過去研究指出，院內感染不僅是造成死亡率增加的主因，更會延長病患的住院時間，特別是近年SARS及H1N1流感疾病爆發後，更突顯出病原菌經空氣傳播而感染的危險性，因此增強通風量及滅菌劑成為空氣中病原菌移除之主要方法，但風量過大卻會造成熱舒適性問題，殺菌劑過量亦會增加化學性危害。本研究利用氣流模式模擬暴露艙之最佳滅菌位置，再藉通風氣流傳輸特性，同時噴灑次氯酸水，以評估空間的最佳滅菌效果；最後，並於實際診所環境中進行試驗，以瞭解是否可能受實場污染物分布的影響。實驗結果證實滅菌噴霧放置於模擬預期濃度易累積的區域，可在一分鐘內達到整體空間滅菌效果的提升，在通風量較小的條件下 (6 ACH)，其滅菌效益亦可隨著時間延長而增加，但通風量較大的條件下 (12 ACH)，則因細菌大多數已藉通風移除，故無法顯示出次氯酸水的時間效益。此外，實場則因污染物的影響，造成變異度甚大，因分析發現不受外氣干擾的診所，其人為活動對於細菌濃度的影響甚大，而真菌則與室內的溼度有關，可能係因現有技術仍無法利用電腦準確的模擬污染物濃度的分布所致。因此本研究建議在氣流分佈較穩定的室內環境中，可透過電腦模擬技術選擇適當的滅菌位置，以有效移除生物性污染物，並同時達感染控制的效果。

Nosocomial infection is known to contribute significantly to the global morbidity and mortality. Although direct contact is considered the major route of infection transmission, the outbreak of SARS and H1N1 imply the importance of aerosol infection. Enhanced ventilation rate and use of disinfectant could effectively eliminate the pathogen, however, the concern of thermal comfort and chemical residue remains. To improve the disinfection efficiency, this research attempted to identify the appropriate positions of harmless hypochlorous acid (HOCl) spray by using CFD simulation in a controlled environment. The ventilation rate was set for 6ACH and 12ACH in experimental chamber. Chamber study implied that posit the disinfected spray in the expected high contaminated region by CFD simulation could eliminate the microorganism in this region in 1 minute. The disinfection efficiency increased as the disinfection time increased as the air exchange rate was small, while the disinfection effect can not last long when the exchange rate was large because most of the bacteria might have been removed by the ventilation system. To confirm the practicability of the chamber experiment above, two clinics were chosen to investigate the relationship between airflow pattern predicted by CFD simulation and the environmental contaminant as a pilot test. For the field test, CFD could not accurately simulate the pollutant concentration distribution in a field clinic where far too many environmental factors were still unmeasured. Fro examples, analysis result showed that indoor bacteria concentration was associated with occupant number and fungi concentration related to the indoor humidity. In the relatively controllable indoor environment, such as hospital ward or sanatorium, positioning the disinfected spray in the expected high concentration areas predicted through CFD simulation could effectively eliminate the microbial contamination.

Acheson DJ. 1990. Elementary Fluid Dynamics: Oxford University Press.
Appelgren P, Hellstrom I, Weitzberg E, Soderlund V, Bindslev L, Ransjo U. 2001. Risk factors for nosocomial intensive care infection: a long-term prospective analysis. Acta Anaesthesiol Scand 45(6): 710-719.
Barrette WC, Jr., Albrich JM, Hurst JK. 1987. Hypochlorous acid-promoted loss of metabolic energy in Escherichia coli. Infect Immun 55(10): 2518-2525.
Barrette WC, Jr., Hannum DM, Wheeler WD, Hurst JK. 1989. General mechanism for the bacterial toxicity of hypochlorous acid: abolition of ATP production. Biochemistry 28(23): 9172-9178.
Bassetti M, Righi E, Tumbarello M, Di Biagio A, Rosso R, Viscoli C. 2006. Candida infections in the intensive care unit: epidemiology, risk factors and therapeutic strategies. Expert Review of Anti-Infective Therapy 4(5): 875-885.
Beggs C, Noakes C, Sleigh P, Fletcher L, Siddiqi K. 2003. The transmission of tuberculosis in confined spaces: an analytical review of alternative epidemiological models. The international journal of tuberculosis and lung disease: the official journal of the International Union against Tuberculosis and Lung Disease 7(11): 1015.
Beghein C, Jiang Y, Chen QY. 2005. Using large eddy simulation to study particle motions in a room. Indoor Air 15(4): 281-290.
Block SS. 2001. Disinfection, Sterilization, and Preservation: Lippincott Williams & Wilkins.
Breathnach AS, de Ruiter A, Holdsworth GMC, Bateman NT, O'Sullivan DGM, Rees PJ, et al. 1998. An outbreak of multi-drug-resistant tuberculosis in a London teaching hospital. Journal of Hospital Infection 39(2): 111-117.
Chao CY, Wan MP. 2004. Experimental study of ventilation performance and contaminant distribution of underfloor ventilation systems vs. traditional ceiling-based ventilation system. Indoor Air 14(5): 306-316.
Chau OKY, Liu CH, Leung MKH. 2006. CFD Analysis of the Performance of a Local Exhaust Ventilation System in a Hospital Ward. Indoor and Built Environment 15(3): 257.
Chen Q, Jiang Z, Moser A. 1992. Control of Airborne Particle Concentration and Draught Risk in an Operating Room. Indoor Air 2(3): 154-167.
Chen SC, Chang CF, Liao CM. 2006. Predictive models of control strategies involved in containing indoor airborne infections. Indoor Air 16(6): 469-481.
Cheong KWD, Phua SY. 2006. Development of ventilation design strategy for effective removal of pollutant in the isolation room of a hospital. Building and Environment 41(9): 1161-1170.
Chow TT, Yang XY. 2003. Performance of ventilation system in a non-standard operating room. Building and Environment 38(12): 1401-1411.
Chow TT, Yang XY. 2004. Ventilation performance in operating theatres against airborne infection: review of research activities and practical guidance. J Hosp Infect 56(2): 85-92.
Clark J, Barrett S, Rogers M, Stapleton R. 2006. Efficacy of super-oxidized water fogging in environmental decontamination. Journal of Hospital Infection 64(4): 386-390.
Cole EC, Cook CE. 1998. Characterization of infectious aerosols in health care facilities: An aid to effective engineering controls and preventive strategies. AJIC: American Journal of Infection Control 26(4): 453.
Drinka PJ, Krause P, Nest L, Gravenstein S, Goodman B, Shult P. 2002. Delays in the application of outbreak control prophylaxis for influenza A in a nursing home. Infect Control Hosp Epidemiol 23(10): 600-603.
Dvorak G, By PR, Roth J, Amass S. 2005. Disinfection 101. Ames, IA, The Center for Food Security & Public Health, Iowa State University.
Emori TG, Gaynes RP. 1993. An overview of nosocomial infections, including the role of the microbiology laboratory. Clin Microbiol Rev 6(4): 428-442.
Finlayson EU, Gadgil AJ, Thatcher TL, Sextro RG. 2004. Pollutant dispersion in a large indoor space. Part 2: Computational fluid dynamics predictions and comparison with a scale model experiment for isothermal flow. Indoor Air 14(4): 272-283.
Fowler RA, Scales DC, Ilan R. 2004. Evidence of airborne transmission of SARS. N Engl J Med 351(6): 609-611; author reply 609-611.
Friberg B, Friberg S, Burman LG. 1999. Correlation between surface and air counts of particles carrying aerobic bacteria in operating rooms with turbulent ventilation: an experimental study. Journal of Hospital Infection 42(1): 61-68.
Fukuzaki S. 2006. Mechanisms of actions of sodium hypochlorite in cleaning and disinfection processes. Biocontrol Science 11(4): 147.
Gao N, Niu J. 2006. Transient CFD simulation of the respiration process and inter-person exposure assessment. Building and Environment 41(9): 1214-1222.
Gastmeier P, Stamm-Balderjahn S, Hansen S, Nitzschke-Tiemann F, Zuschneid I, Groneberg K, et al. 2005. How outbreaks can contribute to prevention of nosocomial infection: analysis of 1,022 outbreaks. Infect Control Hosp Epidemiol 26(4): 357-361.
Goldmann DA, Platt R, Hopkins C. 1992. Control of hospital-acquired infections. Infectious Diseases Philadelphia, PA: WB Saunders 45: 378-390.
Harnett SJ, Allen KD, Macmillan RR. 2001. Critical care unit outbreak of Serratia liquefaciens from contaminated pressure monitoring equipment. Journal of Hospital Infection 47(4): 301-307.
Hathway A, Noakes C, Sleigh P, Leeds U. 2008. CFD modelling of a hospital ward: Assessing risk from bacteria produced from respiratory and activity sources.
Hoge CW, Reichler MR, Dominguez EA, Bremer JC, Mastro TD, Hendricks KA, et al. 1994. An Epidemic of Pneumococcal Disease in an Overcrowded, Inadequately Ventilated Jail. 643-648.
Holmberg S, Chen Q. 2003. Air flow and particle control with different ventilation systems in a classroom. Indoor Air 13(2): 200-204.
Jeffrey DJ. 1995. Chemicals used as disinfectants: active ingredients and enhancing additives. Revue Scientifique et Technique de l'OIE 14(1): 57-74.
Johnson B, Martin D, Resnick I. 1994. Efficacy of selected respiratory protective equipment challenged with Bacillus subtilis subsp. niger. Applied and Environmental Microbiology 60(6): 2184.
Jones AM, Govan JR, Doherty CJ, Dodd ME, Isalska BJ, Stanbridge TN, et al. 2003. Identification of airborne dissemination of epidemic multiresistant strains of Pseudomonas aeruginosa at a CF centre during a cross infection outbreak. Thorax 58(6): 525-527.
Kennedy J, Bek J, Griffin D, University of N-L, Cooperative E. 2000. Selection and Use of Disinfectants: Cooperative Extension, Institute of Agriculture and Natural Resources, University of Nebraska-Lincoln.
Kim C, Hung Y, Brackett R. 2000. Roles of oxidation–reduction potential in electrolyzed oxidizing and chemically modified water for the inactivation of food-related pathogens. Journal of food protection 63(1): 19-24.
Kumar R, Gupta A. 2008. Analysis of the Ventilation System of an Isolation Room for a Hospital. International Journal of Ventilation 7(2): 139-149.
Larson EL. 1995. APIC Guideline for Handwashing and Hand Antisepsis in Health Care Settings*. AJIC: American Journal of Infection Control 23(4): 251.
Len S, Hung Y, Chung D, Anderson J, Erickson M, Morita K. 2002. Effects of storage conditions and pH on chlorine loss in electrolyzed oxidizing (EO) water. J Agric Food Chem 50(1): 209-212.
Li C, Kuo Y. 1994. Characteristics of airborne microfungi in subtropical homes. Science of the total environment 155(3): 267-271.
Li Y, Leung GM, Tang JW, Yang X, Chao CYH, Lin JZ, et al. 2007. Role of ventilation in airborne transmission of infectious agents in the built environment-a multidisciplinary systematic review. Indoor Air 17(1): 2-18.
Liao C-F, Chen, Y.-C., Hsiao, W.-C., Huang, K.-J.&Yu, J. Y.-L. 2006. Application of hypochlorous acid in management of the laboratory animal facility. In: 中華實驗動物學會第九屆第二次會員大會暨學術研討會IBMS, Academia Sinica, Taipei.
Lin X, A. Reponen T, Willeke K, Grinshpun S, Foarde K, Ensor D. 1999. Long-term sampling of airborne bacteria and fungi into a non-evaporating liquid. Atmospheric Environment 33(26): 4291-4298.
Lin X, Reponen T, Willeke K, Wang Z, Grinshpun S, Trunov M. 2000. Survival of airborne microorganisms during swirling aerosol collection. Aerosol Science and Technology 32(3): 184-196.
Liu X, Zhai Z. 2007. Identification of Appropriate CFD Models for Simulating Aerosol Particle and Droplet Indoor Transport. Indoor and Built Environment 16(4): 322.
Mainelis G, Grinshpun S, Willeke K, Reponen T, Ulevicius V, Hintz P. 1999. Collection of airborne microorganisms by electrostatic precipitation. Aerosol Science and Technology 30(2): 127-144.
Maris P. 1995. Modes of action of disinfectants. Rev Sci Tech 14(1): 47-55.
Mazumdar S, Chen Q. 2008. Influence of cabin conditions on placement and response of contaminant detection sensors in a commercial aircraft. J Environ Monit 10(1): 71-81.
Menzies D, Fanning A, Yuan L, FitzGerald JM. 2000. Hospital ventilation and risk for tuberculous infection in canadian health care workers. Canadian Collaborative Group in Nosocomial Transmission of TB. Ann Intern Med 133(10): 779-789.
Morawska L. 2006b. Droplet fate in indoor environments, or can we prevent the spread of infection? Indoor Air 16(5): 335-347.
Morley PS. 2002. Biosecurity of veterinary practices. The Veterinary clinics of North America Food animal practice 18(1): 133-155.
Murakami S. 1998. Overview of turbulence models applied in CWE–1997. Journal of Wind Engineering & Industrial Aerodynamics 74: 1-24.
Myatt TA, Johnston SL, Zuo Z, Wand M, Kebadze T, Rudnick S, et al. 2004. Detection of airborne rhinovirus and its relation to outdoor air supply in office environments. Am J Respir Crit Care Med 169(11): 1187-1190.
Nicastri E, Petrosillo N, Puro V. 2004. Evidence of airborne transmission of SARS. N Engl J Med 351(6): 609-611; author reply 609-611.
Nicholson KG, Wood JM, Zambon M. 2003. Influenza. The Lancet 362(9397): 1733-1745.
Nishimura M, Kariya N, Hulan U, Duan C, Shimono T. 2004. Comparison of the hand disinfectant effects between super hypochlorous water and 7.5% povidone-iodine. PEDIATRIC DENTAL JOURNAL 14(1): 1-3.
Noakes C, Sleigh P, Escombe A, Beggs C. 2006. Use of CFD analysis in modifying a TB ward in Lima, Peru. Indoor and Built Environment 15(1): 41.
ONO T, MIYAKE M, YAMASHITA K. 2006. Studies on the disinfection of hatching eggs by spraying weak acid hypochlorous water mist. Journal of Antibacterial and Antifungal Agents 34(8): 465-469.
Papineni RS, Rosenthal FS. 1997. The size distribution of droplets in the exhaled breath of healthy human subjects. J Aerosol Med 10(2): 105-116.
Park G, Boston D, Kase J, Sampson M, Sobsey M. 2007. Evaluation of Liquid-and Fog-Based Application of Sterilox Hypochlorous Acid Solution for Surface Inactivation of Human Norovirus? Applied and Environmental Microbiology 73(14): 4463-4468.
Phillips D, Sinclair R, Schuyler G. 2004. Isolation room ventilation design case studies.
Pugliese G, Hunstiger CA. 1992. Central services, linens, and laundry. Hospital Infections 3rd ed Boston, MA: Little, Brown and Co: 335-344.
Qian H, Li Y, Nielsen PV, Hyldgaard CE, Wong TW, Chwang AT. 2006. Dispersion of exhaled droplet nuclei in a two-bed hospital ward with three different ventilation systems. Indoor Air 16(2): 111-128.
Qian Y, Willeke K, Ulevicius V, Grinshpun S, Donnelly J. 1995. Dynamic size spectrometry of airborne microorganisms: laboratory evaluation and calibration. Atmospheric Environment 29(10): 1123-1129.
Richmond-Bryant J. 2008. Transport of exhaled particulate matter in airborne infection isolation rooms. Building and Environment.
Roberts K, Hathway A, Fletcher L, Beggs C, Elliott M, Sleigh P. 2006. Bioaerosol production on a respiratory ward. Indoor and Built Environment 15(1): 35.
Roy CJ, Milton DK. 2004. Airborne transmission of communicable infection--the elusive pathway. N Engl J Med 350(17): 1710-1712.
Salim SM, Viswanathan S, Ray MB. 2006. Evaluation of source model coupled computational fluid dynamics (CFD) simulation of the dispersion of airborne contaminants in a work environment. Journal of Occupational and Environmental Hygiene 3(12): 684-693.
Shetty N, Srinivasan S, Holton J, Ridgway G. 1999. Evaluation of microbicidal activity of a new disinfectant: Sterilox 2500 against Clostridium difficile spores, Helicobacter pylori, vancomycin resistant Enterococcus species, Candida albicans and several Mycobacterium species. Journal of Hospital Infection 41(2): 101-105.
Shiomori T, Miyamoto H, Makishima K, Yoshida M, Fujiyoshi T, Udaka T, et al. 2002. Evaluation of bedmaking-related airborne and surface methicillin-resistant Staphylococcus aureus contamination. Journal of Hospital Infection 50(1): 30-35.
Smith B. 1990. Large animal internal medicine.
Tanaka H, Hirakata Y, Kaku M, Yoshida R, Takemura H, Mizukane R, et al. 1996. Antimicrobial activity of superoxidized water. Journal of Hospital Infection 34(1): 43-49.
Tang JW, Li Y, Eames I, Chan PK, Ridgway GL. 2006. Factors involved in the aerosol transmission of infection and control of ventilation in healthcare premises. J Hosp Infect 64(2): 100-114.
Tian ZF, Tu JY, Yeoh GH, Yuen RKK. 2006. On the numerical study of contaminant particle concentration in indoor airflow. Building and Environment 41(11): 1504-1514.
Tomoko ONO MMaKY. 2006. Studies on the Disinfection of Hatching Eggs by Spraying Weak Acid Hypochlorous　Water Mist. Journal of Antibacterial and Antifungal Agents ３４: ４６５－４６９.
Tong TR, Liang C. 2004. Evidence of airborne transmission of SARS. N Engl J Med 351(6): 609-611; author reply 609-611.
Vincent JL. 2003. Nosocomial infections in adult intensive-care units. Lancet 361(9374): 2068-2077.
Wang JT, Chang SC, Ko WJ, Chang YY, Chen ML, Pan HJ, et al. 2001. A hospital-acquired outbreak of methicillin-resistant Staphylococcus aureus infection initiated by a surgeon carrier. J Hosp Infect 47(2): 104-109.
WHO. 2009. Influenza A(H1N1): Epidemic and Pandemic Alert and Response (EPR). Available: http://www.who.int/csr/don/2009_06_08/en/index.html [accessed 9 June 2009].
Willeke K, Baron P. 1993. Aerosol measurement: principles, techniques, and applications: Van Nostrand Reinhold New York.
Woloszyn M, Virgone J, Melen S. 2004. Diagonal air-distribution system for operating rooms: experiment and modeling. Building and Environment 39(10): 1171-1178.
Wong TW, Lee CK, Tam W, Lau JT, Yu TS, Lui SF, et al. 2004. Cluster of SARS among medical students exposed to single patient, Hong Kong. Emerg Infect Dis 10(2): 269-276.
Wu P-C, Su H-J, Lin C-Y. 2000. Characteristics of indoor and outdoor airborne fungi at suburban and urban homes in two seasons. Science of the Total Environment, The 253(1-3): 111-118.
Yan W, Zhang Y, Sun Y, Li D. 2008. Experimental and CFD study of unsteady airborne pollutant transport within an aircraft cabin mock-up. Building and Environment.
Yang S, Lee GWM, Chen CM, Wu CC, Yu KP. 2007. The Size and Concentration of Droplets Generated by Coughing in Human Subjects. Journal of Aerosol Medicine 20(4): 484-494.
Yu IT, Li Y, Wong TW, Tam W, Chan AT, Lee JH, et al. 2004. Evidence of airborne transmission of the severe acute respiratory syndrome virus. N Engl J Med 350(17): 1731-1739.
Zhang W, Chen Q. 2000. Large eddy simulation of indoor airflow with a filtered dynamic subgrid scale model. International Journal of Heat and Mass Transfer 43(17): 3219-3231.
張上淳. 2004. 行政院衛生署疾病管制局 91 年委託研究計畫成果報告. 院內感染在不同層級醫院所造成額外醫療資源花費之比較.
張上淳, 蔡佳倫, 王振泰, 黃高彬, 呂學重, 莊銀清, et al. 2004. 台灣醫學中心與區域醫院 1999-2002 年院內感染之概況. 感染控制雜誌 14(1): 1-11.
謝在鈞. 2008. Development of Long-term Sampling Equipment for Viable Bioaerosols. Tainan: National Cheng Kung University.