JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol.11 - N''4/2016
Danh gia kign thwc va khao sat sy tuan thu ve sinh tay cua nhan vien y tg tai Benh vien Quan y 354
Assess knowledge and survey of hand hygiene compliance of medical staff at 354 Military Hospital
Biii Thi Kim Qui B$nh vien Quan y 354
Tom tat
Muc tieu: Danh gia kien thiJc va khao sat sii tuan thCi v^ sinh tay cCia nhan vien y te trong Benh vien Quan y 354 nam 2015. Doi tugng vd phUdng phdp: Phat cau hoi, trS Idl, k^t hop v6i giam sat trUc tiep tai cac khoa phong. Kit qud vd kit ludn: Khao sat can bo nhan vien y te eda 5 khoa lam sang, ket qu3:30,81%
cho r^ng mang gang co the thay the duge ve sinh tay, 57,70% khong neu chfnh xac daoc 5 th6l di^m vg sinh tay. T;^ |g tu3n thCi ve sinh tay tai 5 thcJi diem: Tra6c khi tiep xuc ngUcfl benh (44,17%); trudc khi l^m thu thuat vo khuan (54,14%); sau khi tiep xuc be mat cac vat dung trong buong benh (18,05%), sau khi ti^p xtJc vdi ngLfcil benh (62,38%), va sau khi tiep xuc vdi djch tiet cCia ngUdl benh (83,60%).
rjy/f/joa.-Vf sinh tay.
Summary
Objective: Evaluate the knowledge and survey the hand hygiene compliance by medical staff in the 354 Military Hospital in 2015. Subject and method: Delivered questionnaires, observed performance on hand hygiene practices of medical staff. Result and conclusion: Investigated In medical staff, w e found that: 30.81% of medical personnels believed that wearing medical hand gloves w i t h o u t washing hands is adequately hygienic. 57.70% of them hasn't understood well about 5 moments for hand hygiene. The ratios of medical staffs compliance in 5 moments for hand hygiene were different: Lowest was before touching a patient (44.17%), before cleaning and aseptic procedures (54.14%), after touching patient surroundings (18.05%), after touching a patient (62,38%) and after contact w i t h patient fluids (83.60%).
Keywords: Hand hygiene.
I . O g t v a n c t e vien khoang 5 - 10% d cac nude phat t r i l n va cac Nhi^m khu^n benh vien (NKBV) la m o t t r o n g " ^ ^ ^ ^ ^ " 9 Phat t r i l n la 1 5 - 2 0 % .
nhOng th^ch thiJfc va m o i quan t a m rat Idn tai Viet ^*^ " ' ^ ' ^ " ^^^ ^° 9^y anh h u d n g nhiem khuan Nam cung n h u trgn toan t h i gldl. Nhieu nghien cUu ^^^^ ^ ' ^ " "^'^- ' ^ ° ' trudng 6 n h i e m , b^nh t r u y i n cho thay nhiem khuan bSnh vien lam t a n g t ^ le tilf " ' ^ ' ^ ^ ' ^^ ^9 d u n g cu chua d u n g q u y t r i n h , cac thCi vong, keo dai t h d i gian nam vien, t a n g viec sCt d u n g ^ ^ " ^ ^ ^^"^ ' ^ " *^° ^^^ nhUng 6 nhiem ban tay cCia khang sinh, tang de khang khang sinh va t a n g chi " ^ ^ " ^ ' ^ " ^ *^ (NVYT) la 1 mat xfch q u a n t r p n g trong phi dieu trj. Theo t h o n g k#, t y le nhiem khuan b M h ^^'^ chuyen n h l ^ m khuan benh vl&n. Theo y van the gidi Ccinh bao co t d i 8 0 % nhiem khuan b e n h vien la do sU t h a m gia cCia ddi b^n tay.
Phan bien khoa hQc: TS. DINH VAN TRUNG
TAP CHf Y DUpc LAM SANG 108
TSp 11-So 4/2016
Nhilm khuan benh vl§n hoan toan cdthe ngan ngCra dUdc thdng qua chuong trinh kilm soat nhiem khuan hieu qu^. Trong do, chucfng trinh tang cUdng tu3n thu" Ve sinh tay" dugc cho la bien phap ddn giein. It t6n kem va hieu qua nh^t. Chinh vi v$y, nam 2009 To cht^c y t l the gidl da phat dpng chiln djch
"VI sinh tay to^n cau". Viet Nam da k;^ cam k i t tham gia chiln djch nay. Ve sinh tay dUpc quy dmh tai dieu 1, Thong tU 18/2009/TT-BYT hUdng dan to chiJc thUc hien cong tac kilm.soat nhiem khuan trong cac ca sd kham chOfa b#nh. Ve sinh tay con dUdc dUa v^o npi dung danh gia chat lu'png binh viln hang nam.
Vu dllu tri Bp Y te da ban hanh Cong van so 7517/BYT- Otr qui dmh va hUdng dan quy trinh ve sinh tay thudng quy, npi dung cdng van da dupc pho bien toan t h i can bp, nh§n vien toan Benh vien.
Tuy nhien, trong thUc te nhan thu"c cda nhan viln y t l (NVYT) chua day du, ehUa thay doi dUpc thdi quen, phuong tiln ve sinh tay cdn thieu, vj tri ve sinh tay cdn chua hdp ly nen tJ le ve sinh tay (VST) cdn thap. Vi vay, chiing toi tien hanh nghien culi nay nham 2 muc tieu:
Ddnh gid kien thUc ve vi sinh tay cua nhdn vien y ti tgi Benh viin Qudn y 354. Khdo sdt sU tudn thO vi sinh tay cda nhdn viin y ti trong Benh viin.
2, Doi tUtfng va phiftfng phap
2.1. Ddi tugng93 bac sT, 130 dilu dudng va 140 sinh vien dang hpc tap va cong tac tai 5 khoa lam sang (3 khoa ndi va 2 khoa ngoai), Benh vien Quan y 354. Thdi gian tU thang 9 den thang 12 nam 2015.
2.2. Phuang phdp
Dinh gia kiln thUc bang bp cau hdi phat cho nhSn vien y te t r i Idi theo cac phUPng an neu san, chpn c3u tra Idi dung (20 ciu) trong 10 phut. Thong ke so lieu tra Idi dung sai.
Quan sat trUc tilp so ca hdi v l sinh tay ma nhan vien yte thuc hien.
2.3. PhUcmg phdp thu thdp xCflysdIieu Thu thap so lieu dupc thUc hi§n qua giam sat true tilp tai cac khoa trong benh vien va dien vao bing dinh gii.
T6ng hpp so lieu, phan tich chi tilt, cu t h i , ro rang tCrng doi tUdng, tC/ng thdi dilm VST va dUa ra ty le%.
3. Ket qud
3.1. Ddnh gid kien thCtc v4 ve sinh tay
Bang 1. Kien thO'c ve tac dung cua mang gang trong thUc hanh cham s6c ngUdi benh
JriliA
Khong thay t h e dUdc ve sinh tayD61 khi thay t h e dupc ve sinh tay
Thay the dddc ve sinh tay Khong tra idi
Cong
So luong 153
88 118 24 3S3
T 9 l i %
39,9522,97 30,81 6,27
700
N/idnx^f: 30,81% NVYT cho rang mang gang cd t h i thay t h i dupc ve sinh tay, day la nhan thu"c chUa dung va lam gia tang nguy ca 6 nhiem tU ban tay.
Bang 2. Nhan thii'c ve 5 thdi diem ve sinh tay
TraloriT r i Idi ddng TrS Idi thieu TrS Idi sai Khong trS Idi
Cdng
So lUtfng 162
79 122 20 3S3
T y l e % 42,30 20,63 31,85 5,22
100
Nhdn xet: 57,70% NVYT khdng neu chinh xie dupc 5 thdi diem vg sinh tay (tri Idi thilu, t r i Idi sai, khdng tra Idi).
3.2. Ddnh gid ve sU tudn thu vi sinh tay cua nhdn viin yti
Bdng 3. Ty ie tuan thu VST trifdc khi tiep xuc vdi ngirdi benh
Qoi tUcmg BacsT Di^u dudng Sinh viSn
Cong
Tong so ctf hoi
53 134 19 206
So ctf hdi t u i n thu dung
28 59 4 97
T y l e
%
52,83 44,02 21,05 44,77
JOURNAL OF 108 - CLINICAL MEDICINE AND PHARMACY Vol.11-N°4/2016
Nhdn xet: Ty le t u a n thO VST t r u 6 c khi t i e p xiic vdi ngudi b e n h cao nhat d n h o m bac sy, t i e p din la Mu d u a n g , t h a p nhat la sinh vien.
B i n g 4 . Ty l i t u a n thA VST sau khi tiep xiic ngudi benh
BSng 7. T J |g t u i n t h i VST sau t i e p xuc c4c vat dung t r o n g b u 6 n g b e n h
D5i tuong
BacsT Bi^u ducfng Sinh vien
Cong
TSng so COT hoi
95 171 61 327
So ctf hoi tuan thil dung
79 104
21 204
TJI§%
83,15 60,81 34,42 62,3a
Doi tuong BacsT Bleu dudng Sinh vien
Cdng
Tong so ctf hdi
66 101 62 229
So Ctf hdi tuan thu dung
38 58 28 724
T y l e
%
57,57 57,42 45,16 54,74 Nhdn xet: Ty le t u a n thCi VST trudc khi l i m thCi thuat vd khuan cao nhat d n h d m bac sT, tiep den la d i l u d u d n g , thap nhat la sinh vien.
Bdng 6. T^ le tu3n thu VST sau khi tiep xOc vdi d k h tiet cQa ngtfdi benh _ v . Tdngsd Doi tUtfng . .
• " ctfhdi Bac sT 1 29 Dieu dudng [ 28 Sinh vien
Cong 4 67
Sd ctf hdi tuan thij dung
26 22 3 57
T j l d
%
89,65 78,57 75 83,60 Nhgn xet: Ty le t u a n t h u VST sau khi t i l p xuc vdi djch t i l t cao nhat la bac sy, t i l p den la dieu d u d n g , thap nhat la sinh vien.
Ddi tUtfng BacsT D i ^ u dudng Sinh vien
Cdng
Tdng sd ctfhdi
22 39 11 72
Sd ctf hdi tuan t h i dUng
7 5 1 73
Tile
%
31,81 12,82 9,09 78,05
Nhdn xet Ty Id t u i n t h d VST sau khi tiep xuc vdi ngUdi benh cao nhat d n h d m bac sy, t i l p den la dieu d u d n g , t h a p nhat la sinh vien.
BSng 5. T^ le tuan t h u VST trUdc khi lam th£i t h u S t v d k h u ^ n
Nhdn x l f : T^ le t u a n thi!i VST sau khi t i l p xCicbe m a t c i c vat d u n g t r o n g b u d n g b e n h cao nhat d n h d m bac sy, t i e p d i n la d i l u d u d n g , t h a p nhat Ik sinh vien.
4 . Ban luan 4.1. Ve kien thdrc
Qua d a n h gia sd bp kien thiJc v l v $ sinh tay, chdng t d i thay c d n nhieu van de c i n dupc n g h i i n cUu, t a n g cUdng d a o tao, t a p huan.
30,81% NVYT cho rang m a n g gang cd the thay t h i dugc ve sinh tay, ^ l u d d cd t h e dan den viec lam d u n g va ngd nhan khi m a n g gang. ThUc t l l i khi thiic hien cac ky thuat va cham sdc i r g i r d r b e n l i r d d n O c NVYT chi d d n g m d t ddi g i n g cham sdc xong benh nhan nay lai sang benh nhan khac ma khdng thay gang, t h a m chi xong viec m d i thao gang tay. D i l u do khdng d i m b i o dupc y l u cau cham sdc sach, ma chl cd tac d u n g p h d n g ngisa cho NVYT trUdc m i t m i khdng dam bao an t o a n cho ngUdi b i n h . ChUa k l NVYT mang gang sang p h d n g hanh chi'nh lam lay nhiem tU ngudn benh nhan sang NVYT t r o n g khoa.
57,70% NVYT k h d n g n l u chinh xac dUpc 5 thdi d i l m ve sinh tay (tra Idi t h i l u , tra Idi sai, khdng t r i Idi). D i l u nay cho t h a y NVYT chUa nhan thiJc day dD t a m quan t r o n g cua VST, chua h i l u rd c i c t h d i d i l m can VST.
Tren thUc t l , khi t h u c hanh cham sdc ngUdI b i n h thi khdng phai cho nao cung cd lavabo nude va xa p h d n g de thUc hien viec ve sinh tay. Ngay c i khi co day dCi trang t h i e t bj thi ngudi NVYTcung khdng t h i cu" kham hoac t i e m t r u y i n x o n g m o t ngudi benh lai den lavabo ve sinh tay m o t lan. Do vay can thay doi n h i n thUc d l t i n g cudng v# sinh tay bang d u n g djch chUa con. Day la p h u o n g phap ve sinh tay nhanh v i cd hieu q u i .
124
TAP CHlYDi;pC LAM SANG 108 Tap11-S64/2016
4.2. Vetyli tudn thd vi sinh tay
T^ le t u a n thCi t h e o 5 t h d i d i l m ve sinh tay cda T o c h i ^ c Y t l T h l g i d l .
K i t q u i nghien cdu cho thay; Trudc khi tiep xuc ngUc^ benh, t / le tuan thd v& sinh tay cCia nhan v i l n t h i p (44,17%). D i y l i d i l m can h i t sii-c luu ^ vi cd t h i lam l i y nhiem vi khuan t d ban tay khdng sach cua n h i n vien y t l cho ngUdl benh, va cung l i mot nguyen nhan lam gia tang t y le lay cheo trong benh v i l n .
Nghien cuXi cda L I K i l n Ngai (Benh vl$n Nhi Trung Udng), tv-1$ t u i n thu chung la 58,6%. Trudc khi lam t h u t h u i t vd khuan l i 56,8%, sau khi tiep xdc ngUisi benh 65,6% cac ty' le nay cao hdn cua chi:ing tdi.
Nghien cdu cda Ta Thi Thanh (Benh vi&n Kontum), t y te t u a n t h d chung la 75%, t r o n g d d b i c sT l i 60%, d i l u d u d n g 83,5%. J^ le t u a n t h d t h e o cac thdi ^ I m trudc khi tiep xdc ngudi benh 63,56%, trUdc khi lam t h d t h u a t v d k h u l n v d khuan 79,93%, sau tiep xuc ngudi b i n h 4 1 % , sau khi t i l p xuc djch t i l t 93,67%, sau tiep xijc b l mat x u n g quanh 35,38%.
K i t q u i cho thay tJ' le t u i n t h u tai t h d i diem sau khi t i l p xuc ngudi benh cao hon so vdi t h d i d i l m sau khi t i l p xuc v i t d u n g x u n g quanh ngUdI benh.
4. Ket luan
T d k i t q u i nghien cdu t r l n , chung t d i rut ra ket luan nhusau.
4.1. Ket qud dd dgt dUctc
K i l n t h d c cua NVYT v l ve sinh tay cua nhan vidn y t l cdn chUa t o t : 30,81% cho rang mang gang cd the thay t h e dupc v l sinh tay, 57,70% khdng neu chinh xac dupc 5 t h d i d i l m ve sinh tay.
Ty- le tuan thd v l sinh tay khong deu d cac t h d i d i l m : Thap nhat la thdi diem sau khi tiep xuc be mat cac v i t d u n g trong buong b i n h (18,05%), sau d o den thdi d i l m trudc khi tiep xuc vdi benh n h i n (44,17%), trUdc khi lam thCi t h u i t v d khuan (54,14%), sau khi t i l p xuc vdi benh n h i n (6238%) va cao nhat l i sau khi t i l p xdc vdi d j d i t i l t cua ngudi benh (83,60%).
4.2. li/ldt so ton tgi hgn che
Da so NVYT chua t h a y dupc t i m quan t r o n g cda VST va chUa thay doi dUpc t h d i quen t d n h i l u nam qua.
Thdc hien giam s i t t u i n t h d ve sinh tay chUa cao va chUa t h u d n g xuydn, chUa co sU p h o l h p p vdi c i c CP quan cd lidn quan t r o n g cdng t i e k i l m soat n h i l m khuan.
Tai lieu t h a m khdo
1. Bp Y t l (2007) Cdng van sd 7517/BYT-Dtr: "Quy dinh vd hudng dan quy tdnh ve sinh tay thudng quy".
2. Le Kiln Ngai, Luc Thi Thu Quy^nh va cs (2011) Hiiu qud cOa cdc chuang trinh thde ddy tudn thd ve sinh tay tgi Binh viin Nhi Trung Udng. Tap chi Nghidn cdu Y hpc l i m sang. Benh vien Trung UOng H u l , 8(6), tr. 7 4 - 7 9 .
3. Nguyen Viet Hung (2010) Visinh tay NXB Y hpc.
4. Ta Thj Thanh (2013) Nghien cUu kiin thUc vd tudn thd vi sinh tay 6 dieu dUdng benh viin Kon Turn. Tap chf nghidn cdu y hpc l i m sang. Benh vidn Trung uong Hue, 8(15), tr. 109-113.
5. WHO. Guidlines on Hand hygiene in Health care facility - fvpril 2010.
