張靜文臺灣大學:環境衛生研究所劉怡汎Liu, Yi-FanYi-FanLiu2010-05-072018-06-302010-05-072018-06-302008U0001-0302200810363900http://ntur.lib.ntu.edu.tw//handle/246246/181404本研究針對醫院環境評估工作者健康與室內污染物暴露情形。其中工作者健康情形經由問卷調查得知，室內空氣品質監測項目除真菌及細菌外，尚包含物理性因子（風速、風量、溫度、相對濕度及表面濕度）及化學性因子（懸浮微粒、二氧化碳、一氧化碳、總揮發性有機化合物及甲醛），同時亦收集環境管理及建築體特徵（建築物屋齡、淹水紀錄、整修紀錄、通風換氣方式/設備型態、通風設備故障與清洗紀錄、人口密度及室內盆栽數）等資料。境測定結果顯示，空氣中真菌及細菌濃度多符合我國建議值。在菌屬種類方面，Aspergillus sp.（可呼吸性及總濃度）、Candida（可呼吸性濃度）、Paecilomyces（可呼吸性及總濃度）、Penicillium（不可/可呼吸性及總濃度）、Scytalidium（可呼吸性及總濃度）及Trichophyton（可呼吸性濃度）之室內/室外濃度比值均大於1，顯示上述真菌可能具有室內污染源，其中可呼吸性Trichophyton之室內濃度更顯著高於室外 (p=0.0058)。物理性因子部分，醫院平均溫度 (23.06~23.14 ℃) 符合我國與香港、新加坡及英國之建議值，相對濕度 (55.80~63.43 %) 則符合澳洲、加拿大、香港、新加坡及德國之建議值，室內懸浮微粒PM10質量濃度 (14.84~30.42 μg/m3) 則低於香港及新加坡建議值。化學性因子部分，二氧化碳8小時平均值 (690.30~945.24 ppm) 超過我國建議值 (600 ppm)，且其中一家醫院一氧化碳 (6.55 ppm) 及甲醛平均濃度 (0.25 ppm) 均超過我國建議值 (2 ppm；0.1 ppm )，而總揮發性有機化合物平均濃度 (228.67~619.37 ppb) 則低於我國建議值 (3000 ppb)。一步利用多變項迴歸模式分析影響院內空氣中真菌及細菌濃度之環境因子時發現，風速較低及建材表面濕度較高可顯著增加不可呼吸性Cladosporium濃度，風速較低及相對濕度較高顯著增加總Cladosporium濃度；相對濕度較高及屋齡較久可顯著增加總Penicillium濃度，增加相對濕度及表面濕度則顯著提高不可呼吸性潮濕性真菌 (Acremonium, Aspergillus versicolor, Cladosporium及Stachybotrys) 濃度。另在風速較低且水漬面積較大之地點不可呼吸性革蘭氏陽性細菌濃度顯著增加。以多變項迴歸模式分析影響工作者健康之環境因子時，發現醫院屋齡及A. versicolor與多項呼吸道症狀或疾病達顯著相關，顯示此二項因子對工作者健康最具影響。整體而言，真菌與建築體屋齡對醫院員工健康影響高於細菌、物理性及化學性因子。This study aims to evaluate the relationship between workers’ health and their exposure to bioaerosol in hospital environment. Hospital workers’ health situation is obtained from questionnaire. Data of indoor quality monitored include biological factors such as fungi and bacteria, physical factors (wind velocity, wind volume, temperature, relative humidity and surface moisture ), chemical factors (particulate matter, carbon dioxide, carbon monoxide, ozone, total volatile organic compound, formaldehyde) and environment management and characteristics of buildings (age of building, record of flood and restoration, ventilation types, record of ventilation equipments breakdown and cleaning, and density of people, potted plants).he environment monitoring result shows that the measured concentrations of fungi and bacteria accords with the suggested figure by Taiwan but exceeds other nations in measured figure contrarily. Secondary, among different fungal flora , the indoor/ outdoor concentration of Aspergillus sp. (total and respiratory concentrations）, Candida (respiratory concentration）, Paecilomyces (total and respiratory concentrations), Penicillium（total and respiratory/non-respiratory concentrations）, Scytalidium（total and respiratory concentrations） and Trichophyton (respiratory concentration) is greater than 1. This demonstrates that the above fungi possibly have potential indoor latent source. Concentration of respiratory Trichophyton indoors exceeds in concentrations outdoors significantly (p=0.0058). As to physical factors, the average temperature (23.06~23.14 ℃) in hospital accords with the suggested figure by Taiwan, Hong Kong, Singapore and England； the relative humidity (55.80~63.43 %) accords with the suggested figure by Australia, Canada, Hong Kong, Singapore and Germany. Yet the indoor PM10 mass concentration (14.84~30.42 μg/m3) is lower than the suggested figure by Hong Kong and Singapore. Finally, as to chemical factors, 8-hour average concentration of carbon dioxide (690.30~945.24 ppm) exceeds the suggested figure in Taiwan (600 ppm). The average concentration of carbon monoxide and formaldehyde are, respectively, 6.55 ppm and 0.25 ppm which exceed the suggested figure in Taiwan (2 ppm；0.1 ppm ). Average concentration of total votatile organic compound (228.67~619.37 ppb) is lower than the suggested figure in Taiwan (3000 ppb).he study analyzes the environmental factors which affects concentrations of fungi and bacteria in air by using multiple regression model. We found that concentration of non-respiratory Cladosporium increased remarkably when the wind velocity is lower and surface moisture is higher on one hand, total concentration of Cladosporium increased remarkably when the wind velocity is lower and relative humidity is higher, on the other. Higher relative humidity and older building contribute to the significant increase of total concentration of Penicillium. Also, higher relative humidity and surface moisture contribute to the significant increase of concentration of non-respiratory humid fungi (Acremonium, Aspergillus versicolor, Cladosporium and Stachybotrys). Lower wind velocity and bigger dampness area contribute to the increase of concentration of non-respiratory Gram positive bacteria.e analyzed those affecting health factors by multiple regression model and have found a significant relationship between age of building, A. versicolor and many respiratory symptoms and diseases, which is saying, these two factors affects hospital workers most markedly. Generally speaking, fungi and the age of building have greater effect on hospital workers’ health than bacteria, physical and chemical factors do.第一章 前言 1.1 研究背景 1二章 文獻回顧 2.1 生物性因子 2.1.1 可培養性真菌 2.1.1.1 室內空氣中常見真菌 2.1.1.2 真菌濃度相關研究 4.1.1.3 真菌之健康效應 4.1.1.4 潮濕與真菌暴露 10.1.1.5 建築體表面真菌分佈及其健康效應 11.1.2 可培養性細菌 12.2 物理性與化學性因子 14.2.1 物理性因子 14.2.2 化學性因子 15.3 建築物特性及使用管理方式 17.4 多因子暴露與相關性研究 17.5 國內外室內空氣品質建議值 18.6 國內外工作場所有害因子暴露恕限值 22.7 本研究的重要性 23三章 研究目的 24四章 研究架構 25五章 材料與方法 26.1 研究設計 26.2 問卷設計及調查 27.3 環境採樣策略 28.3.1 採樣醫院及部門選取 28.3.2 採樣位置 28.3.3 採樣時段與重複採樣 29.3.4 生物採樣 29.3.4.1 空氣中可培養性真菌與細菌採樣 29.3.4.2 表面真菌採樣及表面濕度量測 30.3.5 物理性因子量測 31.3.6 化學性因子量測 31.4 生物性樣本分析 36.4.1 空氣樣本 36.4.2 表面樣本 37.4.3 品質保證與品質控制 37.5 統計分析 38六章 結果 39.1 所有受訪者健康狀況及環境自覺 39.2 環測醫院別及部門別之選擇 48.3 高低暴露區受訪員工健康狀況及環境自覺 50.4 醫院環境概況 55.5 環境採樣與室內空氣品質監測結果 60.5.1 空氣中可培養性總真菌與細菌濃度 60.5.2 不同真菌培養基之分析結果 76.5.3 室內外空氣中真菌菌屬（種）分佈情形 85.5.4 室內不同採樣位置真菌分佈情形 120.5.5 過敏性、感染性、致毒性及潮濕性真菌分佈情形 127.5.6 室內外空氣中細菌型態分佈情形 135.5.7 高低暴露區真菌與細菌特性 138.5.8 建材表面可培養性真菌 140.5.9 物理性因子 151.5.10 化學性因子 160.6 健康影響多變項迴歸分析 182.7 生物性污染物之環境因子間迴歸分析 214七章 討論 257.1 醫院工作者健康現況 257.2 環境採樣與室內空氣品質監測 259.2.1 不同醫院、採樣時段及高低暴露組之總真菌與總細菌濃度分佈概況 259.2.2 不同真菌培養基之分析結果 267.2.3 室內外空氣中真菌菌屬（種）與細菌型態分佈情形 267.2.4 室內不同採樣位置真菌與細菌分佈情形及I/O值 269.2.5 過敏性、感染性、致毒性及潮濕性指標真菌之分佈 273.2.6 物理性因子暴露概況 275.2.7 化學性因子暴露概況 275.3 健康影響多變項迴歸分析 280.4 生物性污染物之環境因子迴歸分析 283八章 結論 285九章 研究限制 288考文獻 291錄 298錄一、問卷 298錄二、採樣紀錄表 300錄三、Observed Positive-Hole Counts and Corrected Particle Counts 309錄四、直讀式儀器之校正方法與校正頻率 310錄五、環境因子之濃度變化圖 311application/pdf1717818 bytesapplication/pdfen-US生物性因子物理性因子化學性因子環境管理及建築體特徵醫院健康效應Biological factorPhysical factorChemical factorenvironment management and characteristics of buildingshealthcare settingshealth effectsthesishttp://ntur.lib.ntu.edu.tw/bitstream/246246/181404/1/ntu-97-R94844003-1.pdf