NGHIEN c t f u KHOA HOC
NGHIEN CIKU TINH TRANG
NHlim KHUAN HUYET LIEN QUAN CATHETER TINH MACH TRUNG TAM TAI KHOA HOI SUfC NGOAI - BENH VIEN NHI TRUNG UONG
Thyc hi$n: ClveO, BCII TH! THANH HLfONG, ThS. TRINH VAN HANH, CNDD LLTU TH! BiCH THU?
Ngirin hi^ng din: TS. T R A N MINH DI^N. ThS DANG V A N THdC Khoa H6I sd-c Ngo^i - B$nh vi$n Nhi Trung urmg
Ngu^ thim djnh- TS. T R A N QUANG HUY
TdMTAT
Muc tidu:
Md ta tinh trang nhiem k h u i n h u y l t (NKH) lien quan catheter ITnh mach tmng tam (TMTT) trdn benh nhan lai khoa H l i sue Ngoai, Bdnh vi$n Nhi Tmng u a n g .
Xac djnh mdt s6 y l u to lien quan d i n nhiem khuin huyet lien quan catheter ITnh mach tmng tam.
P h u a n g p h d p nghien ciHi: Md la e l l ngang:
70 catheter TMTT CiJ?ac dgt trdn cae bgnh nhan (BN) tai khoa Hdi sdc Ngoai, Bdnh vidn Nhi Trung uang t d thdng 4 den thang 9 nam 2014.
Ket qua: S d catheter TMTT mde NKH Id 14 ca (20%). T i Id NKH lien quan catheter TMTT tren 1.000 ngay luu catheter la 17,63. K i t qua vi khuan phdn ldp d u g c Id Aeinelobaeler baumannii (85,7%), Klebsiella pneumonia (14,2%.). Mgt s l ydu to lidn quan xac djnh d u g c la: can ngng d u d i 5.000 grams [p = 0,014, OR 0,73 (0,62 - 0,86)], tren 3 lan dam kim qua da khi ddt catheter TMTT [p = 0,0001, OR 9,33 (2,49 - 35,00)] vd n h i l m k h u i n lgi vj tri dat catheter TMTT [p = 0,001, OR 0 , 0 7 5 ( 0 , 0 1 6 - 0 , 3 6 ) ] .
Ket Iuan: 14/70 catheter TMTT m i e NKH (chiem 20%i), ti Id NKH lidn quan catheter TMTT/1000 ngdy luu Id 17,63. Mgt so y l u to lidn quan d i n NKH lien quan ealheter TMTT Id can nang bgnh nhan d u d i 5000g, trdn 3 lan ddm kim qua da khi ddt catheter vd nhiem tmng tgi vi trf dat catheter. Vi k h u i n Gram am Id nguyen nhdn ehu ydu gay nhidm k h u i n .
T I P khda: nhiem k h u i n bdnh vign, nhidm k h u i n huyet lidn quan catheter ITnh mgch trung tdm, d a n vi hdi s u e tich c y c nhi.
1.DATV&HDE
Catheter TMTT id loai catheter thiet k l ddc bidt d u g c ddt t r y e tiep vao cae maeh mdu Idn do v l b u I n g tim nhdm mgc dich h i t r g tich c y c trong dieu tn h l i s d e cdc b^nh nhdn ngng tgi cae d a n vj hdi s d c c l p c u u . NKH lien quan catheter mach mdu Id nguyen nhan dung I h d ba trong cde nhiem k h u i n bgnh vign (NKBV) Ihudng gap, lam keo ddi thdi gian n i m vidn, tang chi phf d i l u trj, tang ti lg t u vong lidn quan d i n nhiem k h u i n (NK).
Mgt so nghien cdu trdn t h l gidi cho t h i y trung b i n h e u 15 tridu ngay luu catherter TMTT tai khoa h l i sue thi cd li Id n h i l m k h u i n do catheter id khoang 5,3/1000 ngdy, u d c tinh trong 250 nghin trudng hgp NKH lidn quan catheter TMTT thi ti id t u vong Id 1 2 - 2 5 % .
Tai My, mdi nam ed khoang han 5 tndu catheter TMTT duge s u dgng, ti le NKH lien quan catheter TMTT 7,7 ea/1000 ngay mang catheter, 80.000 ca bdnh NKH lidn quan ealheter. Id nguydn nhan gay ra 2.400 - 20.000 ca t u vong/nam vd chi phi cd I h l ldn ldi 296 tridu - 2,3 ti USD/nam.
Tai Vigt Nam, khoa Hoi sue tich eye s a sinh - Bgnh vien Nhi D i n g 1, ti ig NKBV Id 12,4%, trong dd NKH la nguyen nhan pho b i l n dung I h d hai sau viem phoi bgnh vidn, nguy ea NKBV gap 10 l l n khi cd dat catheter TMTT.
Tai khoa Hoi sue Ngogi, Bgnh vign Nhi Trung u a n g , cdc bdnh nhan vdo khoa trong tinh trgng b^nh ndng, di tal b i m sinh phdc lgp ndn vige dat catheter TMTT d u g e thye hign l u a n g d l i nhieu.
TT Id nhiem khuan bgnh vien (NKBV) ndi chung
^ B ^ - D I ^ U DUONG 39 I
NGHIEN CCru KHOA HOC
eung nhu ll 1$ NKH lidn quan catheter TMTT ndi ridng dang Id v l n d l thdch thde, khd khdn Idn trong d i l u trj vd cham sde. X u l t phdt t d nhung v l n d l tren, chCing tdi lien hdnh nghidn cdu de tdi nham myc lieu sau:
- Md Id dge d i l m n h i l m k h u i n h u y l t lidn quan caUieter tTnh mgch trung lam trdn b§nh nhi dieu tri tai khoa H l i sdc Ngoai khoa - B§nh vign Nhi Tmng uang.
Tim h i l u mgt so yeu t l lidn quan d i n n h i l m k h u i n h u y l t lien quan catheter tTnh mach trung tdm.
2.PHirdHGPHAPHGHl£HCini
2.1. D l i t u g n g nghidn cd'u: T i t c d cdc bdnh nhi d u g e dieu tri tgi khoa Hoi sue Ngoai - Bgnh vidn Nhi Tmng u a n g : d u g e dgt catheter TMTT tai khoa.
2.1.1. Tieu chuan lira chgn
Tat ca cdc bgnh nhi duge dgt vd luu catheter TMTT tren 48 gid tai khoa.
2.1.2. Tliu chuin lofi trir
- Cdc BN dugc dat catheter t u khoa khde ehuyen denjhoge cd thdi gian luu catheter dudi 48 gid;
- Cac BN m I e nhiem k h u i n h u y l t ( k l l qua eay mau duang Unh) trudc khi dgt catheter TMTT.
2.2. Phuang phap nghien cd>u 2.2.1. Thiit ki nghien cu'u: Md ti cit ngang 2.2.2. Quy trinh chgn mau: C/ipn miu thu$n ti$n
2.2.3. Thoi diim ciy binh phim diu trong catheter TMTT: It nhit sau 48h tu- khi d$t catheter TMTT vd cd chi djnh rOt cua bic sy.
2.2.4. Tieu chuin chan doan
Nhiem khuin huylt lien quan catheter TMTT la linh trgng nhiem khuan h u y l t khdng lidn quan den cdc nguin Idy khae ngoai catheter TMTT cd
Diiu duong khoa Truyin nhiem chim sdc b$nh nhi
k i t qua cay d i u trong catheter duang tinh vd th&i gian luu catheter trdn 48 gid [7]. [18], [20].
2.2.5. 77idi gian vd dja diim nghiin ciru Nghidn edu d u g c t i l n hanh tai khoa H l i sue Ngogi - Bdnh vi§n Nhi Trung u a n g trong khoang thdi gian t d 01/4 d i n 30/9/2014. j ^
2.2.6. Khia c?nh d^o dire nghiin ciru ^1%
- Doi t u g n g nghidn c d u d u g c gldi thich rd;
- Cde thdng tin ddm bdo tinh chfnh xdc, giO
bl m^l. ^ - .
J- •^
- Quy trinh nghidn c d u d u g c thdng qua tripdc nhdm bdc sy va d i l u d u d n g trong toan khoa. .^^
2.2.7. Thu thap vi xip 1;^ so ligu - Cdc thdng tin d u g e thu thgp theo m i u b^nh dn nghien cdu t h i n g n h i t ;
- So lieu d u g c nh^p vd x u Iy trdn p h i n m l i | . SPSS 16.0
3.KiTQUAHGHl£HCini
Trong thdi gian I d thdng 4 d i n thdng 9 nam 2014 cd 70 BN du tidu c h u i n nghidn euu. Chiing^
tdi xde djnh d u g e t? lg BN cd k l l qud c i y diu trong ealheter TMTT d u a n g tfnh Id 20%.
I 40
NGHIEN CUU KHOA H p c
3.1. Dac d i l m chung cua doi t u o n g nghien c u u Bang 3 . 1 . T i 1^ b g n h n h a n phan bo t h e o t u o i
Nhom tu&i
> 12 thang
>28n9ay-12thSng
<28ng&y Tong
n 16 24 30 70
Tllf%
22,9%
34,2%
42,9%
100%
Nhan xet: Trong 70 BN nghien cuu, ti lg BN sa sinh (0 - 28 ngdy) chiem IT Id cao n h l l 42,9%
(30 bdnh nhan).
Bleu do 3.1. Ti le benh nhan phan bo theo gioi Nhan xit: Khdng cd s y khac bigt n h i l u ve gidi cua dol t u g n g nghien euu.
Bang 3.2. Ti lg bgnh nhan phan bo theo can nang Can n|ng
<6kg 2 5kg Tong
n 52 18 70
Tiie%
74,3%
25,7%
100%
Nhan xet: B?nh nhan co can nang du'di 5 kg la chu yiu 52/70 BN, chiem 74,3%
3.2. D a c d i e m nhiem k l i u a n huyet lien quan catheter TIVITT
- Trong 70 BN nghien oJu co 14 BN c6 ket qua cay duong tinh. chi6m tf l§ 20%.
- Tong so ngay luu catheter TMTT; 794 ngay (tmng binh: 11,3 n g i y , t w a n g hap d4i nhat IS 25 ngay, ngan nhat IS 3 ngay).
- TI le nhiSm khuan catheter/1000 ngay: 17,63.
Bang 3.3. Phan bo can n g u y g n v i khuan gSy NKH li§n q u a n catheter TMTT Loai vi khuin
Acinetobacterbaumannii Klebsiella pneumonia
Ting
n 12 2 14
Tll^%
85,7%
14,2%
100%
Nhiin xit: Loai vi k h u i n (VK) gdy NKH lien quan catheter TMTT p h i bien Id Acinetobacter (85,7%), cdn Igi 14,2% la Klebsiella.
Bang 3.4. Tinh trgng chan catheter TMTT khi rut Dac diem
C6 l6n IhLfong viem Binh ttiu'&ng
Tfing
n 9 61 70
Til?%
12,9%
87,1%
100%
Nhan xet: 61/70 benh nhdn (87,1%) cd bieu hien binh Ihudng tai chdn catheter khi rut.
3.3. Mot so yeu t o lidn quan den nhiem khuan h u y l t lien quan catheter TMTT Bang 3.5. M l i lidn quan giij'a cdn nang v d i
NKH lien q u a n catheter TMTT
^ ^ , ^ Ket qua Can n|ng ^ \
<5kg 2 5kg P OR (95% Cl)
Diromg tinh n 14 0
Tlle%
26,9 Am tinh n 38 18
Tile%
73,1 100
T6ng 52(100%) 18(100%) 0,014
0,73 (0.62 - 0,86)
Nhan xet: TI lg NKH lidn quan catheter TMTT d nhdm can ngng t h i p d u d i 5kg eao han nhdm trdn 5kg vdi p < 0,05.
Bang 3.6. Moi lidn quan giira vj t r i dgt v d i NKH lidn quan catheterTMTT
\ „ ^ Ket qua
Vj Irl dat \ ^ TM dudi d6n TMben TMcanh P
Du-ong tinh n 13
1 0
Tl le % 21,7 16,7 0
Am tinh n 47 5 4
Ti 1; % 78,3 83,5 100
Tfing
60 (100%) 6 (100%) 4(100%) 0,564
N G H I E N CLTU KHOA HOC
Nh$n xet: Ti Id NKH lien quan catheter TIVITT khdng lien quan den vj trf ddi ( p > 0,05).
Bang 3.7. M i l lien quan giu'a s l ndng catheter v d i NKH lien quan catheter TMTT
\ ^ f i t q u a Sfi n 6 n g ^ \ 2 nong 3 nong P
Dirong tinh n 9 5
Ti 1; % 21,95 17,25
Am tinh n 32 24
T i l ; % 78,06 62,75
Tfing 41 (100%) 29 (100%) 0,151
Nh$n xet: S l ndng cOa catheter TMTT khdng lidn quan den tinh trgng nhidm khuan catheter TIVITT (p > 0,05).
Bang 3.8. Moi lidn quan giiPa so lan dam kim qua da v d i NKH lien quan catheter TMTT
\ Kit qua
So lan dam\
kim qua da \ S3 lan
>3lan P OR (95% Cl)
Dirong tinh
n 4 10
Til?%
7,27 66,67
Am tinh
n 51 5
Tile%
92,73 33,33
Tfing
55(100%) 15(100%) 0,0001
9,33(2,49-35,00)
Nhan xet: Ti Id NKH lien quan den catheter TMTT d nhung BN cd so l l n dam kim tren 3 ian cao han so vdi nhCrng BN cd so l l n dam kim d u d i 3 l l n (p<0,05).
Bang 3.9. Lien quan g i u a NK catheter TMTT v d i t i n h trang chan catheter
^ ^ ^ , , ^ Ket qua T.trang^^^^
Chan cathete?^^
Cd ton thuong vigm Binh thirdng P OR (95% Cl)
Dirong tinh
^
6 SITils%
66,67 13,11
Am tinh
U!L
3 63
Tl le % 33,33 86,89
Tong 9 (100%) 61 (100%) 0,0001
0,075 (0,016-0,36)
Nhan xet: Tinh trang NKH lien quan den catheter TIVITT a nhom BN cd ton thuang viem tal chan catheter cd nguy co cao hon nhdm BN cd bieu hien binh thud-ng.
I 42
Bdng 3.10. M6i lien quan giira thcri gian liru catheter v&i NKH iien quan catheter TIMTT
^ - ^ ^ ^ Kit qui Thd'l gian l i r u ^ - ^ 5 7 ngSy
> 7 ngAy P
•. * ^
Dirai!|tinh n 5 9
Til$%
12,82 29,03
Am tinh n 43 22
TIIe%
e7,l«j
r ^ i ^
TfingC T9^-r
S9 (100%) 70,9SI' 31 (100%) 0,092
Nh$n xit: Khdng cd m l i lien quan gida thdi gian luu catheter TMTT trdn vd d u d i 7 ngay vdi tinh trgng NK (p > 0,05).
4.BANLUAN
4 . 1 . Dac d i e m c h u n g cua n h o m nghien cdu Trong t h d i gian nghien c d u , chung tdi thu dup'c 70 BN cd dCi dieu kign nghidn cuu. Trong dd chu yeu Id cdc BN trong dd t u l i sa sinh (42,9%). O i l u ndy phu hp'p vdi dac diem m6 hinh benh tdt: tim b i m sinh phde tap d tre sa sinh, tre nhd, cdc di tgt nang d tre sa sinh (thodt vj hoanh, teo t h u c qudn, di tgt tieu hda...) nhom BN phiiu thudt t h i n kinh. Day Id nhung BN can h l i s d c tich cue vd cham sde dae bigt ndn vigc dat catheter TMTT Id r i t c i n thiet. Cung vdi Ida l u l l t h i p thi edn nang cua BN trong nghien cdu ndy cung thap d u d i 5kg c h i l m ehu yeu (74,3%).
Trong nghien euu ndy, chung tdi khdng tira ttily s u khde bigl ve gldi. Nghien euu cua tac gia Nguyin T. T. Hd v l NKH d trd s a sinh Benh vign Nhi d i n g 1 va eua Phan Thi Hang d Bdnh vign HOng V u a n g ve NKBV tai khoa sa sinh cung cho I h l y khdng ed s y khde biet ndy [2],[3].
4.2. Dgc d i l m n h i e m khuiin huyet lien quaa^
catheter TMTT
Ti Id BN nhidm khuan h u y l t lidn quan den catheter TMTT la 14/70 ca (chilm 20%). Tgi Thdi Lan, Chuengchitraks S nghidn c u u nam 2010 thi thay ti le m I e NKH lidn quan den catheter TMTT '' (16,4%). Tgi Benh vign Bgeh Mai nam 2011, Nguyen Ngpc Sao nghien cdu Ihdy tf lg nay la 15,7%. Ti 1$ cua chung ldi cd cao han so vdi cdc ^ nghidn cuu khde. D i l u ndy cd the \)/ gldi do mSi ^ Irudng, dieu ki^n ea s d vat e h i t va md hinh b$nh ''.
I
i--riii*i I ni nMta
1
NGHIEN c a u KHOA HOC
Diiu dirong khoa Hdi sue ngoai chSm s6c benh nhi
tgt khae nhau. Tuy nhien can phai ed nhung nghien cuu rpng han, thdi gian ddi han dge biet nghidn edu da trung tdm de ket qua ehinh xdc han.
Tl Id NKH lidn quan ddn catheter TMTT/1000 ngay luu la 17,63. So sdnh vdi tac gia Macerlo L, Brazil nam 2003 khoa la 10,2 ea/1000 ngdy luu ealheter TMTT. Tuy nhien, trong nghien c u u cua Chopdekar K va edng s u tai An D d ndm 2010 Id 9,26 ca/ 1000 ngay d khoa nhi chung nhung trong dan vj chdm sdc tieh cue s a sinh Id 27,02 c a / 1 0 0 0 ngay. T i lg NKH lien quan d i n catheter TMTT c^a chijng tdi cao han so vdi mdt s l nghien edu khae nhung vi ddi l u g n g nghidn cuu cOa chung tdi cd tdi 42,9% la trd sa sinh ndn ti Id n h i l m k h u i n cao eung Id dleu hgp iy.
Aelnetobaeter baumannii la vi k h u i n c h i l m If lg cao n h i t 85,7%, cdn lai Id 14,2% do Klebsiella pneumonia. Ddy td nhung logi vi khuan t h u d n g gap trong NKBV, t u o n g dong vdi nghidn euu cua khoa Kiem soat nhiem k h u i n - Bdnh vien Nhi Tnjng u a n g nam 2011 cua Ld Kien Ngdi vd cdng s y v l NKBV. Nghien edu cua VO Thi Hang (2005) v l n h i l m laing do catheter TMTT tgi khoa H l i sde tieh cue - Bgnh vign Vidt D(rc, cho t h i y cdc ean nguyen vi k h u i n Id Acinetobacter baumannii ehiem 20%, Klebsiella pneumonia c h i l m 20%.
Cd t h l ndi ddy Id nhiJ-ng logi vi khuan Gram am l l n tai t h u d n g xuydn tTCtpg mdi Irudng bgnh vign,
da khdng khdng sinh vd Id nguydn nhan ehu y l u gdy NKBV.
4.3. Mot s l y l u t l lien q u a n den NKH lidn quan d i n catheter TMTT
Moi lien quan giira can n$ng cua BN v&i NKH liin quan din catheter TMTT
Khi d u a vao phan tich dan bien d^ tim moi lien quan vdi tinh Irgng NKH lidn quan catheter TMTT, ehiing tdi thu d u g c k i t qud vdi p = 0,014.
Bude d i u eho thay can ngng thap ed dnh hudng d i n tinh trang NKH lien quan den catheterTMTT, dong k l l qud vdi nghidn c d u cuaChuengchitraks vdi p = 0,01. Mpt nghien c u u lgi My nam 2001 eda Beth H. Stover vd cgng s u eho t h i y ti Id NKH lidn quan catheter mach mau d Ire s a sinh cd can nang cdng t h i p thi l i 1^ n h i l m k h u i n cang cao (can nang > 2500 g, 1501 - 2 5 0 0 g , 1001 - 1 5 0 0 g va 5 1000 g ed li Id NKH lien quan ealheter maeh mau tuang ung Id 4,4; 4.7; 8,9 vd 12,6/1000 ngdy luu). Trd sa sinh, cdn ndng thap cd hd t h i n g m i l n djch chua hodn chinh Ihudng nam vien vi ly do m i c cdc benh ngng phuc tap, gap n h i l u khd khdn trong cdc quy trinh cham sdc, dieu trj nen cd nguy ca nhiem khuan cao han.
Moi lien quan giira so lin dam kim va ton thirong viim t^i chan catheter v&i NKH liin quan din catheter TMTT
Nhung BN ed s l lan ddm kim qua da tren 3 l l n khi lam thu thudl dat catheter TMTT cd nguy ca nhiem k h u i n eao gap 9,1 lan so vdi nhung BN cd sd l l n ddm kim qua da d u d i 3 lan. D i l u ndy cd the d u g c giai thieh Id do khi Idm Ihu thuat dam kim n h i l u l l n lam l l n thuang nhieu md m l m , gay ly mdu, giam nudi dudng tai chd gay vidm, phCi ne vung chdn catheter d i n d i n nguy ca nhiem k h u i n eao. Khi phdn tich, chung tdi tim t h i y ed s y anh hudng I d s l l l n ehge kim d i n NKH lidn quan d i n catheter TMTT vdi p < 0,05. Trong nghidn cdu Le Bdo Huy cung cho k i t qua t u a n g t y vdi p = 0,04.
N h i l m k h u i n vd t i n Ihuang vidm d vung chdn catheter nhu n l dd, chdy djch, mu Id dieu kign
i j j ^ - f c - D ^ U DUONG
N G H I £ N CCTU KHOA HQC
thuan Igi cho vi khuan xdm nhdp qua dudng ham vao mach man gay tinh trgng nhidm khuan h u y l t . Trong 70 b0nh nhdn nghidn c u u ed 9 BN ed bieu hidn ne vidm chdn ealheter thi cd 6 BN cd k i t qua cay duang tinh (66,67%), moi lien quan nay cd J nghTa vdi p = 0,0001. Le Bao Huy cung nghien cdu eho t h i y 54% chdn catheter sung ne
•va 40% bj ri djch d i u mde NKH lidn quan catheter
"TMTT (p < 0,05). Chdm sde catheterTMTT d u g e ddnh gid eao trong vi^c duy tri, phdng tranh NKH lidn quan catheter TMTT. Thay bang, chdm sdc da, sdt Idiuan v| tri ddm kim can d u g c quan tam han de'phdng trdnh nguy ea nhidm khuan l u chan catt^eter vdo d i u Irong. Khi thay cdc bieu hm\ bat thudng ndy thi ndn nit bd ngay catheter TMTT de gidm thieu tinh trang n h i l m k h u i n ndng them trdn BN.
5.HtrUlAH
Qua nghidn cdu 70 bgnh nhan d u g c dgt catheter TMTT lgi khoa H l i sdc Ngoai khoa - Bgnh vign Nhi Trung uang l u thang 4 den Siang 9 nam 2013, chCing tdi rdt ra mgt so k i t luan sau:
5.1. D n h trgng n h i l m khuan catheterTMTT:
- Ti 1$ BN bi nhilm khuin catheter TMTT la 20%, - TT lg n h i l m khuftn catheter TMTT: 17,63 ca/
1000 ngdy luu catheter.
- Vi khuan thudng gdp Id Acinetobacter (85,7%).
- Ti 1$ b||n1ii§m k h u i n chdn catheter T H ^ la 12,9%.. ,:'' ' ""'^
5.2. Cdc yeu t o lien quan d i n NKH lien quan d e n catheter TMTT
- Cdn ngng thSp d u d i 5kg ed lidn quan den NKH lidn quan d i n catheter TMTT, p = 0,014jl
- S l l l n ddm kim qua da Irdn 3 lan, p = 0,0001 - T i n t h u a n g vidm chdn catheter TMTT, p=0,0001
6.KliHNGHI
Can t h y c hign cdc gdi gidi phdp phbng ngiia, kiem soat nhiem k h u i n lieh c y c vd hidu quj
Nghien jcuu c i n d u g c m d rdng: thdi nghien c d u , c d m i u nghidn c u u .
- ^
NGHtEN CljfU KHOA HOC
TAI LIEU THAM KHAO
Tieng Vigt
1. Ng.T.T.Hd, Cam Ngge Phugng, Hu:/nh Thj Nggc Diep vd cgng s u (2007), "Dgc d i l m dich le hge nhi^m khuan h u y l t trdn tre sa sinh tgi khoa Hoi sue tang eudng S a sinh Benh vidn Nhi d i n g r , Hdi nghj khoa hge d i l u d u d n g Bdnh vign Nhi ddng 1.
2. V u Thj Hang (2005), "Nghien euu v l nhidm tnJng do catheter tTnh mach trung u a n g tai khoa Hoi sue tieh c y c - Bdnh vign Vigt Duc°, Ky y l u Hgi nghj khoa hgc dieu d u d n g ndng cao c h l l lugng cham sdc n g u d i bgnh Irong ngoai khoa l l n thd n h i t - Bgnh vign Viet D d c , trg 67-76.
3. Phan Thi Hang, Nguyen Van Truang (2010), " N h i l m k h u i n benh vign tgi khoa sa sinh Bdnh vien- Hung V u a n g " , Tap chl Y hpc Thanh pho Ho Chl Minh, Tap 14, Sd 3.
4. Le Bdo Huy (2013), "Khdo sdt linh hinh nhiem k h u i n h u y l t lidn quan catheter tTnh maeh trung tam lgi khoa H l i sdc tich cue c h i n g dOc - Bgnh vidn Thong N h i t TP. H i Chi Minh", HOi nghj Hoi s u e Cap c u u Thdnh p h i H i Chi Minh, ldn t h d 14.
5. Bg Y t l (2012), "Hudng dan phdng ngua nhiem k h u i n h u y l t trdn n g u d i bgnh dat catheter trong'idng mgch", Q u y l t djnh so 3671/QD-BYT
6. N g u y i n Ngge Sao, LdThj Binh (2014), "Tinh trgng n h i l m khuan mae phdi trdn bgnh nhdn cd d^t catheter tTnh mach trung tdm tai Bgnh vign Bgch Mai", Tap ehi Y hpc Vigt Nam, trg 4-9.
Tiing Anh
1. Andrea M. Kline RN (2005). "Pediatric Calheter-related Bloodstream Infections", AACN Advanced Critical Care, Vol 16, Number 2, pages 185-198.
2. Beth H. Stover RN, CIC et al (2001),
"Nosocomial infection rates in US children's hospitals' neonatal and pediatric intensive care units", American Joumal of infection Control, Vol.
29, Issues, pages 152-157..
3. Chuengchitraks S, Sirithangkul S, Stewom D, Laohapand C (2010), "Impact of new practice guideline to prevent catheter-related blood stream infection (CRBSI): experience at the Pediatric Intensive Care Unit of Phramongkulklao Hospital", Med Assoc Thai, Vol. 93, pages 79-83.
4. CDC (2011), "Guidelines for the Prevention of Intravascular Catheter-Related Infections.
5. Marcelo L. Abramczyk; Werther B. Carvalho et al (2003), "Nosocomial infection in a pediatric Intensive care unit in a developing country", Brazilian Journal of Infectious Diseases, vol.
7,no 6.
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