...97

ಃΟ࿯ ፦܄ࣴز-ᙴᕍΓ঩ଯགࢉ॥ᓀ࿶Ҝऀڈ໾ϐЈ౛ፂᔐᆶቹៜ...105

่ፕᆶࡌ᝼ ...109

ಃ΋࿯ ่ፕ ...109

ಃΒ࿯ ࡌ᝼ ...111

ಃΟ࿯!ࣴزज़ڋ ...114

ୖԵЎ᝘ ...116

ߕҹ΋ ୯ҥѠ᡼εᏢᙴᏢଣߕ೛ᙴଣ C ࣴزউ౛ہ঩཮խቩ᛾ܴ……...……128

ߕҹΒ ୯ҥѠ᡼εᏢᙴᏢଣߕ೛ᙴଣ C ࣴزউ౛ہ঩཮ቩࢗ᛾ܴ…………...129

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კ߄Ҟᒵ

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კ 2 ᙴᕍΓ঩ኧᆶଞЌวғԛኧϐ଑ᘜϩ݋ᖿ༈……..………..…….……47

კ 3 ѳ֡ՐଣВኧᆶଞЌวғԛኧϐ଑ᘜϩ݋ᖿ༈………...………..47

კ 4 ଯགࢉ॥ᓀ࿶Ҝऀڈ໾ࢬՉੰᏢϐࣴزࢬำკ………...…...…...54

߄ 1 Ӛ୯࿶Ҝऀڈ໾ϐ౰Չ౗ᆶวғ౗ ... 9

߄ 2 Ӛ୯ B ࠠطݹੰࢥǵC ࠠطݹੰࢥϷΓᜪխࣝલЮੰࢥ΋૓ဂᡏ౰Չ౗ 16 ߄ 3 B ࠠطݹੰࢥǵC ࠠطݹੰࢥϷΓᜪխࣝલЮੰࢥՐଣੰΓϐ౰Չ౗... 17

߄ 4 ࿶Ҝऀڈ໾೯ൔၗ਑ύ໚܄ੰΓϐ౰Չ౗ ... 19

߄ 5 วғଯགࢉ॥ᓀ࿶Ҝऀڈ໾ᙴᕍΓ঩໚ᙯޑ॥ᓀࣴز ... 21

߄ 6 ࿶Ҝऀڈ໾ࣴزதҔϐࣴزБݤᓬલᗺКၨ ... 25

߄ 7 Ӛԃࡋୖᆶ EPINet ೯ൔޑᙴଣኧϷ೯ൔ฽ኧ ... 30

߄ 8 Ӛᡂ໨Ӝᆀǵۓကǵᆶᜪࠠ ... 34

߄ 9 ೖፋࡰЇεᆜ ... 42

߄ 10 2011 ԃ 49 ৎୖᆶࣴزᙴଣϐङඳၗ਑ᆶ࿶Ҝऀڈ໾೯ൔኧ ... 44

߄ 11 2011 ԃୖᆶࣴزᙴଣޑ࿶Ҝऀڈ໾วғ౗Ϸ௢՗Ѡ᡼ӄԃޑ࿶Ҝऀڈ໾ วғኧ ... 45

߄ 12 Ӛᙴଣ࿶Ҝऀڈ໾วғԛኧᆶΟ໨ᡂ໨໔࣬ᜢ܄ϐ଑ᘜϩ݋ ... 46

߄ 13 49 ৎᙴଣӚᜪᙴᕍΓ঩ PI ౗ϷаՐଣВኧ௢՗ӚᙍᜪᙴᕍΓ঩ 2011 ԃ วғ PI ԛኧ ... 48

߄ 14 49 ৎᙴଣӚ੝ۓᏔڀ PI ౗ϷаՐଣВኧ௢՗ӄ୯Ӛ੝ۓᏔڀ೷ԋ 2011 ԃ วғ PI ԛኧ ... 50

߄ 15 2011 ԃଞЌ೯ൔس಍ύ೷ԋ࿶Ҝऀڈ໾ޑ߻Ϥ໨চӢ ... 51 ߄ 16 2011 ԃᙴᕍΓ঩วғ࿶Ҝऀڈ໾ࣁ໚܄ੰΓྍޑК౗ϷаՐଣВኧ௢՗

߄ 17 ੰΓྍϐё࿶Ոన໺ኞ܄ੰচᡏᔠᡍ่݀ ... 55

߄ 18 ଯགࢉ॥ᓀ࿶Ҝऀڈ໾ӧӚᙴᕍΓ঩Ϸᙴଣቫભޑϩթ ... 56

߄ 19 ଯགࢉ॥ᓀ࿶Ҝऀڈ໾Ӧᗺϩթ ... 57

߄ 20 ଯགࢉ॥ᓀ࿶Ҝऀڈ໾วғ௃ნϩթ ... 57

߄ 21 ೷ԋଯགࢉ॥ᓀ࿶Ҝऀڈ໾Ӿ᎒ނϩթ ... 58

߄ 22 Їଆଯགࢉ॥ᓀ࿶Ҝऀڈ໾ϐӾ᎒ނচۈҔ೼ϩթ ... 59

߄ 23 όӕӦᗺวғଯགࢉ॥ᓀ࿶Ҝऀڈ໾ޑКٯ ... 60

߄ 24 ᙴৣӧόӕᙴଣቫભǵӦᗺวғଯགࢉ॥ᓀ࿶Ҝऀڈ໾วғКٯϐ࣬ᜢ܄ ... 61

߄ 25 ᙴৣӧόӕӦᗺวғଯགࢉ॥ᓀ࿶Ҝऀڈ໾ϐੰΓྍ໚܄੯ੰᅿᜪϩթ 62 ߄ 26 ᙴৣӧόӕ௃ნᆶวғଯགࢉ॥ᓀ࿶Ҝऀڈ໾Кٯϐ࣬ᜢ܄ ... 63

߄ 27 ᙴৣӧόӕޑӾ᎒ނᅿᜪᆶଯགࢉ॥ᓀ࿶Ҝऀڈ໾วғКٯϐ࣬ᜢ܄ ... 64

߄ 28 ᙴৣӧόӕޑӾ᎒ނচۈҔ೼ᆶଯགࢉ॥ᓀ࿶Ҝऀڈ໾วғКٯϐ࣬ᜢ܄ ... 64

߄ 29 ៈ౛Γ঩ӧόӕᙴଣቫભǵӦᗺวғଯགࢉ॥ᓀ࿶Ҝऀڈ໾วғКٯϐ࣬ ᜢ܄ ... 65

߄ 30 ៈ౛Γ঩ӧόӕቫભᙴଣଯགࢉ॥ᓀ࿶Ҝऀڈ໾ϐੰΓྍ໚܄੯ੰᅿᜪϩ թ ... 66

߄ 31 ៈ౛Γ঩ӧόӕӦᗺวғଯགࢉ॥ᓀ࿶Ҝऀڈ໾ϐੰΓྍ໚܄੯ੰᅿᜪϩ թ ... 66

߄ 32 ៈ౛Γ঩ӧόӕ௃ნᆶวғଯགࢉ॥ᓀ࿶Ҝऀڈ໾Кٯϐ࣬ᜢ܄ ... 67

߄ 33 ៈ౛Γ঩όӕӾ᎒ނচۈҔ೼ᆶଯགࢉ॥ᓀ࿶Ҝऀڈ໾วғКٯϐ࣬ᜢ܄ ... 68

߄ 34 ᙴמΓ঩ӧᙴଣቫભǵӦᗺวғଯགࢉ॥ᓀ࿶Ҝऀڈ໾วғКٯϐ࣬ᜢ܄ ... 69

߄ 35 ᙴמΓ঩ӧᙴଣቫભǵӦᗺวғଯགࢉ॥ᓀ࿶Ҝऀڈ໾วғКٯϐ࣬ᜢ܄

... 70

߄ 36 ᙴמΓ঩ӧόӕ௃ნᆶวғଯགࢉ॥ᓀ࿶Ҝऀڈ໾Кٯϐ࣬ᜢ܄ ... 70

߄ 37 ᙴמΓ঩ӧόӕӾ᎒ނᅿᜪᆶวғଯགࢉ॥ᓀ࿶Ҝऀڈ໾Кٯϐ࣬ᜢ܄ 71 ߄ 38 ᙴמΓ঩ޑӾ᎒ނচۈҔ೼ᆶଯགࢉ॥ᓀ࿶Ҝऀڈ໾วғКٯϐ࣬ᜢ܄ 71 ߄ 39 ЍජΓ঩วғଯགࢉ॥ᓀ࿶Ҝऀڈ໾ᆶᙴଣቫભǵӦᗺϐ࣬ᜢ܄ ... 72

߄ 40 ЍජΓ঩όӕวғ௃ნǵӾ᎒ނᅿᜪǵচۈҔ೼ᆶଯགࢉ॥ᓀ࿶Ҝऀڈ໾ วғКٯϐ࣬ᜢ܄ ... 73

߄ 41 2012 ԃ೯ൔၗ਑ύᙴᕍΓ঩ϐ࿶Ҝऀڈ໾วғ౗ ... 74

߄ 42 όӕᙴᕍΓ঩Һ΋໚܄ଯགࢉ॥ᓀ࿶Ҝऀڈ໾วғ౗௢՗ ... 76

߄ 43 όӕᙴᕍΓ঩ HBV ଯགࢉ॥ᓀ࿶Ҝऀڈ໾วғ౗௢՗... 76

߄ 44 όӕᙴᕍΓ঩ HCV ଯགࢉ॥ᓀ࿶Ҝऀڈ໾วғ౗௢՗... 77

߄ 45 όӕᙴᕍΓ঩ HIV ଯགࢉ॥ᓀ࿶Ҝऀڈ໾วғ౗௢՗ ... 77

߄ 46 όӕᙴᕍΓ঩ఘࢥଯགࢉ॥ᓀ࿶Ҝऀڈ໾วғ౗௢՗ ... 78

߄ 47 όӕᙴᕍΓ঩ჹ HBV ܰགڙဂᡏКٯ௢՗... 80

߄ 48 Ѡ᡼ᙴᕍΓ঩Ӣ HBV ଯགࢉ॥ᓀ࿶Ҝऀڈ໾Զ໚ᙯΓኧ௢՗... 81

߄ 49 Ѡ᡼ᙴᕍΓ঩Ӣ HCV ଯགࢉ॥ᓀ࿶Ҝऀڈ໾Զ໚ᙯΓኧ௢՗... 81

߄ 50 Ѡ᡼ᙴᕍΓ঩Ӣ HIV ଯགࢉ॥ᓀ࿶Ҝऀڈ໾Զ໚ᙯΓኧ௢՗ ... 82

߄ 51 ୖᆶࣴزჹຝϐङඳၗ਑ ... 83

߄ 52 ୖᆶࣴزჹຝ΋ំ߄ ... 84

߄ 53 ࿶ᐕଯགࢉ॥ᓀ PI ჹᙴᕍΓ঩Ј౛ቹៜϩ݋่݀ϐϖ໨ЬᚒϷԛЬᚒ. 85 ߄ 54 ӄѠӢଯགࢉ॥ᓀ࿶Ҝऀڈ໾໚ᙯΓኧ௢՗ፓ᏾ ... 102 ߄ 55 όӕᙴᕍπբޣวғଯགࢉ॥ᓀ࿶Ҝऀڈ໾Кٯၨଯϐ߻Ο໨Ϸࡌ᝼ 104

ᆣ ᆣፕ

ಃ΋࿯ ࣴزङඳ

࿶Ҝऀڈ໾ ( percutaneous injury, PI ) ࢂᙴᕍྣៈΓ঩നதـޑᙍ཰໾্Ƕҗ Ў᝘ӣ៝ёޕԖ 20 ᅿа΢ޑՈన໺ࢉ੯ੰёૈӢ࿶Ҝऀڈ໾Զ໺ࢉ๏ᙴᕍΓ঩Ǵ ځύၨதـޑхࡴ B ࠠطݹੰࢥ ( hepatitis B virus, HBV )ǵC ࠠطݹੰࢥ ( hepatitis C virus, HCV )ǵϷΓᜪխࣝલЮੰࢥ ( human immunodeficiency virus, HIV ) Ǵځ ჹᙴᕍΓ঩ޑπբӼӄᆶ଼ந೷ԋཱུε࠶ુ ( Adams, 2012ǹWu et al., 2015ǹֆǵ

೾ǵᑵǴ2013ǹഋǵ݅Ǵ2008 ) Ǵځύхࡴ೏གࢉޑᐒ౗ǵ໚ᙯޑ॥ᓀǵ੯ੰёૈ

ޑᙯᡂ܌஥ٰޑيᡏྞዖǵࣗԿёૈԝΫޑ࠶ુǵаϷЈ౛΢ޑ໾্Ϸჹπբᕉნ ޑόӼӄག ( Watterson, 2004 )ǴᡉҢჹᙴᕍΓ঩Ϸᙴᕍᙍ൑ࣣ཮೷ԋख़ाޑፂᔐǶ ԶѠ᡼ᙴᕍΓ঩؂ԃزഖԖӭϿ࿶Ҝऀڈ໾ޑวғǻਥᏵᑵలሏ฻ճҔ 2004 ԃ 14 ৎᙴᕍଣ܌ǴԾᜫୖᆶȨύЎހ EPINet ଞЌ೯ൔس಍ȩ ( Exposure Prevention Information Network, EPINet ) ೯ൔޑၗ਑܌ว߄ޑࣴز௢՗Ǵ؂ԃऊԖ 8,000ԛѰѓޑ࿶Ҝऀڈ໾วғӧᙴᕍΓ঩ي΢ ( Shiao et al., 2008 )ǹځࡕമ୏೽

ҭႴᓰᙴᕍଣ܌ճҔԜس಍຾Չ೯ൔǴ٠ܭ 2010 ԃ 3 ДࡰۓύЎހ EPINet ࣁ୯ ϣᙴᕍଣ܌࿶Ҝऀڈ໾ᆶՈᡏనኪ᝻٣ҹޑ೯ൔس಍ǴЪೕۓ୯ϣᙴᏢύЈϷϦ ҥᙴଣԾ 2011 ԃଆࣣ໪மڋ೯ൔ ( ӄ୯ݤೕၗ਑৤Ǵ2015 )Ƕݤೕமڋ೯ൔޑೕ

ۓࡕǴ୯ϣᙴᏢύЈᆶϦҥᙴଣࣣςуΕȨύЎހ EPINet ଞЌ೯ൔس಍ȩ຾Չ೯ ൔǹӧࡹ۬ൂՏႴᓰᆶݤೕமڋೕۓΠǴёૈ׳ૈගଯӚᙴᕍΓ঩ޑख़ຎᆶ೯ൔཀ ᜫǹฅமڋ೯ൔࡕځ࿶Ҝऀڈ໾ޑჴሞวғރݩزഖࣁՖǻॶள຾΋؁ᜢݙǶќፁ ғᅽճ೽ࣁΑᡣᙴᕍΓ঩Ԗ׳ӼӄޑπբᕉნǴନΑӧȨᙴଣຑ᠘୷ྗϷຑໆ໨Ҟȩ ύܴዴஒȨӼӄଞڀȩӈΕགࢉᆅڋࢗਡϷຑ᠘ϣ৒ѦǴҥݤଣҭܭ 2011 ԃ 12 Д 21ВΟ᠐೯ၸঅ҅ᙴᕍݤ 56 చϷ 101 చǴೕۓԾύ๮҇୯ 101 ԃଆϖԃϣᙴᕍᐒ ᄬ໪ࡪКٯ೴؁ֹԋӄय़ගٮӼӄଞڀǴ٠ुԖᆦ߾ ( ֆ฻Ǵ2013ǹӄ୯ݤೕၗ

਑৤Ǵ2015 )ǴаගٮᙴᕍΓ঩΋ঁӼӄޑπբᕉნǹࡺ׆ఈ೸ၸϩ݋மڋ೯ൔࡕ ޑၗ਑ǴΑှᙴᕍΓ঩࿶Ҝऀڈ໾ޑวғރݩǴ٠ӆ຾΋؁௢՗୯ϣᙴᕍπբΓ঩

࿶Ҝऀڈ໾ޑวғ౗ϷځࢬՉੰᏢޑཷݩǴයૈჹᙴᕍ୺཰ᕉნޑ࿶Ҝऀڈ໾ϐ

᏾ᡏϷׯᡂޑᖿ༈Ԗ׳ֹ᏾ޑΑှǴ٠բࣁӧჴࡼӄय़ගٮӼӄଞڀ߻ϐ୷ጕၗ

਑Ǵаගٮ๏࣬ᜢൂՏပჴࡹ฼Ϸ҂ٰׯ๓ᙍ൑ӼӄޑୖԵ٩ᏵǶ

ฅԶӧ೴؁ቚуගٮӼӄଞڀޑය໔ǴᙴᕍΓ঩ϝೀܭ࿶Ҝऀڈ໾ޑ॥ᓀύǴ Ъวғ࿶Ҝऀڈ໾ਔǴऩੰΓྍࢂՈనགࢉ੯ੰޑ໚܄ޣ ( аΠᙁᆀଯགࢉ॥ᓀ

࿶Ҝऀڈ໾ )Ǵځ೏གࢉޑ॥ᓀ׳ଯ ( Centers for Disease Control and Prevention, CDC, 2013 )ǶШࣚፁғಔᙃ ( World Health Organization, WHO ) ௢՗Ǵӄౚޑᙴ ᕍΓ঩؂ԃᎁڙ࿶Ҝऀڈ໾Զளډ B ࠠطݹੰࢥǵC ࠠطݹੰࢥϷࡕϺխࣝόӄ

ੰࢥޣϩձऊԖ 66,000 Γǵ16,000 ΓϷ 1,000 ΓǴΨ௢՗ᑡ஻ HBVǵHCV Ϸ HIV ޑᙴᕍΓ঩ύǴऊԖ 37.0%ǵ39.0%Ϸ 4.4%ёᘜӢࣁπբਔޑ࿶Ҝऀڈ໾܌೷ԋ ( Prüss-Üstün, Rapiti, & Hutin, 2005; WHO, 2002 )ǶԶѠ᡼ᙴᕍΓ঩ޑଯགࢉ॥ᓀ࿶

Ҝऀڈ໾วғ౗ࣁՖǻᙴᕍΓ঩ӧπբᕉნύǴதวғ໚܄ੰΓྍ࿶Ҝऀڈ໾ϐ

ൂՏࢂব٤ǻதـޑӾ᎒ނচۈҔ೼ࣁՖǻวғଯགࢉ॥ᓀ࿶Ҝऀڈ໾ਔЬाࣁ

୺ՉՖᅿݯᕍǻ೷ԋЌ໾ޑӾ᎒ނᅿᜪࣁՖǻࡺऩૈ೸ၸჴሞޑ೯ൔၗ਑ϩ݋Ǵ ᒣ᛽рόӕᙍᆀᙴᕍΓ঩ଯགࢉ॥ᓀ࿶Ҝऀڈ໾ϐวғӦᗺǵ௃ნ฻Ǵό໻ёගٮ ᙴᕍΓ঩уமٛៈ௛ࡼޑୖԵǴҭёаගٮᙴᕍᐒᄬਥᏵࣴزϩ݋่݀Ǵӧ೴ԃቚ уӼӄଞڀޑගٮၸำύǴԵໆᓬӃԛׇϐ٩ᏵǴ٠ว৖࣬ᜢ௲ػ૽ግϷႣٛ௛ࡼǴ а෧Ͽଯགࢉ॥ᓀ࿶Ҝऀڈ໾ϐวғǶ

ќऍ୯੯ᆅֽޑൔ֋ᡉҢǴᗨฅϟΕ܄Ⴃٛ௛ࡼёफ़ե 23%-88%ޑ࿶Ҝऀڈ

໾วғǴՠ٠คݤֹӄ׹๊ ( CDC, 2013 )ǹЪᙴᕍΓ঩ӧᎁڙଯགࢉ॥ᓀϐ࿶Ҝ

ऀڈ໾ࡕǴନΑࡕុଓᙫᔠࢗǵёૈޑႣٛ܄׫ᛰǵགࢉϷ໚ᙯޑ॥ᓀѦǴᗋёૈ

཮ჹᙴᕍΓ঩೷ԋيЈബ໾ ( ֆ฻Ǵ2013 )ǶᙴᕍΓ঩ᎁڙ࿶Ҝऀڈ໾ࡕǴёૈр

౜΋ೱՍޑЈ౛ፂᔐǴӵബ໾ࡕੱংဂǵขቾǵኁᢠ฻ǴЪΨ཮Ӣࣁ೭٤Ј౛ፂᔐ ԶቹៜځғࢲфૈǴӵޗ཮ϕ୏ǵ܄ғࢲϷᙍ཰ཀӛ฻Ǵ೭٤ੱރ೯த཮ӧ࿶Ҝऀ

ڈ໾ࡕҥջр౜ǴЪёૈ཮ӧႣٛ܄׫ᛰය໔Ϸ฻ࡑᔠᡍ่݀ය໔࡭ុӸӧ ( Treloar, et al., 1995; Wald, 2009 )ǴࣗԿԖ 30ʘޑᙴᕍΓ঩ӧ΋ԃࡕϝคݤൺπ ( Henry, et al., 1990 )Ƕᆕᢀ߈ٰ࿶Ҝऀڈ໾ϐЈ౛Бय़ޑࣴزǴӭࢂаໆ܄ࣴزБ ԄǴϩ݋ӧ࿶Ҝऀڈ໾ࡕёૈ೷ԋޑЈ౛ፂᔐǴӵബ໾ࡕੱংဂ܈ขቾǵኁᢠำࡋ ( Winchester et al., 2012; Zhang & Yu, 2013 )ǴଞჹᙴᕍΓ঩࿶Ҝऀڈ໾ϐੰΓྍࣁ Ոనགࢉ܄੯ੰ໚܄ޣϐЈ౛གڙǵ่݀ϷёૈޑቹៜӢનϐࣴز׳ࢂбϐᚅӵǶ

ࡺҁࣴز׆ఈ೸ၸଞЌ೯ൔس಍ޑჴሞᅱෳၗ਑Ǵ௢՗୯ϣ࿶Ҝऀڈ໾ޑว ғ౗ǴନගٮჹᙴᕍΓ঩࿶Ҝऀڈ໾׳ుΕΑှځᖿ༈ѦǴ٠ёբࣁӧӄय़ගٮӼ

ӄଞڀ߻ϐ୷ྗᗺၗ਑ǹ຾΋؁ӆϩ݋ӚᙍᜪᙴᕍΓ঩ଯགࢉ॥ᓀ࿶Ҝऀڈ໾ϐ วғӦᗺǵ௃ნϷӾ᎒ނЌ໾ᅿᜪϷวғ౗Ǵ٠௢՗ᆶႣෳёૈ໚ᙯޑ॥ᓀǹќଞ ჹමวғଯགࢉ॥ᓀ࿶Ҝऀڈ໾ޑᙴᕍΓ঩຾Չ፦܄ೖፋǴుΕΑှځჹଯགࢉ

॥ᓀ࿶Ҝऀڈ໾ޑЈ౛ቹៜᆶፂᔐǹନΑයఈ٬ӚᜪᙴᕍΓ঩ӧଯགࢉ॥ᓀൂՏ Ϸ୺Չଯགࢉ॥ᓀϐᙴᕍೀ࿼ਔǴૈගଯ᝾᝺Ǵ௦ڗ፾྽ޑٛៈǴа෧Ͽགࢉ੯ੰ

ޑ॥ᓀϷࡕុޑፂᔐǴ٠׆ఈගٮᙴᕍᐒᄬᆅ౛ޣϷ࣬ᜢࡹ฼ڋۓޑЬᆅൂՏ҂

ٰӧ࿶Ҝऀڈ໾ٛݯ฼ౣǵӼӄଞڀᓬӃගٮϐൂՏᒧ᏷ϷЌ໾ࡕុޑଓᙫᇶᏤ Ԗ׳ᆒዴޑୖԵ٩ᏵǴаቚуᙴᕍΓ঩୺཰ᕉნޑӼӄϷ෧Ͽᙍ཰໾্ޑวғǶ

ಃ

ಃΒ࿯ ࣴزҞޑ

ࡺҁࣴزЬाࣴزϣ৒ϩࣁаΠΟε೽ϩǺ

΋ǵġ ᙴᕍΓ঩࿶Ҝऀڈ໾ӄ୯วғ౗ϐ௢՗Ƕ

Βǵġ ϩ݋Ѡ᡼ӚᜪᙴᕍΓ঩ଯགࢉ॥ᓀ࿶Ҝऀڈ໾ϐࢬՉੰᏢǶ Οǵġ ፦܄ࣴز--ᙴᕍΓ঩ϐଯགࢉ॥ᓀ࿶Ҝऀڈ໾ޑЈ౛ፂᔐǶ

ࡺҁࣴزϐࣴزҞޑࣁǺ

΋ǵġ ᙴᕍΓ঩࿶Ҝऀڈ໾ӄ୯วғ౗ϐ௢՗

1. аᙴଣੰ׉ኧǵӄᙍᙴᕍπբΓ঩ኧǵϷᕴՐଣВኧ௢՗ӄ୯࿶Ҝऀڈ໾ϐ วғ౗Ƕ

2. ௢՗όӕᙴᕍπբΓ঩วғ࿶Ҝऀڈ໾ϐӄ୯วғኧǶ

3. ௢՗όӕଞڀᅿᜪǵᐒڋǵচۈҞޑ೷ԋ࿶Ҝऀڈ໾ϐӄ୯วғኧ 4. ௖૸Ԗคወӧ܄ଯགࢉ॥ᓀ࿶Ҝऀڈ໾ޑวғǶ

Βǵġ ϩ݋Ѡ᡼ӚᜪᙴᕍΓ঩ଯགࢉ॥ᓀϐ࿶Ҝऀڈ໾ࢬՉੰᏢ

1. ϩ݋ଯགࢉ॥ᓀ࿶Ҝऀڈ໾ӧόӕቫભᙴଣǵӚᜪᙴᕍΓ঩ޑಕᑈวғ౗Ƕ 2. ϩ݋ӚᜪᙴᕍΓ঩วғଯགࢉ॥ᓀ࿶Ҝऀڈ໾ϐൂՏǵӦᗺǵᐒڋǵচۈҞ

ޑϷଞڀᅿᜪǶ

3. ௢՗ଯགࢉ॥ᓀ࿶Ҝऀڈ໾೷ԋӚᜪᙴᕍΓ঩གࢉ੯ੰޑᐒ౗Ƕ 4. ௢՗ӚᙴᕍΓ঩ё࿶Ոన໺ኞ܄ੰচᡏ໚ᙯޑҹኧǶ

Οǵġ ፦܄ࣴز--ᙴᕍΓ঩ϐଯགࢉ॥ᓀ࿶Ҝऀڈ໾ޑЈ౛ፂᔐ 1. ᕕှᙴᕍΓ঩࿶ᐕଯགࢉ॥ᓀ࿶Ҝऀڈ໾ϐЈ౛གڙǶ 2. ௖૸ቹៜᙴᕍΓ঩ჹଯགࢉ॥ᓀ࿶Ҝऀڈ໾ࡕЈ౛ቹៜǶ

ಃ

ಃΟ࿯ Ӝຒۓက

΋ǵ ࿶Ҝऀڈ໾ ( percutaneous injury, PI )Ǻ೏֖ԖՈన܈ᡏనԦࢉޑଞᓐ܈Ӿ᎒

ނऀڈઇҜጥǶ

Βǵ ᙴᕍΓ঩ ( healthcare workers, HCWs )Ǻҁࣴزύх֖ѤεᜪǴᙴৣǵៈ౛Γ

঩ǵᙴמΓ঩ǵЍජΓ঩ǶϩձᇥܴӵΠǺ

1. ᙴৣ ( physician )ǺхࡴЬݯᙴৣǵՐଣ/ჴಞᙴৣǵᙴᏢғǵϷУᙴৣǶ 2. ៈ౛Γ঩ ( nurse )Ǻхࡴៈ౛Γ঩ǵჴಞៈγǵ஑ࣽៈ౛ৣǶ

3. ᙴמΓ঩ ( medical technician )Ǻхࡴڥ֎ݯᕍৣǵᔠᡍΓ঩ǵמೌΓ঩ǵУ

ࣽշ౛Γ঩ǵѦࣽշ౛Γ঩ǵᙴᕍמೌჴಞᏢғǶ

4. ЍජΓ঩ ( support personnel )Ǻхࡴྣ୍៝ܺ঩ǵమዅΓ঩ǵࢱՊ܊πբΓ

঩ǵ᝾ፁ฻Ƕ

Οǵ ё࿶Ոన໺ኞ܄ੰচᡏ ( blood-borne pathogens, BBP )Ǻࡰё࿶җՈనௗ᝻Զ

೷ԋ໺ࢉ੯ੰޑੰচᡏǹӧҁࣴزύࢂࡰ B ࠠطݹੰࢥ ( Hepatitis B virus, HBV )ǵC ࠠطݹੰࢥ ( Hepatitis C virus, HCV )ǵΓᜪխࣝલЮੰࢥ ( Human Immunodeficiency Virus, HIV ) Ϸఘࢥ ( Syphilis ) ѤᅿੰচᡏǶ

Ѥǵġ ੰΓྍ ( source patient )ǺࡰᙴᕍΓ঩วғԜԛଞᓐ܈Ӿ᎒ނЌ໾Ǵচۈ٬Ҕ ޑੰΓǶ

1. ໚܄ੰΓྍǺࡰԜԛЌ໾ϐଞᓐ܈Ӿ᎒ނޑੰΓྍǴځՈమᔠᡍ B ࠠطݹੰ

ࢥǵC ࠠطݹੰࢥǵΓᜪխࣝલЮੰࢥǵఘࢥύҺ΋ᅿ (֖) а΢ϐՈమᔠᡍ ࣁ໚܄ޣǶ

2. ഍܄ੰΓྍǺࡰԜԛЌ໾ϐଞᓐ܈Ӿ᎒ނޑੰΓྍǴځՈమᔠᡍ B ࠠطݹੰ

ࢥǵC ࠠطݹੰࢥǵΓᜪխࣝલЮੰࢥǵఘࢥ฻Ѥᅿ੯ੰϐՈమᔠᡍࣁ഍܄

ޣǶ

3. คݤᒣ᛽ੰΓྍǺࡰԜԛЌ໾ϐଞᓐ܈Ӿ᎒ނޑੰΓྍǴคݤዴޕ܈҂ගٮ ᔠᡍǶ

ϖǵġ ଯགࢉ॥ᓀ࿶Ҝऀڈ໾ ( high risk infectious percutaneous injury )ǺࡰᙴᕍΓ

঩ᎁڙ໚܄ੰΓྍϐ࿶Ҝऀڈ໾ǴӢځ೷ԋՈనགࢉޑӒᓀ܄ၨଯǴ߾Ԝ࿶Ҝ

ऀڈ໾ջࣁଯགࢉ॥ᓀ࿶Ҝऀڈ໾Ƕ

Ϥǵġ EPINetǺExposure Prevention Information NetworkǴଞЌᆶՈᡏనኪ᝻೯ൔس

಍Ǵচബޣࣁऍ୯ᆢӓѭ٥εᏢޑ Jannine Jaggerǹ2003 ԃᑵలሏڗள Jagger ޑ௤៾ǴࡌҥύЎހޑ EPINet ೯ൔس಍Ǵࣁമ୏೽ࡰۓ୯ϣᙴᕍଣ܌࿶Ҝऀ

ڈ໾ᆶՈᡏనኪ᝻٣ҹޑ೯ൔس಍Ƕ

Ў

Ў᝘௖૸

ಃ΋࿯ ࿶Ҝऀڈ໾ϐࢬՉੰᏢ

΋ǵġ ࿶Ҝऀڈ໾วғ౗

Шࣚፁғಔᙃࡰрӄౚ؂ԃऊԖΟԭϖΜ࿤ԛޑགࢉ܄࿶Ҝऀڈ໾วғ ( Prüss-Ustün et al., 2005; WHO, 2002 )ǴЪࣴزࡰр࿶Ҝऀڈ໾ޑեൔ౗ ( under- report ) ࣁ 39.4%~82% ( Ghofranipour et al., 2009; Shiao, McLaws, Lin, Jagger, &

Chen, 2009; Wicker, Ludwig, Gottschalk, & Rabenau, 2008 )ǹԶऍ୯੯ੰᆅڋֽ߾௢

՗؂ԃӧऍ୯ޑᙴଣวғϐ࿶Ҝऀڈ໾ԛኧࣁ 384,325 ԛ ( CDC, 2013 )Ǵᡉـ࿶

Ҝऀڈ໾ჹᙴᕍΓ঩ϐ࠶ુ܄Ƕ (΋) Ӛ୯࿶Ҝऀڈ໾ϐ౰Չ౗

வӚ୯ޑࣴزፓٰ࣮ࢗǴࡐӭᙴᕍΓ঩ӧπբය໔මวғၸ࿶Ҝऀڈ໾Ƕቺ ୯΋ৎεᏢߕ೛ᙴଣፓࢗ 1,598 ӜᙴᕍΓ঩Ǵว౜Ԗ 31.5%ޑΓӧၸѐ 12 ঁДϣ ԿϿวғၸ΋ԛ࿶Ҝऀڈ໾ ( Wicker et al., 2008 )ǹम୯ଞჹ΋ৎ୔ୱᙴଣޑ 300 ՏᙴᕍΓ঩܌଺ޑፓࢗᡉҢǴ38.3%ޑΓӧၸѐ΋ԃϣԿϿวғၸ΋ԛ࿶Ҝऀڈ໾

( Elmiyeh et al., 2004 )ǹќဟ๻УޑፓࢗࣴزᡉҢǴࣗԿԖ 65.0%ޑᙴᕍΓ঩ӧ 5 ԃ ϣමᎁڙ࿶Ҝऀڈ໾ ( Martins, Coelho, Vieira, Matos, & Pinto, 2012 )ǶԶऍ୯ଞჹ 699ՏՐଣᙴৣޑፓࢗว౜Ǵଯၲ 83.0% ( n = 582 ) ޑՐଣᙴৣම࿶วғ࿶Ҝऀڈ

໾ ( Makary et al., 2007 )ǹќӧៈ౛Γ঩Бय़ǴВҁ΋ৎᙴଣޑ 860 ঁៈ౛Γ঩ύǴ 45.6%ၸѐ 1 ԃϣම࿶วғ࿶Ҝऀڈ໾ ( Smith, Mihashi, Adachi, Nakashima, &

Ishitake, 2006 )Ƕᆵ᡼ܭԐයፓࢗ 8,645 ՏᙴᕍΓ঩ǴѝԖ 12.7%ӧၸѐ΋ԃϣ҂Ԗ ၸ࿶Ҝऀڈ໾ǴᡉҢԖ 87.3%ޑᙴᕍΓ঩ࣣමวғၸ ( Guo, Shiao, Chuang, & Huang, 1999 )Ǵёـ࿶Ҝऀڈ໾ჹᙴᕍΓ঩ٰᇥǴࢂதـޑᙍ཰Ӓ্ ( ߄ 1 ȑǶ

(Β) ؂ԃ؂ 1,000 ׉࿶Ҝऀڈ໾วғ౗

ਥᏵEPINet೯ൔس಍ᡉҢǴऍ୯2007ԃ೯ൔޑ29ৎᙴଣၗ਑ᡉҢǴ؂1,000׉

࿶Ҝऀڈ໾วғ౗ࣁ279.7ԛǴځύ௲Ꮲᙴଣѳ֡ࣁ334.9ԛǴߚ௲Ꮲᙴଣ߾ࣁ161.6 ԛ ( Perry, Parker, & Jagger, 2009 )ǹВҁ߾಍ी2009ԃډ2011ԃޑ67ৎᙴଣޑ೯ൔ

ၗ਑ǴᡉҢѳ֡؂1,000׉ޑ࿶Ҝऀڈ໾วғ౗ࣁ62ԛ ( Yoshikawa et al., 2013 )Ƕ

ԶӧѠ᡼ǴਥᏵύЎހEPINet೯ൔس಍ޑၗ਑ᡉҢǴ؂ԃ؂1,000׉ޑ࿶Ҝऀڈ໾

ԛኧࣁ62.2ԛ ( 95% CI = 48.2~81.6) ( Shiao et al., 2008 ) (߄1ȑǴ೭٤ৡ౦ёૈᆶᙴ ᕍΓ঩ޑᙴᕍೀ࿼ޑӭჲǵ࿶Ҝऀڈ໾ٛݯϟΕ܄௛ࡼޑჴࡼᆶ೯ൔ౗ޑৡ౦Ԗ ᜢǶ

(Ο) ؂ 1,000 ՏᙴᕍΓ঩࿶Ҝऀڈ໾วғ౗

ӧऍ୯ਥᏵس಍܄Ў᝘ӣ៝ࣴزၗ਑ᡉҢǴऩࣁ೯ൔၗ਑ϩ݋ǴᡉҢ؂ԃ؂

1,000 ՏᙴᕍΓ঩ځวғ࿶Ҝऀڈ໾ԛኧࣁ 23~103 ԛǹՠऩаӣྉ܄ǵߚ૶Ӝࣴ

زǴ߾؂ԃ؂ 1,000 ՏᙴᕍΓ঩วғ࿶Ҝऀڈ໾ԛኧࣁ 610~674 ԛǹऩа߻ᘳ܄ࣴ

زǴ߾؂ԃ؂ 1,000 ՏᙴᕍΓ঩ޑ࿶Ҝऀڈ໾ԛኧനଯ߾ၲ 839 ԛ ( Lee, Botteman, Xanthakos, & Nicklasson, 2005 )ǶӧကεճǴਥᏵ 37 ৎᙴଣޑ೯ൔၗ਑ᡉҢǴ؂

1,000ՏѦࣽᙴৣวғ࿶Ҝऀڈ໾ޣԖ 101 ԛǴԶៈ౛Γ঩ࣁ 84 ԛǶԶӧѠ᡼Ǵ ਥᏵύЎހ EPINet ೯ൔس಍ޑၗ਑ᡉҢǴ؂ԃ؂ 1,000 ՏᙴᕍΓ঩ޑ࿶Ҝऀڈ໾

ԛኧࣁ 45 ԛ ( 95% CI = 31.3~58.7 ) ( Shiao et al., 2008 )ǹӣྉ܄ࣴزᡉҢǴ؂ԃ؂

1,000ՏᙴᕍΓ঩วғ࿶Ҝऀڈ໾ԛኧࣁ 155-186 ԛ ( Shiao et al., 2009 ) (߄ 1ȑǶ (Ѥ) ؂ 10,000 ՐଣВኧ࿶Ҝऀڈ໾วғ౗

ӧѠ᡼ǴӢ଼ߥ๏бӢનǴӚৎᙴଣ཮ӛ଼ߥֽ೯ൔჴሞՐଣВኧǴаҙፎ Րଣ๏бǹࡺӆਥᏵ೯ൔ EPINet ޑၗ਑௢՗Ǵ؂ 10,000 ՐଣВኧวғ࿶Ҝऀڈ໾

ޑԛኧࣁ 3.2 ԛ ( 95% CI = 2.5~3.8 ) ( Shiao et al., 2008 )ǹځдЎ᝘߾҂ـԜᜪ಍

ीၗ਑ (߄ 1ȑǶ

߄ 1 Ӛ୯࿶Ҝऀڈ໾ϐ౰Չ౗ᆶวғ౗

୯ৎ

࿶Ҝऀڈ໾౰Չ౗ ࿶Ҝऀڈ໾ޑวғ౗

ԛ/1,000 Beds ԛ/1,000 HCWs ԛ/10,000 Inpatient days Ѡ᡼ ᙴᕍΓ঩

87.3% (7550/8645) (Shiao,et al.,1999)

62.2

(Shiao,et al.,2008)

೯ൔၗ਑ 45.0 (Shiao,et al.,2008) ӣྉ܄ 155-186 (Shiao et al., 2009)

3.2 (Shiao,et al.,2008)

ऍ୯ Րଣᙴৣ

83.3% (582/699)/΋ԃ (Makary et al., 2007)

ӄ೽ 279.7

௲Ꮲᙴଣ 334.9 ߚ௲Ꮲᙴଣ 161.6 (Perry, Parker, &

Jagger, 2009)

೯ൔၗ਑ 23~103 ӣྉ܄ 610~674

߻ᘳ܄ 839 (Lee,et al., 2005)

--

Вҁ ៈ౛Γ঩

45.6% (392/860)/΋ԃ (Smith, Mihashi, Adachi, Nakashima, &

Ishitake, 2006)

62

(Yoshikawa et al., 2013)

-- --

म୯ ᙴᕍΓ঩

38.3% (115/300)/΋ԃ (Elmiyeh et al., 2004)

127.4

(Elder & Paterson, 2006)

-- --

ቺ୯ ᙴᕍΓ঩

31.5% (503/1598)/΋ԃ (Wicker, et al, 2008)

-- -- --

ဟ๻

У

ᙴᕍΓ঩

64.5% (234/363)/ϖԃ (Martins, et al., 2012)

-- -- --

ကε ճ

-- -- ѦࣽᙴৣǺ101

ៈ౛Γ঩Ǻ84 (Ippolito, et al., 1999)

--

Β

Βǵġ ࿶Ҝऀڈ໾ϐଯӒᓀဂǵ௃ნᆶӦᗺϷ᎒ނᅿᜪ (΋) ଯӒᓀဂ

୯ϣࣴزว౜Ǵஒ߈ 9 ԋޑᙴᕍΓ঩මวғ࿶Ҝऀڈ໾٣ҹǴѳ֡؂ԃ؂Γ วғ 0.2-4.7 ԛ࿶Ҝऀڈ໾ ( Guo et al., 1999; Shiao et al., 2002; ഋǵ݅Ǵ2008 )ǶԶ ӧ࿶Ҝऀڈ໾ޑ೯ൔၗ਑ύǴаៈ౛Γ঩՞നӭ ( 42%~74% )Ǵځԛࣁᙴৣǵᙴמ Γ঩Ǵ೭ᆶᙴᕍΓ঩܌эΓኧКٯϷനதᆶੰΓޔௗௗ᝻Ԗᜢ ( ᑵǵ݅Ǵ2012ǹ Adams, 2012ǹLee et al., 2005 )Ƕ

(Β) നதวғޑ௃ნᆶӦᗺ

Шࣚፁғಔᙃᇡࣁวғ࿶Ҝऀڈ໾ޑচӢёૈࢂǺ1.ၸࡋ܈ό྽ޑ٬Ҕଞڀǹ 2.Ӽӄଞڀගٮόىǹ3.ଞᓐӣ঺ǹ4.ό፾྽ޑ፺੤ǹ5.٬Ҕଞڀޑၸำ҂஑Јǹ6.

ჹӒᓀޑ᝾᝺܄ե܈લЮ૽ግ ( Prüss-Üstün, Rapiti, & Hutin, 2003 )ǶЪ࿶Ҝऀڈ໾

ёૈวғӧᙴᕍၸำޑҺՖ΋ঁ؁ᡯǴࣴزࡰрനதวғ࿶Ҝऀڈ໾ޑ௃ნࣁ٬

Ҕଞᓐ܈᎒ނ໔ ( 14.1%~27.5% )ǵݯᕍၸำύޑࢌ໨؁ᡯ ( 20.4% )ǵ٬Ҕࡕೀ౛

߻ ( 11.3%~21.1% )Ϸӣ঺ଞ൰ ( 10.7%~16.5% ) ( ᑵǵ݅Ǵ2012ǹShiao et al., 2008ǹ Watterson, 2004ǹWu et al., 2015 )Ƕ

୯ϣѦࣴزࣣࡰрനதวғ࿶Ҝऀڈ໾ޑӦᗺࣁੰ܊ ( Cutter & Jordan, 2012ǹ Wu et al., 2015ǹᑵǵ݅Ǵ2012 )Ǵځԛࣁ໒Θ܊ǵуៈੰ܊ ( ᑵǵ݅Ǵ2012 )Ƕ຾

΋؁ϩ݋Ӛᜪϐ࿶Ҝऀڈ໾วғǴᙴৣޑ࿶Ҝऀڈ໾നதวғӧ໒Θ܊ ( 43.3% )Ǵ Ќ໾চӢࣁݯᕍၸำύࢌ໨؁ᡯ ( 20.4% )ǹៈ౛Γ঩നதวғӧੰ܊ ( 45.4% )Ǵ চӢࣁݯᕍၸำύࢌ໨؁ᡯ ( 39.5% )ǹᙴמΓ঩ӕኬനதวғӧੰ܊ ( 18.5% )Ǵ চӢࣁځд ( 15.5% )Ϸݯᕍၸำύࢌ໨؁ᡯ ( 15.4% )ǹԶЍජΓ঩ҭதܭੰ܊

( 18.0% )ǴวғচӢࣁ೏ςҧకܭ᎒ނԏ໣౯ϐँрޑଞᓐ܈᎒ނЌ໾ ( 40.0% ) ( ᑵǵ݅Ǵ2012 )Ƕ

(Ο) ࿶Ҝऀڈ໾ϐӾ᎒ނᅿ

ޜЈଞᓐࢂനதวғ࿶Ҝऀڈ໾ޑ᎒ނᅿᜪǴ՞ 66.4%ǴځԛࣁѦࣽᏔఓǴ

՞ 32.7%ǶޜЈଞᓐύаܙకԄݙ৔ᏔࣁനӭǴ՞܌Ԗ᎒ނޑ 33.8%ǹѦࣽᏔఓ߾

аᕳӝଞࣁനଯǴ՞ 14.0% ( Wu et al., 2015 )Ƕៈ౛Γ঩ǵᙴמΓ঩ϷЍජΓ঩

ӧ୺Չ཰୍ၸำύǴ೏ܙకԄݙ৔ᏔЌ໾ޑ௃׎നӭǴКٯϩձࣁ 43.7%ǵ34.3%

Ϸ 41.0%ǴԶ೷ԋᙴৣЌ໾ޑ᎒ނ߾аᕳӝଞനӭ ( 29.9% )ǴځԛωࢂܙకԄݙ

৔Ꮤ ( 27.3% ) ( ᑵǵ݅Ǵ2012 )Ƕ Ο

Οǵġ ࿶Ҝऀڈ໾ϐ҂೯ൔ౗

Ӄ߻ޑࣴز௢՗Ǵ࿶Ҝऀڈ໾ޑ҂೯ൔ౗εऊӧ 26%~85% ( Trim & Elliott, 2003 )Ǵന߈ޑࣴزҭᡉҢ҂೯ൔ౗ϝԖ 39.4%~75% ( Ghofranipour et al., 2009;

Wicker et al., 2008 ) ǶԶӧѠ᡼аӣྉ܄ፓࢗݤࣴز܌ԖᙴᕍΓ঩Ǵමวғ࿶Ҝऀ

ڈ໾ϐК౗ଯၲ 87%Ǵՠ໻Ԗ 18%ӛ܌୍ܺޑᙴଣගрൔ֋ ( Guo et al., 1999 )Ƕ ࣁΑ׳ᆒዴ՗ी࿶Ҝऀڈ໾ޑ೯ൔ௃׎Ǵᑵ฻ ( 2009 ) ճҔ EPINet س಍຾Չࣁය

΋ԃޑࣴزว౜Ǵ࿶Ҝऀڈ໾౗ࣁ؂ 1,000 ՏᙴᕍΓ঩ύԖ 36.1 ԛǴԶܭӕਔය ೯ൔޑᙴଣ຾Չӣྉ܄ፓࢗว౜Ǵځ࿶Ҝऀڈ໾౰Չ౗ଯၲ؂ 1,000 ՏᙴᕍΓ঩ύ Ԗ 170 ԛǴᡉҢ೯ൔ౗ѝԖ 21.1%ǴԖ 79.9%ޑ࿶Ҝऀڈ໾҂೏೯ൔǴځύаᙴৣ

ޑ҂೯ൔ౗നଯࣁ 90.2%Ǵځԛ٩ׇࣁЍජΓ঩ 86.4%ǵᙴᕍמೌΓ঩ 73.3%Ϸៈ

౛Γ঩ 68.4% ( Shiao et al., 2009 )Ǵᆶ୯ѦࣴزᡉҢᙴৣޑ҂೯ൔ౗നᝄख़ϐ่݀

࣬՟ ( Lee et al., 2005 )Ƕ

҂೯ൔޑЬाচӢхࡴǺȨᇡࣁ೏གࢉޑ॥ᓀࡐեȩǵȨϼԆȩǵȨόޕၰ ೯ൔࢬำȩǵȨόགྷाᡉҢрಉЈεཀȩǵȨ᝺ளੰΓᔈ၀ؒԖՈన໺ࢉ੯ੰȩǵ ȨԾρςԖ B طלচ܈לᡏȩ฻ ( Boal et al., 2008; Shiao et al., 2009 ) Ƕ

҂೯ൔ࿶Ҝऀڈ໾٣ҹёૈЇଆޑᝄख़ࡕ݀ǴӵǺᎁڙ࿶Ҝऀڈ໾ޑᙴᕍΓ

঩ؒԖᐒ཮ޕၰԾρགࢉޑӒᓀ܄ǴӢԜคݤ໒ۈႣٛ܄׫ᛰǹቚу໺ࢉ๏ځдΓ ޑ॥ᓀǴЀځࢂ܄Քߧǹ҂೯ൔਔǴӢؒԖ҅ԄЎҹइᒵǴऩЇଆ໺ࢉ܄੯ੰǴஒ คݤፎ؃ᙍ཰ؠ্ޑ፝ᓭǹନԜϐѦǴե՗࿶Ҝऀڈ໾วғ౗ϷલЮ࣬ᜢӒᓀӢન

ૻ৲ޑගٮǴஒफ़ե໤Ь൨؃ׯ๓πբᕉნӼӄ೛ഢ܈ගٮӼӄଞڀޑ୏ᐒ ( Bahadori & Sadigh, 2010; Boal et al., 2008; ᑵǵ݅ǵ݅ǵഋǴ2005 ) Ƕ

ࡺऩӆԵໆ࿶Ҝऀڈ໾ޑ҂೯ൔ౗Ǵ߾ჴሞ࿶Ҝऀڈ໾ޑวғᓎԛК೯ൔރ ݩᗋाଯрࡐӭǴॶள຾΋؁ԵໆǶ

ಃ

ಃΒ࿯ ࿶Ҝऀڈ໾ޑགࢉ॥ᓀ

ᙴᕍΓ঩࿶җ࿶Ҝऀڈ໾Զགࢉ੯ੰޑ॥ᓀڙډΠӈ൳ঁӢનޑቹៜǺ࿶Ҝ

ऀڈ໾วғ౗ǵ࿶Ոన໺ኞੰচᡏϐ౰Չ౗ǵ࿶Ҝऀڈ໾໚܄ੰΓྍޑ౰Չ౗ǹ࿶

Ҝऀڈ໾ࡕ໚ᙯޑ॥ᓀ ( Lee et al., 2005ǹֆ฻Ǵ2013 ) Ƕ

΋ǵġ ࿶Ҝऀڈ໾ޑวғ౗

ᙴᕍΓ঩࿶Ҝऀڈ໾ޑ॥ᓀёҗ࿶Ҝऀڈ໾ޑวғ౗ٰ௢՗Ǵӵӧᙴଣ܌բ ޑ߻ᘳ܄ࣴزᡉҢǴ؂ 1000 ՏᙴᕍΓ঩Ԗଯၲ 839-880 ՏԖ࿶Ҝऀڈ໾ޑ࿶ᡍ ( Aiken, Sloane, & Klocinski, 1997 )ǹӧѠ᡼ਥᏵ 2004 ԃࣴزࡰрǴਥᏵύЎހଞ Ќ೯ൔس಍ޑၗ਑ᡉҢǴ؂ԃ؂ 1,000 ՏᙴᕍΓ঩ύǴԖ 45 ԛޑ࿶Ҝऀڈ໾วғǴ

௢՗؂ԃޑ࿶Ҝऀڈ໾ԛኧᔈࣁ 8,100 ԛ ( 95%CI = 5,634-10,566 ԛ ) ( Shiao et al., 2008 )ǹऩӆԵቾ҂೯ൔ౗Ǵ߾௢՗Ѡ᡼؂ԃᔈԖऊ 30,000 ӭҹޑ࿶Ҝऀڈ໾

วғ ( ഋǴ2011 )Ǵҭջ؂λਔऊԖѤҹ࿶Ҝऀڈ໾٣ҹวғǶ

Βǵġ ࿶Ոన໺ኞ܄ੰচᡏ ( blood-borne pathogens ) ౰Չ౗

ӧҁࣴزύ࿶Ոన໺ኞ܄ੰচᡏ ( blood-borne pathogens, BBP ) ࢂࡰ B ࠠط ݹੰࢥ ( Hepatitis B virus, HBV )ǵC ࠠطݹੰࢥ ( Hepatitis C virus, HCV )ǵΓᜪ խࣝલЮੰࢥ ( Human Immunodeficiency Virus, HIV ) Ϸఘࢥ ( Syphilis ) Ѥᅿੰ

চᡏǶ

(΋)ǵB ࠠطݹੰࢥ ( Hepatitis B virus )

Bࠠطݹੰࢥ ( Hepatitis B virus, HBV )ࣁѐ਼ਡᗐਡለȐDNAȑੰࢥǴB ࠠ طݹੰࢥϣۘӸԖѐ਼ਡᗐਡለᆫӝ䁙ȐDNA polymeraseȑǴӧಒझϣаϸᙯᒵፄ ᇙ߄౜Ƕ΋૓а B ࠠطݹੰࢥ߄य़לᡏȐanti-HBsȑǵਡЈלᡏȐanti-HBcȑϷ e לᡏȐanti-HBeȑٰϩձ߄Ңჹᔈܭ߄य़לচȐ HBsAg ȑǵਡЈלচȐ HBcAg ȑ Ϸ e לচȐ HBeAg ȑϐלᡏǶB ࠠطݹ߄य़לচёӧᡏనϷϩݜనϣ೏ว౜Ǵՠ ѝԖՈనǵᆒనϷ഍ၰϩݜނᡉҢڀགࢉ܄ ( ፁғᅽճ೽੯ੰᆅڋ࿿Ǵ2015 )Ƕࡺ

Ьाޑ໺ࢉ೼৩ࣁόӼӄޑ܄Չࣁǵ٬Ҕ೏Ոనԡࢉޑݙ৔Ꮤ܈᎒ނݙ৔ᛰނ܈

Ќ໾ǵࠟޔ໺ࢉ฻ࢂख़ा໺ࢉ೼৩ǶҞ߻ё೸ၸႣٛௗᅿ׎ԋלᡏٰफ़ե೏གࢉޑ

॥ᓀ ( ፁғᅽճ೽੯ੰᆅڋ࿿Ǵ2015ǹCDC, 2012 )Ƕ 1. ΋૓ဂᡏ౰Չ౗

ӧчऍࢪϷኻࢪǴགࢉ೯தวғӧߙԃਔයࡕǹӧчऍӦ୔ǴԋΓคੱރ B

ࠠطݹ஥চ౗ऊࣁ 0.5ʘ ( ፁғᅽճ೽੯ੰᆅڋ࿿Ǵ2015 )ǹӧቺ୯ଞჹڀԖж߄

܄ޑΓαኬҁϐ୯ৎ଼நᔠࢗፓࢗࣴزᡉҢǴ1998 ԃځ҇౲ B ࠠطݹޑ஥চ౗ࣁ 0.6% ( Thierfelder, et al., 2001 )ǴԶ 2008~2011 ԃϐࣴزၗ਑ᡉҢǴ18~79 ྃޑቺ୯

҇౲ B ࠠطݹޑ஥চ౗ࣁ 0.3% ( Poethko-Muller, et al., 2013 ) (߄ 2 )Ƕ

ӧ٥ࢪϷߚࢪӦ୔ǴᓻٽϷٽูයϐགࢉߚதදၹǴᆵ᡼ԐයЬा໺ࢉӢનǴ

ٰԾܭ҆ᡏࠟޔ໺ࢉǴҭջ஥চޑ҆ᒃӧғౢ߻ࡕஒ B ࠠطݹੰࢥ໺ࢉ๏ཥғٽ ( ፁғᅽճ೽੯ੰᆅڋ࿿Ǵ2015 )ǶԶਥᏵᆵ᡼ԐයޑӧчѠ᡼ҡݨϦљ 1500 Ӝ 22~67ྃ঩πޑՈనፓࢗᡉҢǴHBV ౰Չ౗ޑऊࣁ 20.5% ( Sheu et al., 1993 )ǹՠ Ծ 1984 ԃ 7 Дଆଞჹ B ࠠطݹ߄य़לচ໚܄҆ᒃϐཥғٽჴࡼ B ࠠطݹࣝभݙ

৔ीฝǴϷ 1986 ԃ 7 Дଆӄय़ჴࡼᓻѴٽ B ࠠطݹႣٛௗᅿࡕǴ٬ளᆵ᡼ 15 ྃ аΠޑ B ࠠطݹ஥চޣςவ 1984 ԃޑ 9.8%Πफ़Կ 1999 ԃޑ 0.7% ( Ni et al., 2001 )Ǵ ԶϤྃٽู B ࠠطݹ஥চ౗Ψҗ 1989 ԃ 10.5%ᡉ๱Πफ़Կ 2007 ԃ 0.8ʘ ( ፁғ ᅽճ೽੯ੰᆅڋ࿿Ǵ2015 )ǹฅԶਥᏵ Chen ฻ᏢޣԾ 1996 ԃԿ 2005 ԃޗ୔ᑔᔠ

ၗ਑ᡉҢǴᆵ᡼ 18 ྃа΢ޑ҇౲ϝԖ 17.3%ޑ B ࠠطݹੰࢥ஥চޑ໚܄౰Չ౗

( Chen et al., 2007 ) (߄ 2 )Ƕ 2. ՐଣੰΓ౰Չ౗

୯ϣѦࣴزᡉҢǴᙴଣύ ( Shiao, Guo, & McLaws, 2002ǹWicker et al., 2008 )

܈੝ۓൂՏӵՈన೸݋࠻ϐੰΓ ( Petrosillo et al., 2001 ) ޑ࿶Ոన໺ኞੰচᡏՈ మ౰Չ౗ၨ΋૓ဂᡏଯǶਥᏵ߄ 3Ǵӧቺ୯Ꮲޣ Wicker ฻ΓճҔ 2005 ԃԿ 2007 ԃޑεᏢߕ೛ᙴଣΕଣਔՈమၗ਑ϩ݋Ǵว౜ HBV ౰Չ౗ࣁ 5.3% Ǵࢂቺ୯΋૓

ဂᡏ౰Չ౗ޑ 9 ७ ( 709 / 13,358 ) ( Wicker et al., 2008 )ǹќӧѠ᡼Ǵᑵలሏ௲௤฻

Γܭ 1997 ԃԿ 1998 ԃǴ຾Չ 1,805 ՏՐଣੰΓޑՈమၗ਑ϩ݋Ǵว౜ՐଣੰΓ HBVޑ౰Չ౗ࣁ 16.7% ( Shiao, Guo, & McLaws, 2002 )Ƕ

җа΢ၗ਑ᡉҢǴѠ᡼ B ࠠطݹੰࢥ஥চ౰Չ౗Ǵόᆅࢂ΋૓ဂᡏ܈ᙴଣဂ ᡏϝၨኻऍ฻ς໒ว୯ৎଯǶ

(Β)ǵC ࠠطݹੰࢥ ( Hepatitis C virus )

Cࠠطݹੰࢥ ( Hepatitis C virus, HCV ) ࣁڀિ፦Ѧ঺ޑ RNA ੰࢥǴёวғ ܭӄౚӚӦǶЬाᙖҗڙԦࢉϐՈన܈ՈమᇙᏊགࢉǴڙԦࢉϐଞǵݙ৔Ꮤࣁख़ा

໺ࢉ೼৩ǴЀځࢂჹᓉેݙ৔ࢥ᠅ޣǶଯӒᓀဂᡏхࡴڙՈޣǵᓉેݙ৔ࢥ᠅ޣǵ ࢱ๝ޣϷ܄ੰ஻ޣǶሡதௗ᝻ՈనϐᙴᕍΓ঩ҭԖёૈགࢉ C ࠠطݹ ( ፁғᅽճ

೽੯ੰᆅڋ࿿Ǵ2015a )Ƕᄌ܄ C ࠠطݹགࢉޑ஻ޣǴՈύ೿ёෳр C ࠠطݹלᡏ Ϸ C ࠠطݹੰࢥǶՠӧ࡚܄ය஻ޣύǴགࢉ߃යёӃа PCR ᔠෳډੰࢥǴӧวੰ

ࡕ΋ࢤਔ໔ϐࡕǴ C ࠠطݹלᡏω཮և౜໚܄ϸᔈǹ໺ࢉයவวੰ߻΋Կኧຼޔ ډ᏾ঁ࡚܄යǴϷᄌ܄஥চයࣣڀ໺ࢉ܄ǴҞ߻ؒԖࣝभёගٮǴ΋૓ΓࣣԖགࢉ

॥ᓀǴЪԖӭᅿ٥ࠠǴӢԜԖख़ፄགࢉޑёૈ ( ፁғᅽճ೽੯ੰᆅڋ࿿Ǵ2015a )Ƕ 1. ΋૓ဂᡏ౰Չ౗

WHO՗ीӄШࣚԖ 3%ޑΓමགࢉၸ C ࠠطݹ ( ऊ 1 ሹ 8 щ࿤Γ )Ǵ ऊԖ 1.3ሹΓࣁᄌ܄஥চޣǹځύаᐞࢪǵу৾εǵчኻ౰Չ౗നե ( ऊ< 1% ) Ȅऍ୯ ᆶε೽ҽኻࢪ୯ৎ߾ऊࣁ 1%ǴКၨଯࢬՉ୔ࢂߚࢪǵ܎΍ऍࢪǵϷ٥ࢪ ( ऊ>2% ) ( ፁғᅽճ೽੯ੰᆅڋ࿿Ǵ2015a )ǶќਥᏵس಍܄Ў᝘಍ӝࡰрӄౚԾ 1990 ԃԿ 2005ԃǴC ࠠطݹלᡏ౰Չ౗Ծ 2.3%΢ϲԿ 2.8%Ǵ౰Չ౗നեӧчऍλܭ 1.5%Ǵ ӧύኻǵܿኻϷՋኻޑ౰Չ౗εऊࣁ 1.5% ~ 3.5%ǴԶӧύ٥ǵܿ٥฻߾ࣁଯ౰Չ

୔Ǵεܭ 3.5% ( Mohd, Groeger, Flaxman, & Wiersma, 2013 )Ƕ

ќځдᏢޣޑࣴزࡰрǴӧቺ୯ 1998 ԃ҇౲ C ࠠطݹלᡏޑ౰Չ౗ࣁ 0.4%

( Thierfelder, Hellen, Meisel, Schreier, & Dortschy, 2001 )Ǵډ 2008~2011 ԃځ౰Չ౗

ࣁ 0.3% ( Poethko-Muller, et al., 2013 )ǹम୯ࣁ 0.6%~1.0% ( Cornberg, et al., 2011 )Ǵ ӧऍ୯߾ࣁ 1.6% ( Chak, Talal, Sherman, Schiff, & Saab, 2011 )Ƕᆵ᡼ԐයᏢޣፓࢗ

ࣴزᡉҢǴѠ᡼҇౲ऊԖ 2.5% C ࠠطݹלᡏޑ౰Չ౗ ( Sheu et al., 1993 )ǴԶԾ 1996ԃډ 2005 ԃޑᑔᔠၗ਑ᡉҢǴ΋૓ԋΓ C ࠠطݹלᡏ౰Չ౗௢՗ऊࣁ 4.4%

( Chen et al., 2007 ) (߄ 2ȑǶ 2. ՐଣੰΓ౰Չ౗

ਥᏵ߄ 3Ǵቺ୯ Wicker ฻Γޑࣴزၗ਑ᡉҢǴC ࠠطݹלᡏ౰Չ౗ࣁ 5.8%

(1,167 / 20,163 )Ǵࢂቺ୯΋૓ဂᡏ౰Չ౗ޑ 15 ७ ( Wicker et al., 2008 )ǶԶӧѠ᡼Ǵ ᑵలሏ฻ΓޑΕଣੰΓՈమၗ਑ϩ݋Ǵ่݀ᡉҢΕଣੰΓޑ C ࠠطݹלᡏ౰Չ౗

ࣁ 12.7%ǴࣁѠ᡼΋૓ဂᡏޑ 2.8 ७ ( Shiao, Guo, & McLaws, 2002 )Ƕ

җа΢Ў᝘ᡉҢǴӧѠ᡼ C ࠠطݹੰࢥלᡏ౰Չ౗Ԗ΢ϲᖿ༈ǴЪ౰Չ౗ҭ

ၨኻऍ฻ς໒ว୯ৎଯࡐӭǴჹѠ᡼ᙴᕍΓ঩ޑ࠶ુҭॶளᜢݙǶ (Ο)ǵΓᜪխࣝલЮੰࢥ ( Human Immunodeficiency Virus )

HIVȐHuman Immunodeficiency Virus, HIVȑջࢂΓᜪխࣝલЮੰࢥǴ߫ᆀང

෷ੰࢥǴࢂ΋ᅿઇᚯխࣝس಍ޑੰࢥǴ٬ੰ஻ޑيᡏܢלΚफ़եǴ྽խࣝس಍ᎁډ ઇᚯࡕǴচҁό཮೷ԋғੰޑੰ๵ǴᡂளԖᐒ཮གࢉΓᜪǴᝄख़ਔ཮Ꮴठੰ஻ԝΫǶ ང෷ੰࢥགࢉࡕǴሡा࿶ၸ΋ࢤਔ໔Ոనω཮ౢғང෷ੰࢥלᡏǴӢԜӧགࢉࡕޑ ԐයǴёૈӢלᡏۘ҂ౢғǴԶᔠᡍև഍܄ϸᔈǴԜջࣁޜืයǶ΋૓ԶقǴޜื

යऊࢂང෷ੰࢥགࢉࡕ 6-12 ຼϣǴၸѐΨԖ႟ࢃޑൔ֋ว౜ޜืයߏၲ 12 ঁДǶ ᒿ๱ᔠᡍБԄޑ຾؁Ǵޜืයςёаᕭอډ 1-2 ࢃයǶӧԜය໔Ǵ஻ޣᡏϣޑང෷

ੰࢥੰࢥໆനଯǴ໺ࢉΚமǶޜืයਔ೚ӭ஻ޣؒԖੱރǴ܈ࢂੱރό੝ਸǴܰ೏

౧۹܈ບᘐԋ΋૓ޑགߵǴӢԜ஻ޣёૈᝩុவ٣ଯӒᓀ܄Չࣁ໺ࢉځдޑΓǹЬ

ाޑ໺ࢉ೼৩ࣁ܄Չࣁǵ҆ηࠟޔ໺ࢉǵՈన໺ࢉ฻ǴҞ߻ҭؒԖࣝभёႣٛགࢉ

( ፁғᅽճ೽੯ੰᆅڋ࿿Ǵ2015b )Ƕ 1. ΋૓ဂᡏ౰Չ౗

ᖄӝ୯ང෷ੰٛݯीฝ ( The Joint United Nations Programme on HIV / AIDS, UNAIDS ) ࡰрӄౚཥ೯ൔঁਢᗨவ 2001 ԃޑ 320 ࿤Πफ़ډ 2012 ԃޑ 250 ࿤ΓǴ ՠӄౚང෷གࢉΓαࠅϝԖऊ 3,400 ࿤ǹҞ߻ང෷ੰ஻ޣ౰Չ౗നଯޑӦ୔ࢂߚࢪ Ӧ୔ǴԶӧऍ୯ 15~49 ྃޑԋΓύ౰Չ౗ऊ 0.5% ~ 1.0%Ǵӧቺ୯߾ऊ 0.2% ~ 0.3%Ǵ ӧम୯ऊ 0.1% ~ 0.2%ǴӧВҁ߾ࣁλܭ 0.1% ( UNAIDS, 2012 ) (߄ 2ȑǶ

ᆵ᡼Ծ 1984 ԃр౜ಃ΋ٯགࢉ HIV ੰٯࡕǴ؂ԃऊཥቚ 1,000 ٯǴ಍ीԿ 2015 ԃ 2 Дۭҁ୯ HIV གࢉಕᑈΓኧଯၲ 29,005 ٯǴΞаߙ֧ԃࣁЬाགࢉ௼

ဂǹԶҁ୯ᝤ೯ൔ HIV གࢉޣԾ 1984 ԃԃࡋ೯ൔࣁ 9 ΓǴԿ 2014 ԃԃࡋ೯ൔཥ ቚਢٯኧࣁ 2,300 Γ ( ፁғᅽճ೽੯ੰᆅڋֽǴ2015b )Ƕќ٩ᏵᏢޣࣴزᡉҢǴ

2003ԃӸࢲགࢉΓኧࣁ 9,547 ΓǴ௢՗྽ਔ౰Չ౗ࣁ 0.07% ( ླྀǴ2010 )Ǵډ 2009 ԃ٩ӸࢲགࢉΓኧ 20,669 ΓǴ௢՗ 15 ~ 49 ྃ HIV གࢉ౰Չ౗ࣁ 0.16% ( ླྀ฻Ǵ 2009ȑ(߄ 2)Ƕ

2. ՐଣੰΓ౰Չ౗

ਥᏵ߄ 3 ё࣮рǴቺ୯ HIV ޑ౰Չ౗ࣁ 4.1% ( 552 / 13,381 )Ǵࢂቺ୯΋૓ဂ ᡏ౰Չ౗ޑ 82 ७ ( Wicker et al., 2008 )ǹќӧѠ᡼Ոమၗ਑ᡉҢǴΕଣੰΓ HIV ޑ౰Չ౗ࣁ 0.8% ( Shiao, Guo, & McLaws, 2002 )ǴࣁѠ᡼΋૓ဂᡏޑ 11.4 ७Ƕ

җа΢ё࣮рǴᗨฅѠ᡼ HIV ޑ౰Չ౗ၨኻऍ୯ৎեǴՠѠ᡼ HIV ౰Չ౗Ԗ

΢ϲᖿ༈ ( ፁғᅽճ೽੯ੰᆅڋֽǴ2015b )ǴЪᙴଣϣՐଣੰΓޑ౰Չ౗К΋૓

ဂᡏଯǴᡉـ HIV ჹᙴᕍΓ঩ޑ࠶ુς೴ᅌගଯǶ

߄ 2 Ӛ୯ B ࠠطݹੰࢥǵC ࠠطݹੰࢥϷΓᜪխࣝલЮੰࢥ΋૓ဂᡏ౰Չ౗

୯ৎ HBsAg (+) Anti-HCV (+) Anti-HIV (+) ᆵ᡼ 15ྃаΠ 9.8%(1984)

0.7%(1999) (Ni et al., 2001) 22-67ྃ 20.5%

(Sheu et al., 1993) 18ྃа΢ 17.3%

(Chen et al., 2007)

2.5%

(Sheu et al., 1993) 4.4%

(Chen et al., 2007)

0.07%

Ȝ2003ȝ (ླྀǴ2010) 0.16%

Ȝ2009ȝ (ླྀ฻Ǵ2009)

ቺ୯ 0.6%

(Thierfelder, et al., 2001) 0.2%

(Poethko-Muller, et al., 2013)

0.4%

(Thierfelder et al., 2001) 0.3%

(Poethko-Muller, et al., 2013)

0.1-0.2%

(UNAIDS, 2012)

म୯ -- 0.6-1.0%

( Cornberg, et al., 2011)

0.2-0.3%

(UNAIDS, 2012)

ऍ୯ -- 1.6%

(Chak et al., 2011)

0.5-1.0

(UNAIDS, 2012)

Вҁ -- -- <0.1%

(UNAIDS, 2012)

߄ 3 B ࠠطݹੰࢥǵC ࠠطݹੰࢥϷΓᜪխࣝલЮੰࢥՐଣੰΓϐ౰Չ౗

ჹຝ HBsAg(+) Anti-HCV(+) Anti-HIV (+) ᆵ᡼ (Shiao, Guo, & McLaws, 2002) 16.7 12.7 0.8 ቺ୯ (Wicker et al., 2008) 5.3 5.8 4.1

(Ѥ)ǵఘࢥ (Syphilis)

ఘࢥࢂҗఘࢥᖥ௽ᡏޑੰ๵܌Їठϐ΋ᅿᖏ׉ੱރፄᚇǵᡂ౦܄εޑᄌ܄܄

໺ࢉੰǶᖥ௽๵ΕߟΓᡏ೯தӧҜጥ܈ᗹጢઇཞೀǴӧ၀ೀ׎ԋሥڀ੝ቻ܄ϐচว

܄ੰ؞ǶགࢉࡕόΦǴᖥ௽๵ࡐזණኞӄيǴёаߟҍ൳ЯӄيϐᏔ۔ϷಔᙃǴౢ

ғᡂϯӭᆄϐᖏ׉ੱރǶՠఘࢥΨёаֹӄคᖏ׉ੱރǴѝૈ᎞ఘࢥՈమᔠᡍ᛾ჴ ځӸӧǴ೭ᅿወҷރᄊջ܌ᒏᗦ܄ఘࢥǶఘࢥЬाҗ܄Ҭ໺ࢉǴΨё࿶җᒡՈǵӅ Ҕଞᓐǵଞڀ฻БԄགࢉǹ܈஁ζᚶѫਔᑡ஻ఘࢥǴ࿶җजዬԶགࢉजٽǴ೷ԋӃ Ϻ܄ఘࢥ ( ፁғᅽճ೽੯ੰᆅڋֽǴ2015c )Ƕ

1. ΋૓ဂᡏ౰Չ౗

Ծவ 1940 ԃжΓॺճҔ Penicillin ԋфݯᕍఘࢥࡕǴఘࢥӧς໒ว୯ৎϐว ғ౗ςܴᡉΠफ़ǶਥᏵШࣚፁғಔᙃ 2008 ԃ಍ीၗ਑ᡉҢǴ၀ԃࡋ 15 ~ 49 ྃޑ ԋΓύऊԖ 3,640 ࿤ΓགࢉၸఘࢥǴځύऊԖ 1,060 ࿤ΓࣁཥวੰٯǶऍ୯ 2011 ԃ ఘࢥགࢉཥวੰٯኧऊ 46,042 ٯǴӳวܭ 15 ~ 24 ྃϐԃᇸΓ ( ፁғᅽճ೽੯ੰ

ᆅڋֽǴ2015cǹCenters for Disease Control and Prevention, 2011 )Ƕ୯ϣఘࢥࣝ௃Б य़ǴਥᏵ੯ੰᆅڋֽ໺ࢉੰ೯ൔၗ਑ᡉҢǴӳวԃសܭ 20-29 ྃǶ2001 ԃఘࢥག

ࢉϐ೯ൔΓኧࣁ 4,158 ΓǴԿ 2012 ԃ೯ൔΓኧςቚуԿ 5,915 ΓǴቚу൯ࡋၲ

42.2% ( ፁғᅽճ೽੯ੰᆅڋֽǴ2015c )ǴᡉҢఘࢥޑ࠶ુϝԖ΢ϲޑᖿ༈Ƕ 2. ՐଣੰΓ౰Չ౗

Ҟ߻Ў᝘٠҂Ԗ௖૸ՐଣੰΓՈమύఘࢥޑ౰Չ౗ǴёૈӢఘࢥςૈҗ PenicillinԋфݯᕍԖᜢǶฅவа΢ၗ਑ҭё࣮рǴӧѠ᡼ఘࢥޑ౰Չ౗ϝԖ΢ϲ ޑᖿ༈ǴҭॶளᙴᕍΓ঩ݙཀǶ

Ο

Οǵġ ࿶Ҝऀڈ໾໚܄ੰΓྍޑ౰Չ౗

җ࿶Ոన໺ኞੰচᡏޑ౰Չ౗Ў᝘᏾౛ёޕǴᙴଣύޑੰΓځ࿶Ոన໺ኞੰ

চᡏ໚܄Ոమޑ౰Չ౗ၨ΋૓ဂᡏଯǴࡺᙴᕍΓ঩ӧᙴଣύऩวғ࿶Ҝऀڈ໾Ǵന ᏼኁޑವၸܭᎁڙ໚܄ੰΓྍԦࢉϐӾ᎒ނऀڈ໾ǴԶ೷ԋёૈགࢉޑ॥ᓀǶ

Ԗᜢ໚܄ੰΓྍϐ࿶Ҝऀڈ໾܌೷ԋޑ॥ᓀࡐᜤෳໆǴځࣴزҭ҂ᖿֹ᏾ǹ Ьाࢂ٩Ᏽ࿶Ոన໺ኞੰচᡏӧੰΓՈమύޑ໚܄౰Չ౗Ǵٰж߄࿶Ҝऀڈ໾ࡕ ёૈٰԾ໚܄ੰΓྍϐགࢉ॥ᓀǴӢځ೷ԋՈనགࢉޑӒᓀ܄ၨଯǴࡺӧҁࣴزύ ҭᆀࣁଯགࢉ॥ᓀ࿶Ҝऀڈ໾Ƕ

߄ 4 ࣁӚ୯ᅱෳس಍ޑࣴزၗ਑Ǵё࣮рӚ୯ޑଯགࢉ॥ᓀ࿶Ҝऀڈ໾ޑว ғ௃׎ǶကεճᏢޣճҔ 1994 ډ 1998 ԃ 37 ৎᙴଣ೯ൔՈనᡏనኪ᝻ޑ 19,860 ҹ

ၗ਑Ǵ܌଺ޑࣴز่݀ᡉҢǴӧ 28.0%Ԗ଺ՈమᔠᡍޑޑੰΓྍύǴԖ 13.0%ࣁ HBV໚܄ੰΓྍǵ63.0%ࣁ HCV ໚܄ੰΓྍǵ11.0%ࣁ HIV ໚܄ੰΓྍ ( Ippolito, Puro, Petrosillo, & De Carli, 1999 )Ƕम୯ޑ଼நߥៈֽ ( Agency Health Protection ) ճҔᙴଣԾᜫ೯ൔޑጕ΢ۓᗺᅱෳس಍ ( sentinel surveillance system ) ϐၗ਑ϩ݋

ᡉҢǴவ 2002 ԃډ 2011 ԃޑ 3,140 ҹ࿶Ҝऀڈ໾೯ൔ٣ҹύǴੰΓྍࣁ HBV ໚

܄э 8.0% ( 241 / 3,140 )ǴHCV ໚܄э 48.4% ( 1,521 / 3,140 )ǴHIV ߾э 23.0% ( 723 / 3,140 ) ( Agency Health ProtectionǴ2012 )Ƕа΢ё࣮рǴځᒧ᏷ੰΓྍ຾ՉՈన ᔠᡍ܈ࢂԾᜫᒧ᏷೯ൔϐ࿶Ҝऀڈ໾Ǵёૈς࿶ၸ߃؁ղۓၨڀགࢉ॥ᓀޑੰΓ

ྍϐ࿶Ҝऀڈ໾ǴࡺੰΓྍᔠᡍ่݀Ԗၨଯޑ໚܄౰Չ౗Ƕ

ќВҁ΋ৎᙴଣճҔ 1997 ԃԿ 2004 ԃ೯ൔ EPINet ޑ 259 ҹ࿶Ҝऀڈ໾ύǴ 78%ޑੰΓྍௗڙՈమᔠᡍǴځύ 7.3%ࣁ HBV ໚܄ੰΓྍǴ20.1%ࣁ HCV ໚܄

ੰΓྍǴ0.4%ࣁ HIV ໚܄ੰΓྍ ( Nagao et al., 2007 )ǶԶӧᆵ᡼Ծ 2004 ԃԿ 2009 ԃ 5 Дޑ EPINet ၗ਑ǴӅԖ 79 ৎᙴଣ 2,780 ҹ೯ൔޑ࿶Ҝऀڈ໾ϷՈᡏనኪ᝻٣ ҹǴ80.1%ޑੰΓྍௗڙᔠᡍޑ่݀ᡉҢǴԖ 13.8%ࣁ HBV ໚܄ੰΓྍǵ17.6%ࣁ HCV ໚܄ੰΓྍǵ2.0%ࣁ HIV ໚܄ੰΓྍϷ 3.3%ࣁఘࢥ໚܄ੰΓྍ ( ᑵ฻Ǵ 2010ȑ(߄ 4)Ƕ

୯ϣҞ߻ޑ೯ൔচ߾ࢂԖวғ࿶Ҝऀڈ໾ջ຾Չ೯ൔǴՠኻऍ೽ϩ୯ৎёૈ

ղᘐԖགࢉ॥ᓀω຾Չ೯ൔǹࡺᆕӝа΢࿶Ҝऀڈ໾གࢉޑ॥ᓀϐЎ᝘᏾౛ё࣮

рǴᆵ᡼ϐ HBV ౰Չ౗ᗨฅӢ B ࠠطݹࣝभीฝޑ୺ՉԶԖ෧Ͽᖿ༈Ǵՠᆶς໒ วኻऍ୯ৎ࣬КǴЪᆶёૈࢂςղᘐၨڀଯགࢉ॥ᓀ࿶Ҝऀڈ໾ޑ೯ൔၗ਑࣬КǴ

౰Չ౗ϝၨଯǹу΢Ѡ᡼ HCV ౰Չ౗ǵHIV ಕᑈགࢉΓኧϷఘࢥಕᑈΓኧࣣԖ΢

ϲᖿ༈Ǵࡺᔈ׳уख़ຎଯགࢉ॥ᓀ࿶Ҝऀڈ໾ჹᙴᕍΓ঩ޑ࠶ુǴΑှځวғ੝܄Ǵ аගٮ׳ᆒዴޑႣٛ௛ࡼǶ

߄ 4 ࿶Ҝऀڈ໾೯ൔၗ਑ύ໚܄ੰΓϐ౰Չ౗

ჹຝ HBsAg (+) Anti-HCV(+) Anti-HIV(+) ఘࢥ Ѡ᡼ (ᑵలሏ et al.,

2010)

13.8 17.6 2.0 3.3

Вҁ (Nagao et al., 2007)

7.3 20.1 0.4

म୯ (Protection, 2012) 8.0 48.0 23.0 -- ကεճ (Ippolito et al.,

1999)

13.0 63.0 11.0 --

Ѥ

Ѥǵġ ଯགࢉ॥ᓀ࿶Ҝऀڈ໾ࡕՈమ໚ᙯޑᐒ౗

(΋)ǵՈమ໚ᙯ

ᙴᕍΓ঩ᎁڙଯགࢉ॥ᓀ࿶Ҝऀڈ໾ࡕǴёૈ೏གࢉ B ࠠطݹੰࢥǵC ࠠط ݹੰࢥǵང෷ੰࢥϷఘࢥޑ॥ᓀǴ೷ԋځՈమᔠᡍև౜໚܄ϸᔈǴջࣁՈమ໚ᙯǶ ԶՈమ໚ᙯޑᐒ౗߾٩Ոన໺ኞ܄ੰচᡏޑόӕԶԖৡ౦ (߄ 5)Ƕ

(Β)ǵ໚ᙯޑᐒ౗

1. Bࠠطݹੰࢥ ( Hepatitis B virus; HBV )

ਥᏵ߄ 5 ܌᏾౛ޑࣴز่݀ᡉҢǴऍ୯੯ੰᆅڋύЈමଞჹ 203 Տᎁڙ HBV ଯགࢉ॥ᓀ࿶Ҝऀڈ໾ޑᙴᕍΓ঩຾ՉଓᙫࣴزǴว౜ଓᙫ 99 ՏϣԖ 31 ՏԖՈ మ໚ᙯϸᔈǴीᆉځ໚ᙯ౗ࣁ 31.0% ( CDC, 1976 )ǹќ΋ࣴزύᡉҢǴӧ HBV ଯ གࢉ॥ᓀ࿶Ҝऀڈ໾ޑ 419 ΓύǴ๏ϒՈమխࣝౚೈқݙ৔ǴଓᙫΐঁД ( 36 ຼ ) ࡕǴԖ 69 Γวғ໚ᙯǴځ໚ᙯ౗ࣁ 16.5% ( Seeff et al., 1978 )ǹԶ Werner ฻Γࣴ

زύΨࡰрӧ 390 Տ HBV ଯགࢉऀڈ໾ύǴ๏ϒՈమխࣝౚೈқݙ৔ࡕǴ໚ᙯ౗

ࣁ 12.1% ( Werner & Grady, 1982 ) (߄ϖ)Ƕᆕӝа΢Ў᝘ǴHBV ଯགࢉ॥ᓀ࿶Ҝऀ

ڈ໾ޑ໚ᙯ౗ऊࣁ 12.1% ~ 31.0%Ƕ

2. Cࠠطݹੰࢥ ( Hepatitis C virus; HCV )

ӧ HCV ଯགࢉ॥ᓀ࿶Ҝऀڈ໾೽ϩǴВҁᏢޣଓᙫ 110 Տᎁڙ HCV ໚܄ੰ

Γྍϐ࿶Ҝऀڈ໾ޑኪ៛ࡕԖ 4 Տวғ໚ᙯǴ໚ᙯ౗ࣁ 4.0% ( Kiyosawa et al., 1991 )ǹ ќ Mistsui ฻Γ߾ଓᙫ 68 ՏᙴᕍΓ঩ӧኪ៛ HCV ଯགࢉ॥ᓀ࿶Ҝऀڈ໾ࡕ 6 ঁ ДǴԖ 7 ՏՈమ໚ᙯǴ໚ᙯ౗ଯၲ 10.0% ( Mitsui et al., 1992 )ǶԶӧऍ୯ޑߏයᕵ

ೣ܄ଓᙫࣴزύǴLanphear ฻Γଓᙫ 50 Տวғ HCV ଯགࢉ॥ᓀ࿶Ҝऀڈ໾ޑᙴ ᕍΓ঩Ǵว౜Ԗ 3 ՏวғՈమ໚ᙯǴ໚ᙯ౗ࣁ 6.0% ( Lanphear et al., 1994 )ǶЃՋ ޑࣴزύଓᙫ 38 Տวғ HCV ଯགࢉ॥ᓀ࿶Ҝऀڈ໾ޑᙴᕍΓ঩ǴӅԖ 2 Տวғ

໚ᙯǴ໚ᙯ౗ࣁ 5.0% ( Medeiros et al., 2012 ) (߄ 5)Ƕᆕӝа΢ࣴز่݀ǴHCV ଯ གࢉ॥ᓀ࿶Ҝऀڈ໾ޑ໚ᙯ౗ऊࣁ 4.0%~10.0%Ƕ

3. ΓᜪխࣝલЮੰࢥ ( Human Immunodeficiency Virus; HIV)

ӧऍ୯ǴHenderson ฻Γଓᙫ 179 Տ HIV ଯགࢉ॥ᓀ࿶Ҝऀڈ໾ޑᙴᕍΓ঩Ǵ ว౜Ԗ 1 Տวғ໚ᙯǴ໚ᙯ౗ࣁ 0.6% ( Henderson et al., 1990 )Ǵځҭ຾Չ಍ӝϩ݋

14ጇ࣬ᜢЎ᝘Ǵࡰр HIV ଯགࢉ॥ᓀ࿶Ҝऀڈ໾ϐ໚ᙯ౗ࣁ 0.3% ( Henderson et al., 1990 )Ƕќ Tokars ฻ΓߏයଓᙫΑ 1,103 Տ HIV ଯགࢉ॥ᓀ࿶Ҝऀڈ໾ϐᙴᕍ Γ঩ǴӧගٮႣٛ܄ޑ zidovudine ׫ᛰࡕǴว౜Ԗ 4 ՏวғՈమ໚ᙯǴ໚ᙯ౗ࣁ 0.4% ( Tokars et al., 1993 )ǶԶќ΋Ꮲޣ Gerberding ߾ଓᙫΑ 327 Տ HIV ଯགࢉ॥

ᓀ࿶Ҝऀڈ໾ޑᙴᕍΓ঩Ǵว౜Ԗ 1 Տวғ໚ᙯǴځ໚ᙯ౗ࣁ 0.3% ( Gerberding, 1994 ) (߄ 5 )Ƕҗа΢Ў᝘ёޕǴHIV ଯགࢉ॥ᓀ࿶Ҝऀڈ໾໚ᙯ౗ऊࣁ 0.3% ~ 0.6%Ƕ

4. ఘࢥ ( Syphilis )

ఘࢥԐයёа೸ၸዬ݅Ջѭ ( Penicillin ) ຾ՉݯᕍǴࣗԿёၲډ౫ᘰ ( ፁғ ᅽճ೽੯ੰᆅڋֽǴ2013 )Ǵᆶ΢ॊੰচᡏݯᕍคݤֹӄ౫ᘰԖ܌ৡձǴࡺନ Franco

฻Γමܭࣴزൔ֋ύගϷ௢՗ఘࢥ໚ᙯ౗ࣁ 0.000146% ( Franco et al., 2007 ) ѦǴ ᗲϿࣴز௖૸ଯགࢉ॥ᓀ໺ࢉࡕޑ໚ᙯ॥ᓀǶ

ᆕӝа΢Ў᝘ၗ਑ёޕǴҞ߻ޑࣴزӭࢂଞჹᙴᕍΓ঩࿶Ҝऀڈ໾܌଺ޑࢬ ՉੰᏢፓࢗǴၨϿଞჹՈనགࢉ੯ੰϐ໚܄ੰΓྍޑଯགࢉ॥ᓀ࿶Ҝऀڈ໾ϐϩ թޑࣴزǴჴԖѸाଞჹԜଯགࢉ॥ᓀ࿶Ҝऀڈ໾຾΋؁຾Չ௖૸ᆶϩ݋Ǵаᙶమ ӚᙍᜪᙴᕍΓ঩ന৒ܰวғଯགࢉ॥ᓀ࿶Ҝऀڈ໾ޑӦᗺǵᐒڋǵ܌୺Չޑᙴᕍೀ

࿼฻࣬ᜢϐࢬՉੰᏢፓࢗǴаճ҂ٰӧ௦ڗ፾྽ႣٛϟΕ௛ࡼϷٛៈ฼ౣਔϐୖ

Ե٩ᏵǴаᗉխᙍ཰ኪ៛܌೷ԋϐགࢉǶ

߄ 5 วғଯགࢉ॥ᓀ࿶Ҝऀڈ໾ᙴᕍΓ঩໚ᙯޑ॥ᓀࣴز

࿶Ҝऀڈ໾໚܄ੰΓྍ ଓᙫΓኧ ໚ᙯΓኧ ໚ᙯ౗%

HBV

ऍ୯ (CDC,1976) 99 31 31.0

ऍ୯ (Seeff et al., 1978) 419 69 16.5 ऍ୯ (Werner & Grady, 1982) 390 47 12.1 HCV

Вҁ (Kiyosawa et al., 1991) 110 4 4.0 Вҁ (Mitsui et al., 1992) 68 7 10.0 ऍ୯ (Lanphear et al., 1994) 50 3 6.0 ЃՋ (Medeiros et al., 2012) 38 2 5.0 HIV

ऍ୯ Henderson et al., 1990) 179 1 0.6 ऍ୯ (Tokars et al., 1993) 1,103 4 0.4 ऍ୯ (Gerberding, 1994) 327 1 0.3 Syphilis

ကεճ (Franco et al., 2007) -- -- 0.0^*

*0.000146%

ಃ

ಃΟ࿯ ଯགࢉ॥ᓀ࿶Ҝऀڈ໾ࡕჹᙴᕍΓ঩ϐЈ౛ቹៜ

ᙴ ᕍ ൂ Տ ϐ ᙍ ཰ ໾ ্ ύ Ǵ ࿶ Ҝ ऀ ڈ ໾ ࢂ த ـ Ъ ወ ᙒ ଯ Ӓ ᓀ ܄ ޑ ٣ ҹ ( IHCWSC, 2015 )ǶਥᏵ୯ϣύЎހEPINet೯ൔس಍ӧ2004ԃԿ2006ԃ6Дޑ14ৎ ᙴଣၗ਑܌଺ޑࣴزϩ݋Ǵ௢՗ӄ୯࿶Ҝऀڈ໾གࢉྍࣁBࠠطݹޣԖ1,168ҹǵC

ࠠطݹԖ1,263ҹǴHIV໚܄Ԗ59ҹǴఘࢥVDRL໚܄ޣԖ236ՏǴӢԜᙴᕍΓ঩த ኪ៛ܭੰࢥ܄طݹǵHIVੰࢥϷఘࢥޑଯ॥ᓀ ( Shiao et al., 2008 )ǹЪਥᏵࣴزǴ

೏Ԧࢉ܄ଞᓐЌ໾܈Ոᡏనኪ᝻Ǵёૈ཮གࢉBࠠطݹǵCࠠطݹǵఘࢥϷང෷ੰ

฻ӚᅿՈన੯ੰ ( CDC, 2013; Gerberding, 1994ǹMedeiros et al., 2012ǹShiao et al., 2008ǹWerner & Grady, 1982 )ǹё࣮рځჹᙴᕍΓ঩೷ԋޑ࠶ુǶ

ၸѐ୯ϣѦᏢޣޑࣴزύว౜Ǵӧᙴᕍଣ܌ϣǴᙴᕍΓ঩࿶Ҝऀڈ໾٣ҹޑ วғ௃׎ଯၲ87% ~ 92%Ǵՠ໻Ԗ18% ~ 58%ޑΓӛᙴଣ೯ൔǴځᎩ҂೯ൔ ( Lauer et al., 2014; Shiao et al., 2009; Winchester et al., 2012; ᑵ฻Ǵ2005 )ǴᡉҢჴሞЌ໾

٣ҹޑวғ౗К೯ൔाٰޑӭǶᎁڙ࿶Ҝऀڈ໾ޣऩ҂ӛᙴଣ೯ൔǴёૈᏤठ໾ޣ คݤௗڙѸाޑೀ࿼Ǵ྽ό۩೏གࢉਔǴ߾ёૈ໔ௗޑቹៜੰΓӼӄǴคݤܭಃ΋

ਔ໔ׯ๓س಍Ϸπբࢬำ౧ѨϷགࢉࡕคݤᕇளӝ౛ྣ៝Ϸံᓭ฻ ( ᑵ฻Ǵ2010 )Ǵ

ࡺӄᡏᙴᕍπբΓ঩֡ᔈ҅ຎ࿶Ҝऀڈ໾ୢᚒǴаٛጄܭ҂ฅǶ

ᙴᕍΓ঩ӧπբύ࿶Ҝऀڈ໾ନΑ஥ٰࡕុଓᙫᔠࢗϷݯᕍԋҁѦǴჹځي Ј܌೷ԋޑബ໾ҭࢂό৒۹ຎޑ᝼ᚒǶਥᏵ΋໨ᐉᘐ܄ፓࢗ361Տᙴৣᆶៈ౛Γ঩

ޑࣴزᡉҢǴჹܭπբύёૈวғ࿶Ҝऀڈ໾ޑ॥ᓀǴԖ15.2ʘޑڙೖޣ߄ҢԖ௃

ᆣ֚ᘋǴӵขቾǵᏼЈǵคڼǵ৮ཉǴࣗԿག᝺ΠަഞЕǹϩቫࡪ܄ձǵԃសǵπ բᙍᆀϩ݋ኧᏵว౜೭٤Ӣન֡ᆶ࿶Ҝऀڈ໾ࡕޑॄӛЈ౛ᡂϯԖᜢǴζ܄ǵៈ౛

Γ঩کঁΓԃសӧ20-30ྃޑ׳৒ܰགڙډЈ౛΢ޑขቾک਋ש ( Zhang & Yu, 2013 )Ƕќ΋ࣴزа่ᄬԄߚ૶Ӝୢڔፓࢗ120ՏᙴᕍΓ঩Ǵ86ʘ཮ᏼЈ࿶Ҝऀڈ

໾ࡕགࢉՈన໺ࢉ੯ੰǴЪԖ69ʘᇡࣁന৒ܰ೏໺ࢉCࠠطݹǴჹځ଼ந࠶ુനεǴ ԶԖ53ʘᏼЈགࢉBࠠطݹϷԖ13ʘᏼЈHIVགࢉ ( Winchester et al., 2012 )Ƕ

ќӢ࿶Ҝऀڈ໾ࡕёૈགࢉՈన੯ੰޑ॥ᓀǴࡺӚ୯ࣣࡌҥΑ΋ೱՍӧ࿶Ҝ

ऀڈ໾ࡕଓᙫᆶႣٛ኱ྗࢬำǶӵӧኪ᝻HIVՈనᡏనࡕ๏ϒ1ঁДޑႣٛ܄׫ᛰ

ૈ ᡉ ๱ फ़ ե ག ࢉ ޑ ॥ ᓀ ( Upjohn, Stuart, & Korman, 2012 ) Ǵ ࣴ ز ࡰ р ٬ Ҕ

Zidovudine฻Ⴃٛ׫ᛰஒ཮फ़ե79% ໚ᙯޑ॥ᓀ ( CDC, 1996 )ǶฅԶ೭٤Ⴃٛ܄

׫ᛰ೯தՔᒿ๱ࡐӭޑୋբҔǴԶ೷ԋيᡏ΢ޑό፾ੱރǴӵဎᘞǵ⧋ЈǵჍӗϷ ᡏΚ຀১฻ ( Aggarwal et al., 2012 )Ƕ

ԶᙴᕍΓ঩ᎁڙ࿶Ҝऀڈ໾ࡕǴΨёૈр౜΋ೱՍޑЈ౛ፂᔐǴӵബ໾ࡕੱ

ংဂǵขቾǵኁᢠ฻ǴЪΨ཮Ӣࣁ೭٤Ј౛ፂᔐԶቹៜځВதࢲ୏фૈǴӵޗ཮ϕ

୏ǵ܄ғࢲϷᙍ཰דӛ฻ ( Treloar, et al., 1995ǹWald, 2009 )Ǵ೭٤ੱރ೯த཮ӧ

࿶Ҝऀڈ໾ࡕҥջр౜ǴЪӧႣٛ܄׫ᛰය໔Ϸ฻ࡑᔠᡍ่݀ය໔࡭ុӸӧǴӵଞ ჹHIVኪ᝻ޑ20ՏᙴᕍΓ঩ଓᙫځЈ౛ރݩǴว౜΋ԃࡕϝԖ55ʘԖᝄख़ޑЈ౛֚

ᘋǵ35ʘԖύࡋޑЈ౛֚ᘋǴ25ʘ߄Ңځ܄фૈׯᡂǵ30ʘᚆ໒πբคݤൺπ ( Henry et al., 1990 )ǹ Ъ ࡭ ុ ޑ ௃ ᆣ ֚ ᘋ Ϸ ข ቾ ё ૈ ཮ Ꮴ ठ ബ ໾ ࡕ ੱ ং ဂ ( posttraumatic stress disorder, PTSD ) ޑวғǴӵऍ୯ଞჹ2Տ࿶ᐕӕ΋HIV໚܄ੰ

Γྍޑ࿶Ҝऀڈ໾ϐՈన೸݋࠻ᙴᕍΓ঩ߏයଓᙫࡕޑਢٯൔ֋ǴᡉҢᗨฅ2Γӧ

࿶Ҝऀڈ໾ࡕҥջ๏ϒ4ঁࢃයޑHIVႣٛ܄׫ᛰǴЪ࡭ុଓᙫ24ঁДޑHIVלᡏ Ոమᔠᡍࣣև഍܄Ǵϐ߻Ψ҂ԖҺՖЈ౛Бय़੯ੰўǴՠӧଓᙫය໔ࣣև౜࡭ុޑ ขቾǵኁᢠǵѨ઀Ϸख़ፄޑൾფǴЪ೏ዴບࣁᄌ܄ޑബ໾ࡕੱংဂ ( PTSD )Ǵځࡕ

೿คݤӣډচൂՏ ( Ոన೸݋࠻ ) ᝩុπբǴځύ΋Տ2ԃࡕϝคݤൺπǴќ΋

Տ߾ӧ΋ԃࡕᙯډځдൂՏπբ ( Worthington, Ross, & Bergeron, 2006 )ǶᡉҢᎁ ڙ࿶Ҝऀڈ໾ޑ࿶ᡍϷࣗԿӧ೭٤Ⴃٛ܄׫ᛰǵ҂ޕϷ฻ࡑᔠᡍ่݀ޑၸำύǴ೿

Ԗёૈ೷ԋᙴᕍΓ঩ޑ௃ᆣ֚ᘋǶ

வа΢ၗ਑ёޕǴ࿶Ҝऀڈ໾ёૈჹᙴᕍΓ঩ౢғӭᅿޑॄय़ቹៜǴӵᏼЈ གࢉډՈన໺ࢉ੯ੰǵߏයೀܭ௃ᆣ֚ᘋϐύǵႣٛ܄׫ᛰ೷ԋޑғ౛΢ޑό፾ǵ ᏼЈπբᕉნޑӼӄ܈फ़եவ٣ᙴᕍπբޑཀᜫ฻ǴࡺёૈౢғӧЈ౛΢ёෳໆ ᆶόёෳໆϐᓸΚǶՠᕉ៝Ҟ߻܌Ԗ୯ϣѦ௖૸ᙴᕍΓ঩࿶Ҝऀڈ໾ࡕޑፂᔐϐ

࣬ᜢࣴزύǴ໻ԖϿໆаໆ܄ࣴز܈ঁਢൔ֋БԄǴϩ݋ӧ࿶Ҝऀڈ໾ёૈ೷ԋޑ Ј౛ፂᔐǴӵขቾǵኁᢠำࡋ܈ബ໾ࡕੱংဂ ( Sohn, et al., 2006ǹWald, 2009; Wicker et al., 2008ǹWicker et al., 2014; Winchester et al., 2012; Worthington et al., 2006ǹZhang

& Yu, 2013 )ǴฅԶᗲϿჹܭᙴᕍΓ঩࿶Ҝऀڈ໾ϐੰΓྍࣁՈనགࢉ܄੯ੰ໚܄

ޣϐ࿶ᡍ܈ځࡕϐགڙޑࣴزǴډۭ೭٤ଯགࢉ॥ᓀ࿶Ҝऀڈ໾ჹᙴᕍΓ঩܌೷

ԋޑЈ౛ޑቹៜࣁՖǻӧ࿶ᐕଯགࢉ॥ᓀޑ࿶Ҝऀڈ໾ࡕǴჹځࡕុᔠᡍଓᙫǵႣ

ٛ܄׫ᛰǵϷӕ٣ᆶЬᆅϸᔈ฻ೀ౛ၸำޑགڙΞӵՖǻ೭٤೿ॶளךॺ຾΋؁

ుΕΑှᆶӕ౛Ǵ܌а܈೚೸ၸ፦܄ࣴزǴᡣךॺჹଯགࢉ॥࿶Ҝऀڈ໾ޑᙴᕍΓ

঩ϐ࿶ᡍགڙᆶЈ౛ϸᔈԖ׳ుቫޑ౛ှǴωૈڐշךॺӧڋۓ࣬ᜢ࿶Ҝऀڈ໾

ٛݯǵ೯ൔଓᙫǵπբӼӄ฼ౣਔǴૈ׳಄ӝᙴᕍΓ঩ޑཀᜫᆶሡ؃Ǵωૈගٮᙴ ᕍΓ঩Ӽӄޑ୺཰ᕉნǶ

ࡺҁࣴز׆ఈ೸ၸଞЌ೯ൔس಍ޑჴሞᅱෳၗ਑Ǵ௢՗୯ϣ࿶Ҝऀڈ໾ޑว ғ౗ǴନගٮჹᙴᕍΓ঩࿶Ҝऀڈ໾׳ుΕΑှځനཥޑᖿ༈ѦǴ٠ёբࣁӧӄय़ ගٮӼӄଞڀ߻ޑ୷ྗᗺϐၗ਑ǹ຾΋؁ӆϩ݋ӚᜪᙴᕍΓ঩ଯགࢉ॥ᓀ࿶Ҝऀ

ڈ໾ϐวғӦᗺǵ௃ნϷϷӾ᎒ނЌ໾ᅿᜪϷวғ౗Ǵ٠௢՗ᆶႣෳёૈ໚ᙯޑ॥

ᓀǴаගٮӚᜪᙴᕍΓ঩ჹᙍ൑ଯགࢉ॥ᓀ࿶Ҝऀڈ໾ޑٛጄǴԖ׳ᆒዴǵڀᡏޑ ᇡޕǴЪᗨฅന٫ޑБԄࢂӄय़ගٮӼӄଞڀǴՠऩคݤ΋ԛӄय़ගٮޑᙴᕍൂՏǴ ҭ׆ఈ೸ၸҁࣴز่݀Ǵբࣁ೴ԃගٮӼӄଞڀൂՏǵଞڀᅿᜪᓬӃᒧ᏷ޑڀᡏୖ

Ե٩Ᏽǹќଞჹමวғଯགࢉ॥ᓀ࿶Ҝऀڈ໾ޑᙴᕍΓ঩຾Չ፦܄ೖፋǴ׆ఈ೸ၸ य़ჹय़ޑుΕೖፋࣴزǴჹҁيϐ࿶Ҝऀڈ໾ϐੰΓྍࣁՈనགࢉޣޑ٣ҹǴࡌᄬ ᙴᕍΓ঩ϐ࿶ᡍᆶЈ౛གڙǴаుΕΑှଯགࢉ॥ᓀ࿶Ҝऀڈ໾ჹځޑቹៜǴගٮ ჹঁਢ౛ှǶ

ࣴ

ࣴزБݤ

ҁࣴزஒϩࣁΟ೽ϩǴх֖ಃ΋೽ϩǺᙴᕍΓ঩࿶Ҝऀڈ໾ӄ୯วғ౗ϐ௢

՗ǹಃΒ೽ϩǺϩ݋Ѡ᡼ӚᜪᙴᕍΓ঩ଯགࢉ॥ᓀ࿶Ҝऀڈ໾ϐࢬՉੰᏢǹϷಃΟ

೽ϩǺ፦܄ࣴز--ᙴᕍΓ঩ϐଯགࢉ॥ᓀ࿶Ҝऀڈ໾ޑЈ౛ፂᔐϷቹៜǶ

Ԗᜢܭ࿶Ҝऀڈ໾ࢬՉੰᏢፓࢗ࣬ᜢޑࣴزБݤǴεठёϩࣁ߻ᘳ܄ࣴز ( prospective study )ǵӣྉ܄ࣴز ( retrospective study )ǵϷ٬Ҕ೯ൔၗ਑ ( ӵ EPINet ) ຾Չӣྉ܄ԛભၗ਑ϩ݋ϩ݋ǶځόӕࣴزБݤϐᓬલᗺ᏾౛ᘜયӵ߄ 6Ƕ

߄ 6 ࿶Ҝऀڈ໾ࣴزதҔϐࣴزБݤᓬલᗺКၨ

! ߻ᘳ܄ ӣྉ܄ ӣྉ܄ԛભၗ਑ϩ݋

(EPINet೯ൔၗ਑৤) ᓬᗺ 1. ό཮ԖӣᏫୃৡ

2. ёளډ࿶Ҝऀڈ

໾ޑวғ౗ǵ࣬

ჹӒᓀ܄฻

1. ࣴزਔ໔อ 2. ޸຤࣬ჹၨϿ 3. ؒԖঁਢѨѐଓ

ᙫୢᚒ

1. ࣴزਔ໔อ 2. ޸຤࣬ჹၨϿ

3. ෧Ͽࣴزၗ਑ԏ໣ύёૈวғޑ֚

ნ

4. ࣁߏය೯ൔၗ਑ǴڀԖᕵೣࣴزኧ Ᏽޑᓬ༈

5. ёڗளၗ਑৤ύεໆኬҁǴЪ׳ڀ ж߄܄

6. ёਥᏵ೯ൔၗ਑ளډ࿶Ҝऀڈ໾ว ғ౗ǵ࣬ჹӒᓀ܄

7. ၨܰ຾Չၠ୯໔ޑКၨ

લᗺ 1.ሡाၨߏࣴزਔ ໔

2.޸຤ܳ຦

3.ሡाԾᜫޣୖᆶ аठࣴز่݀ค ݤ௢ቶډ΋૓௼

ဂ

4.ሡεໆࣴزঁਢ 5.ࣴزঁਢԖѨѐ

ଓᙫୢᚒ

1. Ӣࣁፓࢗၸѐ΋

ࢤਔ໔ޑ࿶Ҝऀ

ڈ໾࿶ᡍǴёૈ

ԖӣᏫୃৡ 2. ѝૈளډ࿶Ҝऀ

ڈ໾ޑ౰Չ౗

1. ၗ਑৤༤ൔၗ਑όֹ᏾

2. ᔠෳၗ਑ޑ҅ዴ܄ၨࣁ֚ᜤǴՠऩ

ૈӧၗ਑೯ൔය໔ջ຾Չၗ਑ዴ ᇡǴ߾ёᗉխԜલᗺ

ӣྉ܄ԛભၗ਑ϩ݋٬Ҕ౜ԋεໆኬҁޑፓࢗၗ਑ǴߚՠڀԖ࣪ਔǵ࣪Κǵ

࣪ᒲޑᓬᗺǴԶЪၗ਑৤ε೿ᇆ໣ߏය܄ޑၗ਑ǴӢԜӧᡍ᛾ଷ೛ਔǴёаᕇள׳

ࣁ୲ჴޑፕ᛾Ǵ೭ࢂঁձ܄ፓࢗࣴزࡐᜤբډޑǹќࣴزޣόሡा೛ीໆ߄ᆶୢڔǴ όሡाແ஌ୢڔᆶध฻ӣԏǴόሡᏼЈӣԏ౗ޑୢᚒǴё࣪ࠅεໆޑ࿶຤ (໳Ǵ 2006 )Ƕ

ຑ՗όӕࣴزБݤޑᓬલᗺࡕǴЪԵໆӧਔ໔ǵ࿶຤ǵኬҁж߄܄ᆶڀᕵೣ

܄ࣴزኧᏵޑᓬ༈Ǵࡺҁࣴزಃ΋೽ϩϷಃΒ೽ϩஒ௦ӣྉ܄ԛભၗ਑ϩ݋ݤǶќ ଞჹಃΟ೽ϩǴࣁ፦܄ࣴزБݤǴ຾Չय़ჹय़ుΕೖፋࣴزǶаΠஒଞჹӚ೽ҽࣴ

زБݤ຾ՉᇥܴǶ

ಃ

ಃ΋࿯ ᙴᕍΓ঩࿶Ҝऀڈ໾ӄ୯วғ౗ϐ௢՗

΋ǵġ ࣴز೛ी

ҁ೽ϩЬाགྷ௢՗ӄ୯ᙴᕍπբΓ঩࿶Ҝऀڈ໾ϐวғ౗Ϸ࣬ᜢࢬՉੰᏢཷ

ݩǶӢԜǴ௦ӣྉ܄ԛભၗ਑ϩ݋Ǵ೸ၸᙴᕍΓ঩ӼӄፁғύЈϐȨύЎހ EPINet ଞЌ೯ൔس಍ȩǴճҔ೯ൔၗ਑৤ڗள࿶Ҝऀڈ໾೯ൔၗ਑Ƕ

Βǵġ ࣴزπڀ

ҁࣴزಃ΋೽ϩᆶಃΒ೽ϩࣣ٬ҔȨ The Exposure Prevention Information Network (EPINet) ೯ൔس಍ȩࣁࣴزπڀǴࡺଞჹԜπڀ຾ՉϟಏǶ

ȨThe Exposure Prevention Information Network (EPINet) ೯ൔس಍ȩচബޣࣁ ऍ୯ᆢӓѭ٥εᏢޑ Jannine Jagger کځӕ٣ӧ 1991 ԃബҥǴЬाࢂࣁගٮ࿶Ҝ ཞ໾ᆶՈనᡏనኪ᝻ޑ኱ྗϯ૶ᒵϷଓᙫБݤǴх֖ଞЌϷӾ᎒ނЌ໾ൔ֋ǵՈన ᡏనኪ᝻ൔ֋ǴϷଞЌکՈనኪ᝻ࡕϐଓᙫΟε೽ϩǴ٠ճҔ Microsoft Access ೬ ᡏගٮ೯ൔᆶଓᙫǶEPINet ೯ൔس಍ڀᛙۓϷֹ๓ϩ݋ǵ಍ीфૈǴёᔅշᆅ౛

ޣᒿਔЪᇸܰӦᕕှǵϩ݋೷ԋȨଞЌکՈనǵᡏనኪ᝻٣ҹȩޑวғ౗ǵπբᙍ ᆀǵӦᗺϩթǵሺᏔ೛ഢᅿᜪϩթǵӧ஻ޣي΢٬ҔၸϐКٯǵӵՖวғǵӢ࿶Ҝ

ऀڈ໾ԶགࢉՈన໺ࢉ܄੯ੰޑวғ౗Ϸ٣ࡕೀ౛ᆶ่݀฻Ƕவ EPINet ޑ೯ൔၗ

਑ύǴёаᙶమব٤ࢂё೏׳ӼӄޑᙴᕍᏔڀႣٛޑЌ໾ǹᆶځдᐒᄬϩ٦کКၨ

࣬ᜢၗૻϷԋфޑႣٛБݤǹຑॶཥ೛ഢޑ೛ीޑႣٛਏ੻ǹගٮଯ॥ᓀ೛ഢޑႣ

ٛϟΕ௛ࡼǹёගٮ؂Дǵ؂ۑϷ؂ԃޑϩ݋ኪ᝻ൔ֋ ( IHCWSC, 2015 )Ƕ 1992 ԃ Jagger ௲ ௤ ಔ ᙃ ᆢ ӓ ѭ ٥ ε Ꮲ ޑ ୯ ሞ ᙴ ᕍ Γ ঩ Ӽ ӄ ፁ ғ ύ Ј ( International Healthcare Worker Safety Center, IHCWSC ) ϷȨEPINet ࣴزი໗ȩǴ EPINet ೯ൔس಍ගٮᙴᕍᐒᄬԾᜫϩ٦ၗૻޑᆛ๎Ǵ؂ԃٰԾऍ୯ӚӦޑᙴᕍᐒ ᄬஒၗ਑஌ଌԿԜύЈ༼᏾ԋၗ਑৤ǹԾ௢раٰǴӧऍ୯Ԗຬၸ 1500 ৎᙴଣ٬

Ҕ EPINetǴЪԖ 80 ൳ৎᙴᕍᐒᄬ཮ஒၗ਑༼᏾ډύЈǴѬࢂऍ୯ᐕўന஽Φޑᙴ ᕍߥ଼πբޣޑՈనکᡏనኪ᝻ޑၗ਑৤ǹΨࢂԜύЈޑࣴز୷ᘵǴёගٮཥࡹ฼

ޑख़ाჴ᛾ၗ਑ޑЍ࡭ǴӵӼӄύЈޑࣴزი໗ਥᏵ EPINet ၗ਑৤܌ว߄ޑࣴز ԋ݀ගٮҥݤޑୖԵǴаගଯᙴᕍΓ঩ޑӼӄ ( IHCWSC, 2000; Jagger & Perry, 2003 )ǶЪӧ 2000 ԃҥݤޑȨଞЌӼӄٛݯݤ ( The Needlestick Safety and Prevention

Act, NSPA )ȩǴک 2001 ԃঅुࡕޑՈྍ܄ੰচᡏ኱ྗ ( Bloodborne Pathogens Standard, BPS )Ǵा؃ᙴᕍᐒᄬӧኪ᝻٣ҹวғࡕǴѸ໪ߥ੮᎒ᏔЌ໾ޑइᒵǴԿ Ͽхࡴวғޑ೽ߐǵӵՖวғޑǵੋϷޑ೛ഢᜪࠠکࠔจ฻ǴEPINet ೯ൔޑϣ৒

఼ࣣᇂ೭٤ा؃Ǵ٠ගٮ׳ӭځдޑಒ࿯Ǵаڐշᙴᕍᐒᄬዴᇡрଯ॥ᓀޑ೛ഢϷ ᐒᙯǴ٠ૈຑॶϷႣٛ࿶Ҝऀڈ໾ޑཥמೌᆶ೛ࡼޑਏ੻ǴࡺΨ೏ࡐӭ୯ৎ௦ҔǴ хࡴу৾εǵကεճǵՋ੤УǵКճਔǵྷڂǵ޹ើǵངᅟើǵቺ୯ǵᐞࢪǵЃՋǵ ਜ਼܎Өǵᗬ୯ǵВҁکम୯฻ 30 ӭঁ୯ৎ ( IHCWSC, 2015 ) Ƕ

ᑵలሏറγܭ 2001 ԃ໒ۈ௢୏ EPINet ೯ൔس಍Ǵӧ 2002 ԃǴᑵలሏറγڙ Jagger௲௤ϐᗎǴ೛ҥѠ᡼ȨᙴᕍΓ঩ӼӄፁғύЈȩǴ໒ۈᝢഢ EPINet ύЈǴ

׆ఈૈᙖԜࡌҥᙍ཰ኪ៛ϐ୷ጕၗ਑Ǵа଺ࣁׯ๓ᙴᕍΓ঩πբᕉნϷႣٛᙍ཰

໾্௛ࡼޑୖԵ٩ᏵǶӧ 2003 ԃڗள Jagger ௲௤ޑ௤៾Ǵ٠ᆶ Jagger ௲௤ଞჹ EPINetϣ৒ύёঅׯϷόەޣϐ໨Ҟ຾Չ૸ፕǴஒ EPINet অुԋύЎހޑ೯ൔس

಍Ǵය໔࿶ၸ௦Ҕख़ፄᙌ᝿ݤȐback translation methodȑ( Brislin, 1970 )Ǵஒ EPINet س಍ޑϣ৒ǴमЎᙌ᝿ԋύЎǴฅࡕፎ஑ৎਥᏵύЎ᝿ҁᙌ᝿ӣमЎǴ٠ЪКჹύ Ў᝿ҁᆶচۈमЎӧᇟقᏢ΢ޑ҅ዴ܄ᆶৡ౦܄Ǵᆙௗ๱ӆ೸ၸৡ౦ೀޑঅ҅Ǵ٬

চۈᇟཀคᇤࡕǴঅुԋᕷᡏύЎހǹӆ೸ၸΟԛҗ 2 Տᙍ཰ᙴᏢ஑ࣽᙴৣǵ5 Տ གࢉ௓ڋৣϷ 4 Տៈ౛Γ঩܌ಔԋϐขᗺიᡏዴۓୢڔϣ৒ϷҔຒ฻஑ৎਏࡋᔠ

ෳǴ٠ᗎፎ୯ϣчǵύǵࠄǵܿڀж߄܄ϐᙴଣǴ຾Չಃ΋ހϐ EPINet ύЎހෳ

၂Ǵ٠࡭ុঅुځ܌ว౜ޑୢᚒǴԶୖᆶᙴଣύ 50 Տኬҁϐӆෳߞࡋࣁ 92%Ǵᡉ ҢԜ೯ൔπڀԖֹ๓ߞਏࡋ ( Shiao et al., 2008 )ǶύЎ EPINet ගൔൂӅࣁΟҽǺ ϩձࣁȨՈనکᡏనኪ᝻٣ҹൔ֋ൂȩǵȨଞᓐک᎒ނЌ໾٣ҹൔ֋ൂȩǵȨଞЌ کՈనኪ᝻ࡕଓᙫൔ֋ൂȩǴ٠ගٮ΋ҽύЎހ EPINet ගൔൂޑ༤ቪᇥܴǴа٬

ୖᆶගൔᙴଣޑᙴᕍΓ঩׳৒ܰ༤ቪǶ

ගൔൂҗӚᙴଣ܍ᒤॄೢΓڐշᙴᕍΓ঩ӧ٣ҹวғࡕ຾ՉύЎހ EPINet ൔ֋ൂ༤ቪ٠ԏ໣ځ܌༤ൔ֋ൂǴӆҗշ౛ۓය (ऊ΋ڬ) ӛ܍ᒤ঩ԏ໣Ǵ٠ᔠຎ ځ܌༤ϣ৒ࢂցֹ᏾ࡕӆ຾ՉࡌᔞπբǶࣁᡣᙴଣӧ೯ൔวғঁਢ׳ڀਔਏ܄Ǵа ᒿਔඓ௓၀ᜪ໾্٣ҹޑ௃׎ᆶวғ౗Ǵࡺᑵలሏ௲௤ࣴزი໗ࡌҥȨύЎހ EPINetଞЌ೯ൔس಍ȩޑᆛၡ೯ൔس಍Ǵ٠ܭ 2004 ԃ 9 Д 15 В҅Ԅ໒ܫጕ΢೯ ൔǹࣁ൧ख़ᙴଣ܍ᒤΓޑБߡǴё٩܍ᒤΓᒧ᏷೯ൔኳԄǺ1.܍ᒤΓԾՉஒၗ਑ᒡ

Ε೯ൔس಍Ǵշ౛ӆ΢ጕ೴฽ᔠຎၗ਑ࢂց༤ቪֹ᏾ᆶ҅ዴǴऩԖᅪୢ܈༤ቪᒱᇤǴ

߾ҥڅ཮ᆶځႝ၉ᖄ๎অ҅ǹ2.܍ᒤΓແ஌܈໺੿ൔ֋ൂǴ࿶ᔠਡคᇤࡕǴӆҗշ

౛ஒၗ਑ᒡΕ೯ൔس಍ ( ഋǵᑵǵ݅Ǵ2005 )ǹࡺځᒡΕၗ਑ޑࠔ፦ᆶёߞࡋᛙۓǶ Ծ 2004 ԃ໒ۈ௢୏ EPINet ೯ൔس಍Ǵ࿶җόᘐޑঅׯ٠ቚуځфૈǴࡌҥ Α፾ӝѠ᡼ҁβᙴᕍଣ܌٬ҔޑύЎހ EPINet ೯ൔس಍ǴЪമ୏೽ջႴᓰᙴᕍଣ

܌ճҔԜس಍຾Չ೯ൔǶӧ 2007 ԃമ୏೽аୢڔٰᕕှୖᆶᙴଣჹ EPINet ೯ൔ س಍ޑᅈཀࡋǺ཰୍܍ᒤΓБय़่݀ᡉҢǴ64%ჹԜس಍ޑᅈཀǴ36%᝺ளද೯ǹ 88%ᜅԋӄ୯٬ҔԜس಍ǹ76%ள܍ᒤΓ᝺ள٬ҔԜس಍ࡕǴ঩πޑπբӼӄཀ᛽

ԖගϲǶԶଞჹᙴᕍπբΓ঩ፓ่ࢗ݀ᡉҢǴ63.3%ᇡࣁӧᙴଣ٬Ҕ EPINet ଞЌ ೯ൔس಍ࡕǴଣϣ঩πޑӼӄཀ᛽Ԗගϲ ( ഋǵ݅Ǵ2008 )Ƕ2011 ԃ׳຾΋؁ԋ ࣁമ୏೽ࡰۓϐ೯ൔس಍Ǵ٠மڋϦҥᙴଣϷᙴᏢύЈѸ໪ճҔԜس಍຾ՉӾ᎒

ނЌ໾ϷՈనᡏనኪ᝻೯ൔ ( ᑵǵ݅Ǵ2012 )ǶࡺԜၗ਑৤ࣁҞ߻୯ϣԏ໣ᙴᕍΓ

঩࿶Ҝऀڈ໾٣ҹനЬाޑ೯ൔس಍ǴЪ೯ൔޑᙴᕍᐒᄬҭࢂനӭޑၗ਑৤Ƕ ߄ 7 ࣁ 2004 ԃԿ 2013 ԃ 3 Д 31 ВЗӚԃࡋୖᆶ EPINet ೯ൔޑᙴଣኧϷ೯ ൔ฽ኧǶӢമ୏೽மڋೕۓϦҥᙴଣϷᙴᏢύЈӧ 2011 ԃ 1 Д 1 ВଆѸ໪аԜ೯ ൔس಍຾Չ೯ൔǴࡺӧ 2010 ԃۭӚϦҥᙴଣϷᙴᏢύЈഌុуΕǴ٠ܭ 2011 ԃ ଆ຾Չ೯ൔǴࡺӧ 2011 ԃࡕǴ೯ൔ฽ኧِೲቚуǴಕीԿ 2013 ԃ 3 Д 31 ВЗǴ ӅԖ 9,875 ฽೯ൔၗ਑Ƕ

ύЎހ EPINet ೯ൔس಍வ 2004 ԃаٰ࡭ុ௢ቶ٠ԏ໣ډֹ᏾ޑ࿶Ҝऀڈ໾

ᆶՈనǵᡏనኪ᝻ޑҁβၗ਑৤ǴճҔԜၗ਑৤ϐၗ਑຾Չϩ݋ᆶ࣬ᜢࣴزӵΠǺ 1. 2005аၗ਑৤຾Չ௢ᆉӄ୯ޑ࿶Ҝऀڈ໾౗ᆶ໚܄Ոమௗ᝻౗ ( ᑵ฻Ǵ2005 )Ƕ 2. 2008ԃճҔ EPINet ԏ໣ډޑၗ਑Ǵ௢ᆉрѠ᡼؂ԃ؂ 100 ՏᙴᕍΓ঩ύǴԖ

3.3 Տวғ࿶Ҝऀڈ໾܈Ոనᡏనኪ᝻ཀѦ ( Shiao et al., 2008 )Ƕ

3. 2009ԃКၨ EPINet ޑ೯ൔၗ਑ᆶӣྉ܄ၗ਑ǴीᆉрѠ᡼ᙴᕍΓ঩࿶Ҝऀڈ

໾܈Ոనᡏనኪ᝻٣ҹޑ೯ൔ౗ѝԖ 21.2% ( Shiao et al., 2009 )ǴԜኧᏵࣁᙴ ᕍፁғπբᕉნӼӄගٮ΋ঁख़ाޑ᝾ૻǶ

߄ 7 Ӛԃࡋୖᆶ EPINet ೯ൔޑᙴଣኧϷ೯ൔ฽ኧ

ԃࡋ ୖᆶ೯ൔᙴଣኧ ೯ൔ฽ኧ

2004 9 210

2005 21 416

2006 30 489

2007 41 574

2008 68 722

2009 96 654

2010 167 972

2011 231 2,335

2012 249 3,005

2013.3.31 257 498

4. 2010ԃճҔ೯ൔၗ਑Ǵीᆉр୯ϣᙴᕍΓ঩࿶Ҝऀڈ໾܈Ոనᡏనኪ᝻ࡕ೏த ـੰচགࢉԶठՈమ܄໚ᙯޑᐒ཮ ( ᑵ฻Ǵ2010 )Ƕ

5. 2012 ԃଞჹ೯ൔၗ਑຾ՉᙴᕍΓ঩࿶Ҝऀڈ໾ᆶЬाᄍҔЋޑ࣬ᜢϩ݋

( Mbirimtengerenji, Shiao, & Guo, 2012 )Ƕ

ࡺவа΢ёޕǴவ 2001 ԃ໒ۈ௢୏ EPINet ೯ൔس಍ǴȨύЎހ EPINet ଞЌ ೯ൔس಍ȩςԋࣁ୯ϣҞ߻ᏱԖനӭᙴଣӅӕ٬ҔޑଞЌ೯ൔس಍Ǵ٠ԏ໣ډֹ᏾

ޑ࿶Ҝऀڈ໾ǵϷՈనᡏనኪ᝻ޑҁβၗ਑৤Ƕ Ο

Οǵġ ࣴزኬҁ

ӢҁࣴزࣁճҔԏ໣೯ൔၗ਑Ǵ௢՗ӄ୯ᙴᕍΓ঩࿶Ҝऀڈ໾ޑวғ౗Ϸځ

࣬ᜢࢬՉੰᏢޑፓࢗǴࡺԖ೯ൔᙴଣޑ܌ԖΓ঩ࣁࣴزኬҁǴᒧڗ΋ԃޑ೯ൔၗ਑

аीᆉϷ௢՗วғ౗Ǵ٠ࣁᆶᑵ฻ ( 2008 ) ܭ 2004 ԃճҔ೯ൔၗ਑܌଺ޑࣴز຾

ՉКჹǴٰ૸ፕѠ᡼ᙴᕍΓ঩࿶Ҝऀڈ໾ޑᖿ༈ǴЪࣁගٮӧᙴᕍݤಃ 56 చϐঅ ׯ—ा؃ܭ 2012 ԃ໒ۈ୺ՉϖԃϣࡪКٯ೴؁ֹԋӄय़ගٮӼӄଞڀ —ჴࡼ߻