Nghien cdu YDHCT Viet Nam 56 45 - 2015
^THV'C TR^NG CONG TAC KHtJ" KHUAN, TI$T KHUAN DVNG CU Y TE TAI BEVIH VIEN 19-8, BQ CONG AN (2011-2012)
Situation of medical instruments disinfection and sterilization in the 19-8 hospital of ministry of public security (2011-2012)
* Hoing Thi Chinh ', ** Nguyin Tudn Binh ^ ** Cao Ba Lpi ^ ' Benh vi^n 19-8, Bp Cdng an, ^ Benh vien Yhpc cd truyen - Bp cdng an
^ C{ic Yte, Tong cue Hdu cdn - Ky thugl - Bp Cdng an T6m tat
Nghien cuu thifc trgng cdng tdc khu khudn, tiet khudn dung c\i y ti tgi Benh vi4n 19-8 Bp Cdng an ndm 2011-2012 cho thdy ty li cdc dan nguyen ldm sang vdn khir khudn khdng tgp trung: Ti?t khudn tgi chd dan le. Phuang tiin khu khudn, li4t khudn dung cvy ti vdn chua dong bp. 100% don nguyen cd khu vytc rieng, xu ly dung cu bdn. 50% ddm bdo cd chgu ngdm hda chdt du tiiu chudn. Ty I? nhdn vien y ti dupe tgp huSi khie khudn, tiit Idtudn cdn thdp (14,8%). Ty l? thifc hdnh khu khudn, tietkhudn diing cif: Tdt cd cdc dan nguyin diu thitc hi^n npi dung khu khudn, 50% d\ing cy sau Idii ti$t khudn dupe ddng gdi trong tHi hpp kin nhung khdng ghi hgn sit d\ing. Nghien cuu cho thdy, cdn triin khai khu: khudn. tiit khudn tgp trung trong toan binh vign di ndng cao chdt lupng cdng cdc khu khudn, ti?l Idtudn dfing cu y ti.
Tir khda: KhO* khu^n b|nh vi^n 19-8; ti^t khuiln.
Summary
SrrUATION OF MEDICAL INSTRUMENTS DISINFECTION AND STERILIZATION IN THE 19-8 HOSPITAL OF MINISTRY OF PUBLIC
SECURITY (2011-2012)
Assessement the situation of disinfection, sterilization of medical instruments al the 198 Hospital of Ministry of Public Security stage 2011-2012 showed the rate of clinical unit remains unfocused sterilization: Sterilization single spot. Means of disinfection, sterilization of medical instruments has not been synchronized. 100% of unit set private area for handling soiled equipment, 50% of unit guaranteed pots meet quality standard for soaking chemical. Rale of health workers trained for disinfection and sterilization was low (14,8%). Rale of disinfection and sterilization of instruments practices: all clinical unit implemented disinfection work 50% of instruments after sterilization is packed in sealed containers which are not specified expiry date. Research shows that disinfection and sterilization of medical instruments need to be implemented throughout the hospital to improve the quality of medical instruments disinfection and sterilization
Keywords: disinfection; sterilization; 19-8 hospital.
Dja chi lien h$: Nguyen TuSn Binh - B^nh vi^n YHCT BQ cdng an Ngiy nh|n bai: OS/5/2015 Dja chi email: [email protected] Ngiy phin bi|n: 16/5/201S Phan bi^n khoa h9c: PGS.TS. Nguyin Nhirgc Kim Ngiy ding bio: 26/6/2015
• BS; •* TS.BS
/ . . J^i" i ' mm K
Journal of research in viet nam traditional medicine and pharmacy No 45 - 2015
I. DAT VAN DE
Dung cu, thiit bi y te phuc vy cham soc va diSu tri chua dam bao vo khuan, co the true tiep hoac gian tiep gay nhiem khuan cho nguai benh va nhan vien y te. Theo mot so thong bao tgi My, dung cu phau thuSt, dung cu noi soi khong dugrc khijr khuan, tiet khuan diing quy trinh la nguyen nhan dan den nhiem khuan vet mo, nhiem khuan benh vien do yi khuan Lao, Tmc khuan mii xanh [5].
Dam bao chat lugng khir khuan, tiet khu4n dung cu y te la mot ky nang thirc hanh quan trong Qhhm dam bao cho ngircfi benh va nhan vien y te tnrac nguy CO phoi nhiem vai nhung tac nhan gSy benh. Muon vay cac benh vien cin tuan thii diing cac nguyen tic chuyen mon trong su6t qua trmh khur khuin, tiet khuan bao g6m: Thu gom, xu ly sa b6, van chuyen do ban, lam sach, kiem tra dong goi dung cu, khii khuin, tiet khuin va bao quan dung cu vo khuan cho toi khi su dung lai [2], [3]. Mpt trong nhCng bien phap can
ban dam bao chat lugng khur khuan, tiet khuan la chuyen doi hinh thiic khur khuan, tiet khuan va quan ly dung cu khong tap trung sang tap trung tai Tnmg tam tiet khuan Khoa Kiem soat nhiem khuan. Ngoai ra, moi benh vien can trang bi day dii phuang tiSn, hoa chat va kien thiic can thiet ve cong tac nay cho moi nhan vien y te true tiep tham gia khii khuan, tiet khuan.
Tai Benh vien 19-8, Bp C6ng an, phuang tien quan ly tap trung dung cu chua dugc trien khai. Hien nay, mai dang trien khai quan ly tap trung day may thd ciia 2 khoa la Khoa Npi A va Khoa Hoi siic cap ciiu. Do vay, Khoa KiSm soat nhiem khuan van phai dinh ky danh gia cong viec khur khuin, tiet khuan dan nguyen ciia cac khoa lam sang.
Nghien ciiu nay nham muc dich mo ta thuc trang phuang tien, kiSn thiic va thyc hanh cua nhan vien y te ve cong tac khur khuin, tiet khuan tai Benh vien 19-8 nam 2011-2012.
Nghien cihi YDHCT Viet Nam So 45' 2015
IL DOI TlTONG VA PHU'ONG PHAP NGHIEN CUTJ
2.1. Boi tuwng, dia diem va thoi gian nghien cuu
* Boi tirffng nghien c^u:
- Cac dan nguyen lam sang trong benh vien.
- Nhan vien y te dang lam viec tai cac khoa lam sang trong b6nh vien.
* Bfa diem nghien cuu: Benh vien 19-8, Bp Cong an.
* Thdi gian nghien ciru: Nam 2011-2012.
2.2. Phirang phap nghien cvu
* Thiet ke nghien citu: Nghien ciiu mo ta cat ngang.
* Phieffngphdp thu thdp so lieu:
- Phirong tien: Danh gia qua khao sat thuc tS phuang tien xu ly dung cy ban.
- Kien thiic: Phong van nhan vien y te bat ky \e cong tac dao tao, cac yiu to dam bao chat lugng dung cu sau tiet khuan va quy trinh khii khuan, tiet khuan da quy dinh.
- Thuc hanh: KiSm fra quy trinh khu khuin, tiet khuin noi liru giii d\mg cu sau khii khuan, tiet khuan cac yeu to dam bao chit lugng khu khuin, ti^t khuan.
* Phuffng phdp ddnh gid cdc ngi dung nghien cuu:
- Danh gia phuang tien, to chiic tap huin kien thiic va th\rc hanh cua nhan vien y te theo 3 miic dp:
+ Khong CO phuang tien, khong hieu, khong to chiic tap huan, khong thuc hien theo quy trinh, quy dinh khii khuan, tiet khuan.
+ Phuang tien thieu hoitc chua tot, hiSu khong day du, tSp huan khong day dii, thuc hien chua tot quy trinh, quy dinh khu khuan, tiet khuan.
+ Phuang tien diy dii, tdt, hieu diing, tap huan cho 100% nhan vien y te, thuc hien tot quy trinh, quy dinh khii khuan, tiet khuan.
* Aii" ly so lieu: K6t qua nghi6n cuu dugc xii ly bing cac phin mSm y hoc.
Journal of research in viet nam traditional medicine and pharmacy
IIL KET QUA NGHIEN CtTU
3.1. Thong tin chung ve cong tac khu* khuan, tiet khuan dyng cu y te Bang 3.1. Hinh thirc, phirong phap khir khuan, tiet khuan dung cu
D<ni nguyen
Noil Noi 2 Noi A Noi tiet Noi 5 Noi 8 Noi 4 Ngoai 1 Ngoai 2 Ngoai 3 H6i siic cap cuu
Phong kham Ung buou Tai-Miii-Hpng GSy me hoi sue
RHM-MJt Trung tam HHTM
C9ng
Hinh thirc Tap trung
- - - -
X
- - - - - - - -
Khong tap trung
X X X X X X X X X X X X X X X X X
100%
Phirong phap tiet khuan Nhiet
udt
- - - -
X
- , - - - - -
-
Tu say A X X X X X X
X X X X X X X X X X
Dong goi bang hop hoac vai Hoan
toan
- - - - - -
X
- - - - - -
X X
-
Mpt so dyng cu
X X X X X X X X X X X X X X X X X
100%
Nhjn xet: Qua ket qua bang tren eho thay: 100% don nguyen dung hmh thiic tiet khuin khdng tap trung; 100% phuong phap tiet khuin bing tii s4y; 100% dung cu khong duoc dong goi theo bO. Chi co mpt s6 khoa chuyen mon hoa khau tiet khuin t^i Trung tam tiet khuan cjia benh vien v6i m6t s6 dung cu thi d\ing cu dugc tiet khuin bang nhiet uot va dupe dong goi theo bo.
Nghien cHu YDHCT Viet Nam Sd 45-2015
Bang 3.2. So lifu giam sat qua trinh say dung cu bing chi thi sinh hoc lan 1 (9/2011)
Tu say tai cac don nguydn
Ngoai 1 Ngoai 3 Ung buou
Npi 8 Npi 8 (Phong chay than-PK)
Rang-Ham-Mat (PK) Mat Npi 2 Hoi sue cap cmi
Npi tiet Tai-Mui-Hpng
Npi 5 Phong thu thuat TMH
Gay me hoi sue Npi 4 Cpng
Nhiet do/ThM gian say
140°C/lh 220°C/3h 160°C/lh 120°C/lh 120°C/30 phut
270°C/lh 150°C/lh 180»C/2h Nhiet kehong/lh
180°C/lh Nhiet kehong/lh
210°C/lh 160°C/lh
no'c/ih
150°C/lh
Ket qua Dat
X
X
X
X
X
X
X
46,7
Khong d^t
X
X
X
X
X
X
V
X
53,3 Nhan xet: Qua ket qua bang tren cho thay giam sat qua trinh say dvmg cu bang chi thi sinh hpe lan 1 vao thang 9/2011: Kiem tra 15 tu siy tai 13 don nguyen (46,7%
dat) va khong dat (53,3%).
Journal of research in viet nam traditional medicine and pharmacy No 45 - 2015
Bang 3.3. S6 lieu giam sat qui trinh say dung cii bSng chi thj sinh hpe lin 2 (4/2012)
Til say tai cac dom nguy£n N o i l Npi 2 Npi A Ndi tiet Npi 5 Npi 8 Trung tam TNT Npi 4 (Phong kham da lieu)
Ngoai 1 Ngoai 2 Ngoai 3 H6i sue cap ciru
Phong kham Ung buou Tai-Miii-Hpng Phong kham-Tai-Mui-Hpng
Rang-Ham-Mat, Mat Phong kham Mat
Gay me hoi sue Trung tam HuySt hpe truyen mau
Cpng
Nhiet dp/Thai gian say
180°C/lh 180°C/lh 180°C/lh 180°C/lh 180°C/30 phiit 180°C/50 phiit 180°C/45 phiit 180°C/160 phiit 180°C/lh
180''C/90 phiit 180°C/lh 180°C/lh 160°C/lh 150°C/lh 30 phiit
180°C/lh 180°C/lh 150°C/lh 180°C/2h
Ket qua Sat
X X X
X X
-
X X
X X X X X X
X
70
Khong dat
X X
-
X
X
-
X
-
X
-
30 Nhjn xet: Giam sat qua trinh say dung cu chi thi sinh hpe lan 2 vao thang 4/2012, kiim tra 20 tu siy tai 17 don nguyen: 70% tu siy dat, 30% tu siy khong dat.
Nghien ciru YDHCT Viet Nam So 45-2015
3.2. Phuang ti^n khir khuin, tift khuan difng cy y t l
Bang 3.4. Phuang tifn khu khuan, tift khuan dyng cy y te
Khoa
N p i l N6i2 Npi A Npi tiet
Npi 5 Npi 8 Trung tam TNT Npi 4 (Phong kham da lieu)
Ngoai I Ngoai 2 Ngoai 3 Hoi siic c&p ciiu
Phong kham Ung budu Tai-Mui-Hpng Phong kham-Tai-Mui-Hpng
Rang-Ham-Mat, Mat Phong kham Mat
Gay me hoi siic Trung tSm Huyet hpe truyen mau
COng
C6khu vyc xvt ly
dung cu bin *
X X X X X X X X X X X X X X X X X X X X
100%
Ch^u ng&m hoa chat dii tiSu chuan (kin, c6 nSp)
X X X X X X
X
-
X
X
-
X X
X
-
X
-
50%
Hoa chat ngam khir khuin sa b$
d^t chuin
X X X X X X X X X X X X X X X X X X X X
100%
Nhin xet: 100% cac don nguyen co khu v\fc xii ly dung cu bto, 50% cac don nguySn co chau ngam hoa chat dii tieu chuto (chau, xo kin co nap day), 100% cac don nguyen co hoa chit ngam khii khuin so bp dat chuin.
Journal of research in viet nam traditional medicine and pharmacy
3.3. Cong tac t^p huan kien thirc ciia nhan vien y te ve khi^ khuin, ti^t khuan
Bang 3.5. So lirpug nhan vien y te (Dieu dir&ng) dirprc t$p huan Khoa
Npil Npi 2 Npi A Npi tiet Npi 5 Npi 8 Trung tam TNT Npi 4 (PK da lilu) Ngoai 1 Ngoai 2 Ngoai 3 Hoi sue cap cuu Phong kham Ung buou Tai-Miii-Hpng Rang-Ham-Mat, Mat Gay me hoi sue Tnmg tam HHTM
So lugng nhan vien y te dutfc tap huan 2
4 3 2 2 1 2 4 2 2 3 4 2 3 2 2 4 2
Nhan xit: Qua bang tren cho thay, cac dan nguyen co ngirai giam gia t|p huan npi dung khu khuin, tiet khuin la rit it (74/500) chi^m ty le 14,8%.
Nghien cHu YDHCT Viet Nam So 45-2015 Bang 3.6. Thuc hanh khur khuan, tift khuan dyng cy y te
Dan nguyen
Noil Noi 2 Noi A Noi tiit Noi 5 Noi 8 Trung tam TNT Npi 4 (PK da lilu) Ngo^ii 1 Ngoai 2 Ngoai 3 Hoi sue cap eiiu Phong kham Ung buou Tai-Miii-Hpng Phong kham-TMH I^ang-Ham-Mat, Mat Phong kham Mat Gay me h6i siic Trung ttoi HHTM
Cpng
KKSB truofc mpi quy
trinh KK-TT
X X X X X X X X X X X X X X X X X X X X
100%
Mpi quy trinh TK deu duyc ghi vao so theo doi
- - - - - -
X
- - - - - -
X
-
X
-
15%
Mpi dyng cy TKdugc dong goi trong hop
tiii
- - - - - -
X
- - - - - - -
X
-
X
-
15%
Mpi goi hpp dyng cy co dan
bang chi thi nhift ghi ngay
KK-TK
-
- - -
X
- -
- - -
X
-
X
-
15%
Nhto xet: Tat ca cac don nguyen diu thuc hifn npi dung KKSB, 0% khong co dto nhto chi thi nhiet trong qua trinh tiet khuin va 50% dimg cu sau khi tift khuin dupe dong goi trong tiii hop kin nhung idiong ghi han su dung (chi co cac don nguyen tift khuin tai Tnmg tam Tiet Idiuin ciia benh vifn voi mot so dung cy thi dung cu dugc tiet khuto bang nhiet udt va dugc dong goi theo bp).
Journal of research in viet nam traditional medicine and pharmacy No 45 - 2015
IV.MOTS6BANLU^
4.1. Hinh thvc va phirong phdp khv khuin, ti^t khuan dyng ci^ y te
Qua Bang 3.1 thiy t ^ Benh v i ^ 19-8 CO 2 phuang thiic tiet khuin: (1) tiet khuin tai ch§, dan le (tvr ti^t khuin), (2) chuyen mon hoa khSu ti?t khuan tiii Trung tam Tiet khuin cua benh vien (tiet khuan ban tap trung).
Qua do CO the nhan xet:
- Khong phat huy t6i da thiit bj tiet khuin hi?n co t^i Khoa Kilm soat nhiem khuan (co thiet bi tiet khuan tai Khoa Kiem soat nhiem khuan) nhung nhieu khoa trong b^nh vien lai khong sur dung ma sii d\ing tii say ngay tai cac khoa (ton tien mua tu say cho cac khoa va ton dien).
- Khong phat huy toi da co so dyng cu hiSn co, cac khoa phai c6 nhan vien y tl de khii khuan, tiet khuan (khong tiet ki^m n h ^ lire).
- Chit lugng khii khuan, ti?t khuin chua dugc cai thien, tiet khuan dyng cu khong theo b$. Thirc hien quy dinh, quy trinh tai cac don nguyen khong kiem tra dugc c6 diing theo huong din. Kho kiem soat dugc chit lugng va lugng gia cdng tac khii khuin, tiet khuan. Ket qua giam sat qua trinh say d\ing cu bang chi thi sinh hpe nam 2011 (thang 9/2011), 15 dan nguyen t^i cac khoa (Bang 3.2). Ket qua giam
sat qua trinh say d\mg c^ b ^ g chi thi sinh hpe nam 2012 (thang 4/2012). 20 dan nguyen (Bang 3.3).
Tiet khu3n dimg cy t^p trung se khic phye dugc tit ca cac nhugc diem neu tren.
- D6 trien khai phuang thiic ti^t khuan t|p trung lanh d^o va nhan vien y te can thay dugc tam quan trpng cua vi?c dam bao chat lugng khii khuin, ti?t khuin. Khoa Kilm soat nhiim khuan can co mat bang toi thi6u, nhSn vien CO ky nang khii khuin, tiet khuin, CO nguai dii nang lye quan ly va hieu cong tac chuyen mon ciia cac dan vj trong b^nh vien. Ngoai ra, trang thiet ti?t khuan, dung cy can dugc quan ly t£Lp trung tai Khoa Kiem soat nhiem khuan. Benh vien cin co quylt dinh, quy trinh khu khuan, ti?t khuan cu the, quy dinh ro trach nhi?m, co chi phoi hgp giua cac dan vi vdi Khoa Kiem soat nhiem khuan va co bifn phap kiem soat chong that thoat, ddi dyng cy.
4.2. Phirong tifn khu khuan, tift khuan
- Kit qua 6 Bang 3.3 cho thiy tai cac khu vyc KTT, phuang tien khu khuin, tiet khuin con thieu dgc bift la chSu ngam hoa chit quy trinh khii khuin, tift khuin, hudtig din sir dyng hoa chit. 100% don nguyen t^i khu
Nghiin cicu YDHCT Viit Nam S6 45-2015
vfc KTT thyc hifn khii khuin so bf dyng cy. Phuong phap tift khuin chinh 6 khu vyc nky la say kh6 (100%, Bing 3.3).
- T^ If tift khuin thit b?i khi sii dyng tu siy cao hon 2-3 lin so v6i tift khuin bing nhift udt [4].
- TCr nhihig bing ehiing trSn, de c4i thifn chit lugng khii khuin, tift khuin t?i Bfnh vifn 19-8 can diy nhanh tien trinh khii khuin, tift khuin va quto ly dyng cy tf p ttung, dim bao mpi dyng cy dugc khii Idiuan so bf, Itei s(ich vii kiim sodt chit lugng thong qua vifc 4p dyng ttift de phuong ph4p tift khuin bing nhift u6t.
4.3. Cong tic t$p huin kiln thirc ciia nhan vifn y te vl khir khuin, tift khuin
- Tju Bfnh vifn 19-8, cong t&c dao t{io vl kiem soat nhiim khuin ciing chua dugc t6 chiic thudng xuyen do li6n quan din kinh phi chua dugc b6 trg kip thdi. Thirdng tfp huin kit hgp ciing ciic dgt tfp huan ve cdng t&c dieu dudng.
- Thyc trpig tren cd thi do chua cd don nguySn nao ciia lifnh vifn chil dfng to chuc typ huan kbit khuin, tift khuin mf t c4ch bai bto cho nhto vien y tl trong don vi mmh.
4.4. Thyr hanh khir khuin, tift khuan va danh gii chung ve cSng tic khu' khuin, tift khuin dung cy
ytl
- Thyc htoh khii khuin, tift khuin la ylu to quylt dinh chit lupng khii khuin, tift khuin dyng cy y tl d mpt bfnh vifn. Trong nghien ciiu nay, chiing tdi khdng dtoh gia vl htoh vi ciia nhto vien y t l ma tap trung ddnh gid mpt s6 tieu chi mang tinh hf thong.
Tl chiic KKSB, hinh thiic ddng goi va bifn phdp kilm sodt chit lugng. Kit qud cho thiy thyc htoh khd khuin, tift khuin tfli Bfnh vien 19-8 Bg Cdng an chua dugc thyc hifn tot d mgi dom vi, cdc don nguyen thyc hifn tot cac npi dung dugc diiu tra (Bang 3.6). Qua gidm sdt chiing tdi thiy chit lugng tift khuin dyng cy tfii cdc khu KTT hifn chua dugc kilm sodt, ode don nguy6n t»i khu vyc ndy khdng cd phucmg tifn kilm sodt chit lugng tift khuin, til siy dimg tift khuin da dua vao sii dyng nhieu ndm nay, khdng dugc bdo dudng kiem tra dinh ky. Mpt nghien cim t?i Rumani cho thiy, t j If tift khuin thit ' bfii thudng cao a nhihig mdy tift khuin
cu [4].
- Ket qua vl thyc hanh khii Idiuin, tift khuin 100% dom nguyen diu KKSB trudc mgi quy trinh khii khuin, 87
Journal of research in viet nam traditional medicine and pharmacy No 45 - 2015
tift khuin, 0% dan nguyen tai cac don nguyen KTT khong ghi vao so theo doi; dung cy sau khi dong goi trong tiii, hop sau tiet khuin khong co bang chi thi nhift, ngay khu khuan, tiet khuan.
V. K^T LUAN
1. Ty If cac dan nguyen tift khuan khong tap trung la 100%, chi co mpt so khoa chuyen m6n hoa khau tiet khuan tai Trung tam tiet khuan cua bfnh vifn vai mpt so dyng cu.
2. Phuang tien khii khuin, tift khuan dyng cu y te van chua dong bp,
100% dan nguyen co khu vuc rieng xir ly dyng cu ban nhung m6i c6 50%
dam bao co chau ngam hoa chat dii tieu chuan.
3. T5' If nhan vien y te dugc tap huan khu khuan, tiet khuan qua thap (14,8%).
4. Ty le thuc hanh khii khuin, tiet khuan dyng cy: Tat ca cac dan nguyen deu thuc hien npi dung KKSB, 0%
khong CO dan chi thi nhiet trong qua trinh tift khuin va 50% dyng cu sau khi tift khuan dugc dong goi trong tiii hop kin nhung khong ghi h ^ sir dyng.
TAI LIEU THAM KHAO 1. Benh vien Bach Mai va To
chirc Y ti The gioi (2004), Ddnh gid thuc hdnh die phong todn dien tai mot sd CO so yte.
2. Bp Y te-Vu Dieu tri (2004), Hpi thdo huong ddn xdy dtmg phong ngira chudn.
3. Nguyen Thu, Vu Manh, Cong Quyet Thing (1991), Ve sinh benh vien, Nha xuat ban y hpe.
4. Adrian A, Bancescu et al (1999), Infection control practices and
compliance to national recommendation among dentists in Romania, International dental jouma, Vol. 49, pp:
260-261.
5. APIC (2005), Text of Infection control and Epidemiology 2"'* Edition, Vol. 21, pp: 21-210.
6. John H. Keene (1999), Sterilization and Pasteurization Hospital epidemiology and Infection contro, Vol. 78, pp: 1189-1198.
