障害児（者）施設でのCOVID-19クラスター発生における患者の障害特性とPCR検査結果についての考察

Considerations Regarding the Characteristics of Disabilities and the Result of PCR Tests during a COVID-19 Outbreak at a Facility for Persons with Disabilities

要旨

目的：新型コロナウイルス感染症（COVID-19）の患者数増加に伴い，障害児（者）施設などでの感染対策にも大きな影響が及んでいる．医療型障害児入所施設である当施設は，2021年1月に入所患者16名，職員26名，計42名が新型コロナウイルスPCR陽性（以下，PCR陽性）と判明し，クラスターを発生した．PCR陽性患者16名は幸い軽症で経過したが，施設内で隔離対策を講じたうえで看護を継続する必要があり，対応に苦慮した．患者の障害特性とPCR検査結果との関連について明らかにする目的で解析を行った．

方法：全入所患者の年齢，性別，知的水準，移動機能とPCR検査結果の関係について名義ロジスティック解析による多変量解析を行った．

結果：年齢，性別，知的水準とPCR検査結果に有意な関連性はなかったが，移動機能について寝たきり群に比べ移動可能群ではPCR陽性患者が統計学的に有意に多い結果となった．

考察：当施設では患者の大多数に知的障害があるうえ，個々の運動機能障害に応じた介助が必要であり，患者-患者間や患者-職員間の接触が濃厚となりやすい．特に移動可能群では生活空間の中で互いに密集・密着しやすい傾向にあり，このような入所施設特有の課題がクラスター発生の温床になったと推察された．知的障害や運動機能障害をもつ障害児（者）施設において，移動機能がある程度保たれている患者では，より感染対策が困難となる可能性が考えられる．

Objective：As the number of patients with SARS-CoV-2 infection (COVID-19) increases, the infection control measures at facilities for persons with disabilities are also having a great impact. In January 2021, there was an outbreak at our facility for children with disabilities, which was found to have a total of 42 PCR-positive persons, 16 admitted patients, and 26 staff members. Although the 16 admitted patients had a mild illness, it was challenging to deal with it because we needed to continue nursing in the facility while taking isolation measures. Analysis was performed to determine the association between the characteristics of disabilities and the result of PCR tests.

Methods：Multivariate nominal logistic regression analysis was performed to determine the association of age, sex, intellectual level, and degree of motor disabilities of all admitted patients with the results of PCR tests.

Results：Age, sex, and intellectual level were not associated to the results of PCR tests. However, regarding degree of motor disabilities, there were significantly more PCR positive persons in the self-movable group than in the bedridden group.

Conclusion：In our facility, contacts among patients and between patients and staffs are close because all patients need supports for individual disabilities. In particular, the self-movable group tends to be densely crowded and to have close relationships with each other, which was considered to be one of the factors of the outbreak. In facilities for persons with disabilities, infection control could be more difficult for patients who maintain a certain degree of self-movable functions.